Guest Column: Should docs carry guns?

By: August 11th, 2014 Email This Post Print This Post

Thomas A. Smith, CHPA, CPP, is President of Healthcare Security Consultants, Inc. in Chapel Hill, North Carolina, and was formerly Director of Hospital Police and Transportation at University of North Carolina Hospitals, Chapel Hill.

In July, a patient shot and killed his case worker and wounded a physician at Mercy Wellness Center in Darby, Pennsylvania. The wounded physician then pulled a gun and shot the gun-wielding patient who was then subdued by other staff members in the clinic.  That same week video was released from an incident that had occurred earlier this year in an emergency department in North Logan, Utah. In this incident, a patient entered the ED waiting room, pulled two guns and demanded to see his doctor saying that “someone is going to die today.” This patient was shot four times by law enforcement staff that happened to be on site for something unrelated.

After having been responsible for security operations in healthcare facilities since 1981, I could not help but analyze the police and security response, physical security measures (or lack of) emergency responders, public relations staff, and then the gun control and gun proponents during the news cycle or two after the incident.

The answer to the title question is of course, no. But, what should hospitals do to reduce the potential for these incidents and to effectively respond when they do occur?

Conduct a comprehensive evaluation of your security program – Reducing the likelihood of a serious incident involves a layered approach involving many aspects of security including policies, procedures and training as well as physical security, design and other factors. A competent hospital security professional should lead this effort using a multidisciplinary team. Competent means someone with hospital experience and credentials (CHPA and/or CPP). The local PD may have some resources, but you want someone that understands healthcare.

Workplace Violence Policy Assessment – Evaluate your policy and make sure it has senior leadership support. There are several excellent resources to assist in this process including OSHA’s “Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers,” and the ASIS Workplace Violence Prevention and Intervention Standard.

Threat Management Team – A threat assessment team will be part of any decent workplace violence program. Establish this team (usually composed of representatives from Legal, Security, Human Resources, Psychiatry, local law enforcement and others depending on the resources readily available in your HCF). Train the team and use them for threats. This group gets better with experiences as with most teams.

Implement Flag Systems in the Electronic Medical Record – Develop policies and procedures for identifying threatening patients and family members, and patients with violent criminal records. Patients and family members that have previously threatened and or assaulted staff in the past should be identified and flagged so staff members that encounter them in the future have the benefit of the previous experiences. This then allows them to take appropriate measures to protect themselves and others. The best predictor of future behavior is past behavior.

Design Security into New Construction and Renovation Projects – In the next decade there will be billions of dollars spent on new construction and renovation projects. This is a major opportunity to build security into each project. The IAHSS has developed security design guidelines for healthcare facilities. HCFs and healthcare systems should consider these guidelines and develop systems security requirements that each design project implements as a required part of any new project.

Training – Train staff in security sensitive areas on crisis intervention and security policies and procedures. Evaluate your current crisis training and consider if it meets your needs given this new era of violence toward healthcare and human service workers.

This is a call to action. It is easy to become complacent and think these things don’t happen here. Every healthcare organization should consider the risks and take action to make sure you have reasonable, appropriate, risk based security programs in place.


being a security consultant, you never did give a reason for saying no. not allowing individuals the tools to defend themselves is like denying a camper an ax because someone was killed with an ax. you perpetuate the problem by justifying your “expertise.” your solutions for a crisis are noble, in the mind of a noble idiot. all means are on the table during a crisis. when seconds count, the police are minutes away. just ask the doctor with the gun. by the way, the police were very receptive to the armed doctor.

By Victoria Pruitt on August 12th, 2014 at 2:59 pm

Thanks for your article, Passing gun control policy for our healthcare organization has been a real challenge and has been in process for over a year. I found your article encouraging.

By Rita Collett on August 12th, 2014 at 4:24 pm

Having worked in an Emergency Room there has been many times that I felt threatened by clients. I agree with Mike 100%.

By Thomas A. Smith on August 13th, 2014 at 7:58 pm


This subject is deep and wide, but here is the short answer why I am not in favor of allowing hospital staff members to carry concealed weapons.

• A high percentage of healthcare related shooting incidents occur when a highly trained law enforcement, corrections and or security officer have their weapons taken and used against them and others. The weapon was brought to the situation by the officer. These officers, in some cases, had security holsters (that offered a higher level of security/harder to remove), and they were still disarmed and the weapon was used against them and or others. I attended a funeral in 2006 due to this very situation. In this case two people were killed by a forensic patient when a Deputy was disarmed, knocked out and his weapon was used against the responding security officer. Another Deputy was killed while looking for the escaped prisoner/patient.

• Hospital staff members are involved in more hands on situations than most police departments. Patient restraints etc… are cause for placing your hands on people for their own safety (they are a danger to self or others). I do not want untrained people with low level holsters or no holster, involved in this already dangerous situation. If healthcare facilities decide to authorize weapons in their environment leave it to the professionals that are properly trained and using good equipment.

I am not saying trained staff members (security or police) should not be armed. But that is a determination best made as part of the comprehensive evaluation of the security program discussed above.

Tom Smith


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