Doctors pose modified active shooter plan

Patient care could suffer under ‘run, hide, fight’ strategy

The city of Houston played a lead role in the Department of Homeland Security’s “Run, hide, fight” strategy for active shooter events. Now, one Houston doctor is leading an effort to modify the strategy for health care facilities.

In an editorial in the latest New England Journal of Medicine, Texas Medical Center trauma surgeon Dr. Ken Mattox and three experts argue that practical and ethical concerns in certain vulnerable locations in hospitals and other large medical buildings suggests a better strategy: “secure, preserve, fight.”

“For professionals providing essential medical care to patients who cannot run, hide, or fight owing to their medical condition or ongoing life-sustaining therapy, a different set of responses should be considered — secure the location immediately, preserve the life of the patient and oneself, and fight only if necessary,” says the editorial.

The authors created the strategy after reviewing data on hospital shootings between 2000 and 2011. Mattox noted a 2018 active shooter false report at Ben Taub Hospital disrupted the ER and some operating and delivery rooms when some staff followed the strategy to run and hide.

The editorial said the “run, hide, fight” strategy should be followed by doctors, staff, patients and visitors able to comply with it. But it said the strategy is not appropriate in settings involving incapacitated patients who might die if abandoned by caregivers who have a moral and ethical duty not to abandon their patients.

The authors also said the design of most hospitals can pose a problem, with their reliance on elevators and narrow stairwells, “target-rich choke points for a shooter;” and large common areas containing very little furniture, intersecting walls, or equipment to hide behind.

The “secure, preserve, fight” strategy emphasizes preparation, calling for designated areas to be equipped with devices that can lock and secure doors and entry points, and life-saving kits, designed to treat excessive bleeding, to be placed throughout hospital buildings.

Mattox, a Baylor College of Medicine professor of cardiothoracic surgery and Ben Taub chief of staff, said he’s hopeful the modified strategy will become a national campaign, led by the American College of Surgeons and the Department of Homeland Security. Mattox, the paper’s senior author, noted that two of his co-authors are doctors turned SWAT police officers who have already taken the paper to law enforcement agencies.