Increasing incidents of workplace gun violence spurs new initiatives to protect HCPs

Dhaval Desai, MD, is used to surprises. As Director of Hospital Medicine at Emory Saint Joseph’s Hospital, navigating medical emergencies is just part of the job. But during a night shift in 2019, when a code blue summoned him to the hallway near his office, he encountered something that wasn’t covered in his training.

An older man was lying on the hallway floor, his head resting in a puddle of blood—just one detail of a “very graphic scene,” Dr. Desai recalls. He hurried the man, who was suffering from a self-inflicted gunshot wound, onto a stretcher and searched him for a form of identification.

Increasing incidences of workplace gun violence

In the weeks and months after the event, Dr. Desai would carry with him the emotional trauma of gun violence in hospitals. 

“That event is obviously sketched in my memory forever,” Dr. Desai says, “but it really started a conversation for me: How safe are we in the workplace?”

Reports of violence in hospitals, including the use of guns, have increased in recent years. According to the International Association for Healthcare Security & Safety (IAHSS) Foundation’s 2023 healthcare crime survey, “violent crime” in hospitals increased significantly from 2015 to 2021 (with no data reported for 2017).^[] The number of incidents  declined slightly from 2021 to 2022, although numbers were still higher in 2022 than in 2020. For purposes of the data, the IAHSS Foundation considers violent crime to include incidences of murder, rape, robbery, and aggravated assault.

Kristen Fuller, MD, a family physician and MDLinx medical advisory board member, also notes the pandemic’s contributions to gun violence in hospitals. Among other things, she says, conspiracy theories and medical misinformation have influenced anger toward doctors.

“This was seen during the COVID-19 pandemic, when a lot of anger was directed at medical personnel about vaccines and PPE, and the misinformation about the virus spread around the internet,” Dr. Fuller says. “Our broken medical system, the lack of mental health treatment, gun laws and gun violence, the internet and social media for medical misinformation and conspiracy theories, all make for a recipe for disaster [regarding] medical settings and gun safety.”

Increased prevalence of gun violence in hospitals is likely also related to the same rise across the US as a whole, Dr. Fuller says. According to CDC research, more people in the US died from gun-related violence in 2021 than in any other year on record.^[] In the US in 2022, firearm injuries fell in the top-five causes of death for people ages 1 through 44, and the top cause of death among people ages 1 to 19.^[]

Dr. Fuller personally encountered gun violence during her residency on a pediatric rotation. Due to an incident of gang-related violence, a pediatric patient was admitted with a severe gunshot wound, Dr. Fuller recalls. The shooter was in the hospital, so staff had to follow a lockdown procedure until they could get the shooter into custody, she says.

Addressing the issue

There is no easy solution for addressing gun violence in hospitals. For change to happen, Dr. Desai says that multiple people—from patients and doctors, to those in hospital leadership and the government—need to work together.

Four key areas he considers worth addressing include the following.

Security systems

Hospitals have varying security systems, and varying standards for how secure their units should be.

Communication channels

Implementing or strengthening quick communication channels between doctors and staff can increase awareness if a violent act occurs. This can include text messaging channels as well as systemwide alarms and alerts.

Dr. Desai notes that communication is crucial for keeping people safe and making sure they do not feel stranded in dangerous situations. “Before these types of events, there was a lot of reactivity but not a lot of action—and the reactivity didn't have a lot of communication around it,” he says. 

Response plans

Establishing a chain of command among hospital staff and providing resources, such as specific guidance on what to do or not do during a potentially dangerous incident, can give workers necessary tools to effectively respond to violent scenarios.

Education

Is increased security a solution?

Across the country, several local governments and individual hospitals are taking action to address gun violence in hospitals. Some actions, like increased physical security, are met with controversy from those who say that installing large security technology like metal detectors could cause patients to view hospitals as unfriendly environments.^[]

Dr. Fuller tells MDLinx that she believes “security and metal detectors should be the normal standard when entering any type of medical building.” However, she adds that it is important to remember that metal detectors alone do “not stop violence against physicians when they are out of the hospital.”

As of February 2024, the University of Pennsylvania's Penn Medicine said that it was investing more than $28 million to put weapons detection systems in entrances at multiple hospitals and outpatient facilities.^[] That same month, Cone Health in Greensboro, NC, revealed that it had invested $3 million in a security package that would include implementing weapons-detection systems in its EDs and hospital entrances at locations throughout the health system.

Actions currently underway

Various legal and organizational actions have sprung up in recent years to address violence in hospitals. Many initiatives are making waves across the United States—consider the following.

Georgia 

A new bill intends to increase penalties for aggravated assault and aggravated battery committed against healthcare workers in Georgia hospitals and clinics.^[] Known as the Safer Hospitals Act,^[] the legislation also allows for Georgia hospitals to form their own police departments, grants them a “peace officer” who has the power of arrest, and allows for certified hospital security to carry firearms.

Michigan

Two new Michigan laws addressing violence against healthcare workers are scheduled to take effect in 2024.^[] The new legislature will double penalties and fines for assault against a healthcare worker. It will also increase punishment for assaulting a healthcare worker or medical volunteer while they are working, sentencing them up to 93 days in prison and/or a fine of up to $1,000. Punishments and fines can increase if the assault involves a weapon or a “serious or aggravated injury.”

New York

In response to increased violence against healthcare workers in New York, the State University of New York Upstate Medical University has taken steps to hire “workplace violence coordinators” to its Risk Management Team.^[]

Is it enough?

Healthcare workers stress that more work must be done to protect their teams from violence, especially because this violence is a major contributor to many feeling like they want to leave healthcare entirely.

Groups such as the American Nurses Association, American College of Emergency Physicians, and Emergency Nurses Association are calling on Congress to pass the Workplace Violence Prevention for Health Care and Social Service Workers Act.^[]

Many are also rallying behind the Safety From Violence for Healthcare Employees Act, a bill that, if passed, would make it a criminal offense to assault or intimidate hospital employees.

Whatever comes next, continuing to fight for improved safety measures in the event of violence against HCPs is crucial—for both the worker and the patients they are meant to care for, Dr. Desai says.

“Our healthcare workforce is so fragile right now,” Dr. Desai says. “In order for this country to really sustain a healthy healthcare system—which we're far from, at this point—we really have to safeguard the workforce, because we've shown how vulnerable [it] is.”