How to Survive an Active Shooter

 

I am part of the Employee Safety Committee for my work area. A big part of our responsibility has been training staff in what to do during attacks on our facility. Included in the training are presentations by the security supervisors, videos, posters, and tabletop simulations. As part of this, I produced a memo outlining procedures for our specific unit. After the event in Florida, a resident MD (who is active-duty military with combat experience) and I updated the guide. I left some descriptions of specific locations in our area as an example; these, of course, are not applicable to every workplace.

With Las Vegas, Kentucky, and Florida in the news, I’m again going to address a scary possibility: An active shooter in the hospital. We all should have had the class from Security and have seen the posters. You, therefore, know the strategy: Run, Hide, Fight. I will be discussing the specific tactics for our department.

You first need to recognize an active shooter situation. Do not wait for an overhead announcement. Multiple gunshots, explosions, or the sudden appearance of several people with wounds will alert you.

Run! Do not stop to provide first aid. If you can, carry or assist any injured people in escaping, but stopping to provide care will result in you both becoming victims. This is not patient abandonment! You are not going to be of any help to anyone if you are killed or injured. Alert other staff and patients. Direct them to safety. Do not argue, immediately alert the next room and keep on going. Push IV carts and mobile computers into the center of the hall as you pass and close fire doors to provide cover for you and slow down the attacker.

Remember that you have one advantage over any stranger attacking the hospital: You know the layout better than they do. They are not going to be as comfortable moving through the environment as you are. Our unit has only four exits; move quickly to the safest one. This exit is the one nearest to you and furthest from the shooter. The staff hallway to the in-patient rooms is good since it leads away from the front of the hospital. Enter the stairwell at the end of the hall, go down to the next floor and leave the hospital through the door to the Patient Park. (Do you even know about that door?) The hallway from the entrance past the waiting rooms leads to the back of the hospital as well.

Run along walls; do not run across open areas; avoid or duck under windows. Do not congregate in groups within sight of the hospital. If you are in an open area and are being shot at, take shelter behind solid objects: Large tress, concrete pillars, or the engines of cars.

Hide. If all the exits have been blocked or you cannot get to them, you need to hide. Be familiar with the area you are working and immediately go to a room with a solid wood door that can be locked. Avoid a room with windows if possible. Push any objects in the room against the door and crouch on the floor (behind the door; the walls provide less protection). The best hiding place in our unit is the administrative area: It has two entrances, providing an exit if one door is breached, and has multiple internal rooms with lockable doors and no windows. In minor care, all the doors are solid, so you can push a stretcher against the door and lock the wheels. Once you are in a room, stay down and be quiet. Turn off your phone! Do not open the door until you are sure the danger has passed.

Fight. If you or cornered by the shooter, your only way to survive is to attack them. Throw things, spray them with a fire extinguisher, scream and run at them. If they have a rifle or shotgun, you are safer the closer you are to them, past the muzzle of the weapon. Bite, kick, scratch or strike with objects; do not hit with your fist unless you are a trained boxer. Strike at the eyes, throat, wrists or groin.

Lastly, when, the event is over, stay where you are. When you are approached by the police, stay on the ground with your hands open, empty and away from your body. Do exactly what the officers tell you. Until the officers have confirmed who you are, expect to be searched and possibly handcuffed.

The most important thing to do is have a plan beforehand so you take action without freezing. Periodically, look around your work environment and think: Where would I run? Where would I hide? What can I use as a weapon if I’m attacked?

The great likelihood is that such a traumatic event will not happen here. If it does, however, I hope this little guide will prepare you to survive.

In addition, Medscape has recently published an article on active shooters.

There are 26 comments.

  1. Kozak Member

    I keep one of these in my work bag in the ER.

    It won’t stop a rifle round, but will work against almost all pistol ammunition.

    I just need to hold the bag up against my torso. Added protection from all the other crap in my bag.

    I also may or may not sometimes have my CCW weapon in my bag. It could happen. I sometimes forget to leave it in my car….

    If they fire me afterwards, I’m willing to pay that price.

    • #1
    • March 7, 2018, at 3:43 AM PDT
    • 8 likes
  2. Bryan G. Stephens Thatcher

    Ohh i need to get one of those

    • #2
    • March 7, 2018, at 5:24 AM PDT
    • 1 like
  3. Ekosj Inactive

    Kozak (View Comment):
    I keep one of these in my work bag in the ER.

    It won’t stop a rifle round, but will work against almost all pistol ammunition.

    I just need to hold the bag up against my torso. Added protection from all the other crap in my bag.

    I have something similar in my commuting bag. I’m on the subway and in transit hubs in NYC most every day. And while NYC is often unfairly maligned as being dangerous …. it only takes one crazy to ruin an otherwise fine day.

    I should stick some kind of first aid/trauma kit in there too. But no idea how to choose one fit for a complete novice. Any recommendations?

    • #3
    • March 7, 2018, at 5:54 AM PDT
    • 2 likes
  4. Kozak Member

    Ekosj (View Comment):

    Kozak (View Comment):
    I keep one of these in my work bag in the ER.

    It won’t stop a rifle round, but will work against almost all pistol ammunition.

    I just need to hold the bag up against my torso. Added protection from all the other crap in my bag.

    I have something similar in my commuting bag. I’m on the subway and in transit hubs in NYC most every day. And while NYC is often unfairly maligned as being dangerous …. it only takes one crazy to ruin an otherwise fine day.

    I should stick some kind of first aid/trauma kit in there too. But no idea how to choose one fit for a complete novice. Any recommendations?

    https://www.amazon.com/Military-Level-First-Rip-Away-Medic/dp/B01JPVWYRG/ref=sr_1_3?ie=UTF8&qid=1520431570&sr=8-3&keywords=military+surplus+first+aid+kit

    and a Kwik klot dressing. Keep those in my car.

    I’ve got a second insert I keep in my backpack when traveling too.

    • #4
    • March 7, 2018, at 6:07 AM PDT
    • 1 like
  5. EJHill Podcaster

    Ekosj: I should stick some kind of first aid/trauma kit in there too.

    For major emergencies stock it yourself. The most important thing with gun shot wounds is a good pressure bandage. You can get several Olaes or Israeli bandages for less than $20. You might also want to consider buying QuikClot to help stop hemorrhaging. The packets have a shelf life of about 5 years.

    • #5
    • March 7, 2018, at 6:20 AM PDT
    • 1 like
  6. Ekosj Inactive

    @kozak and @ejhill Thanks for the recommendations!

    • #6
    • March 7, 2018, at 6:33 AM PDT
    • Like
  7. Tom Meyer, Common Citizen Contributor

    Excellent advice.

    Generally, when the casualties are high, it’s because people became trapped. Removing oneself and others from the situation is generally the simplest, best way to prevent casualties. Engaging the shooter is what one does when that fails.

    • #7
    • March 7, 2018, at 7:17 AM PDT
    • 2 likes
  8. Bryan G. Stephens Thatcher

    EJHill (View Comment):

    Ekosj: I should stick some kind of first aid/trauma kit in there too.

    For major emergencies stock it yourself. The most important thing with gun shot wounds is a good pressure bandage. You can get several Olaes or Israeli bandages for less than $20. You might also want to consider buying QuikClot to help stop hemorrhaging. The packets have a shelf life of about 5 years.

    AI have heard tampons work too. I don’t carry those of course.

    • #8
    • March 7, 2018, at 7:42 AM PDT
    • Like
  9. EJHill Podcaster

    Bryan G. Stephens: AI have heard tampons work too. I don’t carry those of course.

    Not well. And actually they can do a lot of damage. The focus should be on stopping the bleeding, not soaking up the blood.

    • #9
    • March 7, 2018, at 8:50 AM PDT
    • 2 likes
  10. Tom Meyer, Common Citizen Contributor

    EJHill (View Comment):

    The focus should be on stopping the bleeding, not soaking up the blood.

    All bleeding stops … eventually.

    • #10
    • March 7, 2018, at 9:18 AM PDT
    • Like
  11. Quietpi Member

    Bryan G. Stephens (View Comment):
    AI have heard tampons work too. I don’t carry those of course.

    Why not? They work. Many of us do. And while they aren’t the same as the OLAES and Israeli pressure bandages, they’re so much less expensive, and more compact, that they shouldn’t be ruled out at all.

    BTW pressure bandages are no substitute for tourniquets, and tourniquets are no substitute for pressure bandages. Both are necessary, along with training on how – and when – to use each.

    Also BTW, @ejhill is correct too. Tampons, major trauma dressings, 4X4’s, whatever, alone, aren’t pressure bandages. They’re dressings. Pressure has to come from some other source. Some bandages have attached dressings, or dressings have attached bandages, whatever. But don’t confuse the two.

    • #11
    • March 7, 2018, at 10:33 AM PDT
    • 1 like
  12. James Gawron Thatcher

    Jose,

    I’m sorry but this doesn’t cut it. Whether the shooter has an AK or a .357Mag semi-auto pistol (the pistol is probably more lethal at close range like in the recent shooting) doesn’t matter. If you are unarmed you are a target. Odds are you will be shot unless the shooter can’t get into the room you are in.

    I support concealed carry inside the school by only a select few who have their normal concealed carry permit and have gone through an additional training course that is specific to the institution that they will be guarding.

    Jose, you sound like the guy who could give the additional training course to the select concealed carry people. However, expecting people to be able to fight someone who has a Glock with chairs or whatever is creating a false hope that will probably end with tragedy.

    Why don’t we go with what we know will work?

    Regards,

    Jim

    • #12
    • March 7, 2018, at 11:50 AM PDT
    • 1 like
  13. Quietpi Member

    @jamesgawron, you’re leaving out a lot to consider. I agree that, one-on-one, one person with a book, or a chair, or whatever, doesn’t face favorable odds. At the same time, even, or particularly with the model you propose, the vast majority of people will have no means of defense apart from what they can grab. But by ignoring the R-I-F matrix and training, all those people constitute a target – rich environment.

    People who are able to get away from the immediate vicinity of the killer, and succeed in barricading themselves in a place the killer cannot access, stand a better chance of survival, and also limit the ability of the killer to move, to some extent. While a single person trying to fight with an armed person doesn’t stand great odds, a group of people, acting in concert, can upset the killer enough so that his effectiveness is substantially reduced. Will some people be injured? Probably, but also probably not as many as if the killer had gone unchallenged.

    And I agree that R-H-F is hardly sufficient. I totally endorse the idea of there being armed individuals – CCW types – being in the environment all the time. Neither is sufficient alone.

    Actually, there’s another model out there that has much to recommend it. Rather than “Run – Hide – Fight,” consider this: “Move! Escape or Attack.” Maybe more on that later.

    • #13
    • March 7, 2018, at 2:25 PM PDT
    • 1 like
  14. Kozak Member

    Quietpi (View Comment):
    Actually, there’s another model out there that has much to recommend it. Rather than “Run – Hide – Fight,” consider this: “Move! Escape or Attack.” Maybe more on that later.

    Actually adding “fight” to the process is an improvement. For the longest time fighting back wasn’t even taught as an option….

    • #14
    • March 7, 2018, at 2:32 PM PDT
    • 2 likes
  15. JosePluma Thatcher
    JosePluma Post author

    James Gawron (View Comment):
    However, expecting people to be able to fight someone who has a Glock with chairs or whatever is creating a false hope that will probably end with tragedy.

    I’m not creating a false hope; I’m telling them their only chance of survival. Fighting back when confronted may only be successful 1% of the time. Not fighting back will be successful 0% of the time.

    • #15
    • March 7, 2018, at 7:00 PM PDT
    • 2 likes
  16. Doug Watt Member

    Here are some links to Combat First Aid Kits, and the Israeli Compression Bandage

    Needless to say you would have to be in a safe area to use them. I know exactly where the exits are in my local supermarket, and where they lead to. When I enter a bank I scan every customer, I include the tellers, do they look stressed. Those are old police habits. I do the same in any public place, or at events. When I go to a mall I note the exit signs as I move through the mall. Sounds paranoid, but a lot of that is just my prior training.

    One thing that I do does amuse my wife. I stand to one side of someones front door when I knock, or ring the doorbell. I didn’t realize I was doing that until my wife pointed it out one afternoon. Just the muscle memory of training.

    • #16
    • March 7, 2018, at 8:12 PM PDT
    • 3 likes
  17. JosePluma Thatcher
    JosePluma Post author

    Doug Watt (View Comment):
    Here are some links to Combat First Aid Kits, and the Israeli Compression Bandage

    Needless to say you would have to be in a safe area to use them. I know exactly where the exits are in my local supermarket, and where they lead to. When I enter a bank I scan every customer, I include the tellers, do they look stressed. Those are old police habits. I do the same in any public place, or at events. When I go to a mall I note the exit signs as I move through the mall. Sounds paranoid, but a lot of that is just my prior training.

    One thing that I do does amuse my wife. I stand to one side of someones front door when I knock, or ring the doorbell. I didn’t realize I was doing that until my wife pointed it out one afternoon. Just the muscle memory of training.

    That sounds exactly like me, even 14 years later.

    • #17
    • March 7, 2018, at 11:15 PM PDT
    • 2 likes
  18. Bryan G. Stephens Thatcher

    James Gawron (View Comment):
    Jose,

    I’m sorry but this doesn’t cut it. Whether the shooter has an AK or a .357Mag semi-auto pistol (the pistol is probably more lethal at close range like in the recent shooting) doesn’t matter. If you are unarmed you are a target. Odds are you will be shot unless the shooter can’t get into the room you are in.

    I support concealed carry inside the school by only a select few who have their normal concealed carry permit and have gone through an additional training course that is specific to the institution that they will be guarding.

    Jose, you sound like the guy who could give the additional training course to the select concealed carry people. However, expecting people to be able to fight someone who has a Glock with chairs or whatever is creating a false hope that will probably end with tragedy.

    Why don’t we go with what we know will work?

    Regards,

    Jim

    Jim,

    I disagree. Pistols are not great weapons, even at close range, and people miss. They miss a lot. Especially if they are engaged in rapid fire. The kill rate to rounds expended with trained shooters is crazy low. If you are having chairs thrown at you, it is going to disrupt your aim.

    Further, if the person is in your room and ready to shoot you, you are better to be in motion and attacking than to just sit there. If you actually think just sitting there is better than attacking, by all means, lay that case you. Please, lay that case out, so I can take it apart.

    You are always better attacking someone, and being aggressive in these situations, if you are cornered.

    • #18
    • March 8, 2018, at 7:00 AM PDT
    • 5 likes
  19. Tom Meyer, Common Citizen Contributor

    Bryan G. Stephens (View Comment):

    I disagree. Pistols are not great weapons, even at close range, and people miss. They miss a lot. Especially if they are engaged in rapid fire. The kill rate to rounds expended with trained shooters is crazy low. If you are having chairs thrown at you, it is going to disrupt your aim.

    Further, if the person is in your room and ready to shoot you, you are better to be in motion and attacking than to just sit there. If you actually think just sitting there is better than attacking, by all means, lay that case you. Please, lay that case out, so I can take it apart.

    You are always better attacking someone, and being aggressive in these situations, if you are cornered.

    Also, fighting back gives other people additional time to escape.

    • #19
    • March 8, 2018, at 9:25 AM PDT
    • 6 likes
  20. Quietpi Member

    Bryan G. Stephens (View Comment):
    You are always better attacking someone, and being aggressive in these situations, if you are cornered.

    Hence my earlier reference to “Move! Escape or Attack.” I finally found a good article:

    https://www.policeone.com/active-shooter/articles/196375006-Why-Move-Escape-or-Attack-is-superior-to-Run-Hide-Fight/

    And as an added bonus, there’s the interesting article from the forum, “The Art of Manliness,” on situational awareness, that @dougwatt and @josepluma exemplify:

    https://www.artofmanliness.com/2015/02/05/how-to-develop-the-situational-awareness-of-jason-bourne/

    • #20
    • March 8, 2018, at 9:39 AM PDT
    • 1 like
  21. Bryan G. Stephens Thatcher

    Tom Meyer, Common Citizen (View Comment):

    Bryan G. Stephens (View Comment):

    I disagree. Pistols are not great weapons, even at close range, and people miss. They miss a lot. Especially if they are engaged in rapid fire. The kill rate to rounds expended with trained shooters is crazy low. If you are having chairs thrown at you, it is going to disrupt your aim.

    Further, if the person is in your room and ready to shoot you, you are better to be in motion and attacking than to just sit there. If you actually think just sitting there is better than attacking, by all means, lay that case you. Please, lay that case out, so I can take it apart.

    You are always better attacking someone, and being aggressive in these situations, if you are cornered.

    Also, fighting back gives other people additional time to escape.

    Also a good point. Of course, if several of us attack him at once ….

    • #21
    • March 8, 2018, at 10:00 AM PDT
    • 2 likes
  22. Quietpi Member

    Bryan G. Stephens (View Comment):
    Also a good point. Of course, if several of us attack him at once ….

    Precisely. Will some people get hurt? Probably. Will fewer people get hurt? In all likelihood, yes, much. This is a great example of getting inside your opponent’s OODA loop, eh?

    Things have changed since 9/11/01, ref: United Flight 93.

    • #22
    • March 8, 2018, at 10:06 AM PDT
    • 2 likes
  23. James Gawron Thatcher

    Bryan G. Stephens (View Comment):

    James Gawron (View Comment):
    Jose,

    I’m sorry but this doesn’t cut it. Whether the shooter has an AK or a .357Mag semi-auto pistol (the pistol is probably more lethal at close range like in the recent shooting) doesn’t matter. If you are unarmed you are a target. Odds are you will be shot unless the shooter can’t get into the room you are in.

    I support concealed carry inside the school by only a select few who have their normal concealed carry permit and have gone through an additional training course that is specific to the institution that they will be guarding.

    Jose, you sound like the guy who could give the additional training course to the select concealed carry people. However, expecting people to be able to fight someone who has a Glock with chairs or whatever is creating a false hope that will probably end with tragedy.

    Why don’t we go with what we know will work?

    Regards,

    Jim

    Jim,

    I disagree. Pistols are not great weapons, even at close range, and people miss. They miss a lot. Especially if they are engaged in rapid fire. The kill rate to rounds expended with trained shooters is crazy low. If you are having chairs thrown at you, it is going to disrupt your aim.

    Further, if the person is in your room and ready to shoot you, you are better to be in motion and attacking than to just sit there. If you actually think just sitting there is better than attacking, by all means, lay that case you. Please, lay that case out, so I can take it apart.

    You are always better attacking someone, and being aggressive in these situations, if you are cornered.

    Brian,

    Yes, of course, I agree with your last sentence. However, to pursue this while denying concealed carry inside the institution is dangerously short-sighted. Of course, I’m not claiming concealed carry is a panacea. However, force must be met with counterforce. Otherwise, you are setting people up to be human sacrifices because you can’t simply demand the counterforce. The sheriff’s people should have gone into the building and secured it. EMT then could have started aid to the wounded. The additional 15 minutes wait probably cost lives. This is a simple fact. The lack of any counterforce inside the building probably allowed Cruz to be as effective as he was. This is a simple fact.

    Don’t absorb the obsessions of the left. They lead nowhere and are just talking points to sound good. They don’t have a plan. They just have a narrative. Don’t give in to them.

    Regards,

    Jim

    • #23
    • March 8, 2018, at 11:57 AM PDT
    • Like
  24. Bryan G. Stephens Thatcher

    James Gawron (View Comment):
    Yes, of course, I agree with your last sentence. However, to pursue this while denying concealed carry inside the institution is dangerously short-sighted.

    I never made this argument. I am for CCW everywhere, and arming teachers.

    • #24
    • March 8, 2018, at 12:31 PM PDT
    • Like
  25. James Gawron Thatcher

    Bryan G. Stephens (View Comment):

    James Gawron (View Comment):
    Yes, of course, I agree with your last sentence. However, to pursue this while denying concealed carry inside the institution is dangerously short-sighted.

    I never made this argument. I am for CCW everywhere, and arming teachers.

    Bryan,

    Then we agree.

    Regards,

    Jim

    • #25
    • March 8, 2018, at 12:52 PM PDT
    • Like
  26. Ontheleftcoast Inactive

    James Gawron (View Comment):
    Whether the shooter has an AK or a .357Mag semi-auto pistol

    Not too many .357 Mag semi autos. If I knew the shooter had a Coonan or Desert Eagle I’d probably be torn between running and wanting to see such an unusual pistol.

    • #26
    • March 8, 2018, at 6:24 PM PDT
    • 2 likes