J.

Randolph Mullins, MD, FACS

Deputy, GCSO/SWAT
And other light hearted subjects


An individual who is actively engaged in
killing or attempting to kill people in a
confined and populated area


An individual who displays or overtly
threatens use of a weapon in order to gain
compliance with their demands.


The armed intruder is much more common

and much simpler to deal with.



Shootings in hospitals are statistically
uncommon

and always targeted against a specific
person

The seemingly random active shooter of
shopping malls and schools is virtually never
seen in the hospital
Annals of Emergency Medicine

Volume 60, Issue 6 , Pages 790-798.e1,
December 2012

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

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
154 shootings were identified, 59% inside the
hospital and 41% on hospital grounds with 235
injured or dead victims.

Perpetrators were men (91%) but represented
all adult age groups.

Shootings occurred in the ED (29%), parking lot
(23%) and patient rooms (19%).


Most events involved a determined shooter with a
strong motive: 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.

Most common victim: the perpetrator (45%).
Hospital employees were 20% of victims;
physician (3%) and nurse (5%) victims were
relatively infrequent.

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%).
Were unlikely to be injured by a weapon while
working in healthcare!


But, that doesnt mean it CANT happen


Nor are we always at work!
Cooperation, NOT confrontation

Attempt to escape the area!

Notify security immediately

Barricade any patients or others who cannot flee

DO NOT attempt to disarm the intruder!
Presume anything they tell you is UNtrue

Do NOT intervene in an escape attempt or assault
involving weapons

Understand they are from a culture you probably
do not know, do not understand and should not
want to be involved with

Presume the LE guarding the prisoner might have
a clue about what theyre doing

Who would do such a thing?

Why?

What do I do if Im there when he gets started?


Andrew Kehoe

--Engineer, Farmer, School Board Member

--Disgruntled over property taxes

--Quite a reputation

--Learned his farm was to be foreclosed


On May 18
th
, he got out of bed

Ate breakfast

Killed his wife

Blew up his own house
Then, he drove to town.

And triggered the explosives hed been wiring
for months.

Killing 45 people, 38 of them children


1927
In an interview this summer with the Christian
Science Monitor, Arnie Bernstein, author of
2009s Bath Massacre: Americas First School
Bombing, noted that there wasn't a media
frenzy like today. The media came in and left.
Three days after it happened, Lindbergh took
off and flew to Paris, and that part of it was
over.
social isolates who harbored feelings of hate
and anger.
very few had "previous arrests for violent
crimes
many had a significant emotional event: loss
of significant relationships, changes in financial
status, loss of a job, changes in living
arrangements, and/or feelings of humiliation
or rejection on the part of the shooter.










We know active shooters are social isolates,

With a grudge,

And a significant emotional event, usually
centered on rejection and loss,

Significantly mentally ill or a religious zealot




Perhaps the first ever useful government
video.

Run, Hide, Fight

Get out!

Know where you are!

Know how to get out of where you are.

Have a plan on how to keep going..

Improvised/environmental weapons: observe,
think, be creative.



Im going to stop and help those poor people

Ill talk the poor, misguided youth out of it

Itll never happen to me

Im going to be armed and take care of
business






Ill talk the poor, misguided youth out of it


Itll never happen to me



Ill be armed and take care of business
Do NOT pull your weapon, then run through
the building, trying to get out while waving it

LISTEN for the sirens and commands

When the police arrive, both hands should be
visible, your gun should not

Know that most active shooters self destruct
when faced with armed resistance




There is NO sign hovering over you that says
GOOD GUY

They cannot read your mind