Most hospital shootings are not preventable

Shooters have a specific target

The day after the horrific Dec. 14, 2012 shootings at an elementary school in Newtown, CT, a visitor — who was reportedly upset over the cardiac care his wife received — shot two employees and a police officer at St. Vincent's Hospital in Birmingham, AL before he was killed by another officer on the scene.

National grief over the Newtown massacre overshadowed the hospital shooting, but it underscored a reality: Every year, hospitals are the site of several shootings or other violent outbursts.

Yet preventing hospital shootings is difficult because most cases involve "a determined shooter with a specific target," according to an analysis of 154 shootings in the past 11 years.1

Johns Hopkins University researchers launched the study in hopes of developing prevention strategies in the wake of a 2010 shooting of a surgeon at the Baltimore, MD, hospital. The gunman was the distraught son of a cancer patient who blamed the surgeon for leaving his mother paralyzed. The surgeon survived, but the gunman shot and killed his mother and himself.

Lead author Gabor Kelen, MD, chair of emergency medicine, and his colleagues emphasized that although hospital shootings have become more frequent in the last six years, they remain rare events. About 3% of the nation's hospitals experienced a shooting incident in the 12-year study period (2000-2011), which amounts to .2% per year. Put in a different perspective, the likelihood of encountering a hospital shooting is about the same as a death from lightning, the authors said.

The findings do shed some light onto where and how the events occur:

  • One-third of the shootings that were inside hospitals occurred in the emergency department. Two in five of the incidents happened on hospital grounds, including the parking area (23%) or the ramp to the emergency department.
  • Shootings happened in hospitals of all size, but they were more common in large hospitals (400 beds or more) than small hospitals.
  • Incidents occurred in all regions of the country, although more happened in the South and fewer in the Northeast. Being in an inner-city or dangerous neighborhood did not appear to be a factor, the authors said.

Great fear, low risk

The burning question of the study was "Can hospital shootings be prevented?" The authors concluded that a magnetometer — or gun detection technology — would have prevented only about one-third of the shootings.

In fact, in about one in four ED shootings, the perpetrator took the gun from a hospital security officer, the authors found.

Most cases involved a "determined shooter" who had one of four motives: A grudge or revenge, suicide, ending the life of an ill relative, or a patient trying to escape police custody.

Yet shootings create stress and fear, and employees may demand more security measures, such as screening devices, the authors said.

"[T]he perception of workplace violence risk in health care settings is often heightened. For example, surveys reveal that the perceived risk of an active shooter on campus was three times the actual risk, whether the campus experienced a previous event or not.

One reassuring finding for health care workers: Only one in five of the shooting victims was an employee, and few of those were physicians or nurses.


  1. Kelen GD, Catlett CL, Kubit JG, et al. Hospital-based shootings in the United States: 2000-2011. Ann Emerg Med 2012;60:790-798.e1.