A team of physician experts is calling for hospitals to change the "run, hide, fight" strategy during active shooter situations to "secure, preserve, fight," according to a recent New England Journal of Medicine editorial covered by the Houston Chronicle.
"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," the editorial says.
The authors developed the strategy after looking at data on hospital shootings between 2000 and 2011.
Although physicians, staff, patients and visitors should follow the "run, hide, fight" strategy if they can, the authors argue, the strategy does not work for incapacitated patients who may die if abandoned by caregivers who have an ethical duty not to abandon their patients.
Among challenges hospitals face when addressing active shooter threats, the facility's design can also present a problem, with reliance on elevators and narrow stairwells, "target-rich chokepoints for a shooter" and large common areas with little furniture, intersecting walls or equipment to hide behind, the authors said.
The "secure, preserve, fight" strategy focuses on preparation, with designated areas having devices that can lock and secure doors and entry points. Lifesaving kits to treat excessive bleeding should also be placed throughout the facility.
The paper's senior author, Kenneth Mattox, MD, a professor of cardiothoracic surgery at Houston-based Baylor College of Medicine and chief of staff at Houston-based Ben Taub Hospital, said he hopes the modified strategy will become a national campaign, led by the American College of Surgeons and the Department of Homeland Security.
Two of the paper's authors are physicians turned-SWAT police who have already shown the paper to law enforcement agencies, Dr. Mattox said.