Advertisement

Hospital-Based Shootings in the United States: 2000 to 2011

  • Gabor D. Kelen
    Correspondence
    Address for correspondence: Gabor D. Kelen, MD, FRCP(C)
    Affiliations
    Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, MD

    National Center for the Study of Preparedness and Catastrophic Event Response, Johns Hopkins University, Baltimore, MD

    Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    Search for articles by this author
  • Christina L. Catlett
    Affiliations
    Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, MD

    National Center for the Study of Preparedness and Catastrophic Event Response, Johns Hopkins University, Baltimore, MD

    Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    Search for articles by this author
  • Joshua G. Kubit
    Affiliations
    Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    Search for articles by this author
  • Yu-Hsiang Hsieh
    Affiliations
    National Center for the Study of Preparedness and Catastrophic Event Response, Johns Hopkins University, Baltimore, MD

    Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    Search for articles by this author

      Study objective

      Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011.

      Methods

      Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed.

      Results

      Of 9,360 search “hits,” 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), “euthanizing” an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%).

      Conclusion

      Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of event represents a significant challenge to hospital security and effective deterrence practices because most perpetrators proved determined and a significant number of shootings occur outside the hospital building.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • US Department of Labor, Occupational Safety and Health Administration
        Workplace violence. OSHA Fact Sheet. 2002.
        (Accessed May 17, 2012)
        • Bureau of Labor Statistics
        National Census of Fatal Occupational Injuries in 2010. (Preliminary Results).
        (Accessed August 22, 2012)
        • National Institute for Occupational Safety and Health
        Workplace violence prevention strategies and research needs.
        (Baltimore, MD) (Accessed May 17, 2012)
        • Bureau of Labor Statistics
        Homicide. Occupational homicides by selected characteristics, 1997-2010.
        (Accessed May 17, 2012)
        • National Institute for Occupational Safety and Health
        Violence: occupational hazards in hospitals.
        (Accessed May 17, 2012)
        • Hahn S.
        • Zeller A.
        • Needham I.
        • et al.
        Patient and visitor violence in general hospitals: a systematic review of the literature.
        Aggression Violent Behav. 2008; 13: 431-441
        • Gates D.M.
        • Ross C.S.
        • McQueen L.
        Violence against emergency department workers.
        J Emerg Med. 2006; 31: 331-337
        • Kling R.N.
        • Yassi A.
        • Smailes E.
        • et al.
        Characterizing violence in health care in British Columbia.
        J Adv Nurs. 2009; 65: 1655-1663
        • Benveniste K.A.
        • Hibbert P.D.
        • Runciman W.B.
        Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis.
        Med J Aust. 2005; 183: 348-351
        • Gerberich S.G.
        • Church T.R.
        • McGovern P.M.
        • et al.
        An epidemiologic study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study.
        Occup Environ Med. 2004; 61: 495-503
        • Kamchuchat C.
        • Chongsuvivatwong V.
        • Oncheunjit S.
        • et al.
        Workplace violence directed at nursing staff at a general hospital in southern Thailand.
        J Occup Health. 2008; 50: 201-207
        • Friedman E.
        Johns Hopkins Hospital: gunman shoots doctor, then kills self and mother.
        (September 16, 2010 [cited November 1, 2010]) (Accessed May 17, 2012)
        • Merchant J.A.
        • Lundell J.A.
        Workplace violence intervention research workshop, April 5-7, 2000, Washington, DC.
        Am J Prev Med. 2001; 20: 135-140
        • Peek-ASA C.
        • Runyan C.W.
        • Zwerling C.
        The role of surveillance and evaluation research in the reduction of violence against workers.
        Am J Prev Med. 2001; 20: 141-148
        • American Hospital Association
        Fast facts on US hospitals.
        (Accessed July 30, 2012)
        • US Department of Commerce
        United States Census Bureau. Population estimates. National tables.
        (Accessed July 30, 2012)
        • Wintemute G.J.
        • Claire B.
        • McHenry V.
        • et al.
        Epidemiology and clinical aspects of stray bullet shootings in the United States.
        J Trauma Acute Care Surg. 2012; 73: 215-223
        • Sorenson S.B.
        • Manz J.G.
        • Berk R.A.
        News media coverage and the epidemiology of homicide.
        Am J Public Health. 1998; 88: 1510-1514
        • Fine P.R.
        • Jones C.S.
        • Wrigley J.M.
        • et al.
        Are newspapers a viable source for intentional injury surveillance data?.
        South Med J. 1998; 91: 234-242
        • Genovesi A.L.
        • Donaldson A.E.
        • Morrison B.L.
        • et al.
        Different perspectives: a comparison of newspaper articles to medical examiner data in reporting of violent deaths.
        Accid Anal Prev. 2009; 42: 445-451
        • UN data: a world of data
        Intentional homicide, rate per 100,000 population.
        (Accessed May 17, 2012)
      1. Harrendorf S. Heiskanen M. Malby S. International statistics on crime and justice, United Nations Office on Drugs and Crime (UNODC), HEUNI Publication Series No. 64. 2010 (Helsinki) (Accessed May 17, 2012)
        • Joint Commission
        Sentinel event alert.
        Preventing violence in the health care setting. 2010 June 3; 45 (Accessed May 17, 2012)
        • Schafter J.A.
        • Heiple E.
        • Giblin M.J.
        • et al.
        Critical incident preparedness and response on post secondary campuses.
        J Criminal Justice. 2010; 38: 311-317
        • Adekoya N.
        • Nolte K.B.
        Struck-by-lightning deaths in the United States.
        J Environ Health. 2005; 67: 45-50
        • Centers for Disease Control and Prevention
        National Violent Death Reporting Systems (NVDRS).
        (Accessed August 24, 2012)
        • Centers for Disease Control and Prevention
        National Violent Death Reporting System coding manual revised [online] 2008.
        (Accessed July 29, 2012)
        • Centers for Disease Control and Prevention
        Surveillance for fatal and non fatal injuries—United States, 2001.
        MMWR. 2004; 53: 1-57
        • Florida Department of Health
        Florida Injury Surveillance System.
        (Accessed July 29, 2010)
        • Grieger T.A.
        • Fullerton C.S.
        • Ursano R.J.
        • et al.
        Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks.
        Psychiatr Serv. 2003; 54: 1383-1387
        • Kelen G.D.
        • Catlett C.L.
        Violence in the health care setting.
        JAMA. 2010; 304: 2530-2531
        • Bureau of Labor Statistics
        Illness, injury and fatalities. Fact sheet. Workplace shootings, July 2010.
        (Accessed May 17, 2012)
      2. AHA Hospital Statistics 2010. Table 2. US Registered Hospitals: Utilization, Personnel, and Finances.
        American Hospital Association, Chicago, IL2011
        • Weiss D.R.
        Smart Gun Technology project final report.
        (Accessed July 30, 2012)
        • National Rifle Association Institute for Legislative Action
        “Smart” guns.
        (Accessed July 30, 2012)
        • National Rifle Association Institute for Legislative Action
        Firearms fact card 2012.
        (Accessed July 30, 2012)
        • Violence Policy Center
        The false hope of the “smart” gun.
        (Accessed July 30, 2012)
      3. Baltimore Sun.
        (Accessed May 17, 2012)
        • Rankins R.C.
        • Hendey C.W.
        Effect of a security system on violent incidents and hidden weapons in the emergency department.
        Ann Emerg Med. 1999; 33: 676-679
        • US Department of Labor Occupational Safety and Health Administration
        Guidelines for preventing workplace violence for health care and social service workers.
        (Accessed May 17, 2012)
        • Campbell J.C.
        • Messing J.T.
        • Kub J.
        • et al.
        Workplace violence.
        J Occup Environ Med. 2011; 53: 82-89