| The Healthcare and Public Health Sector Advisory Bulletin May 21, 2025 |
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Targeted Violence Towards Healthcare Facilities
Violence in or directed towards healthcare facilities presents a significant challenge to patients, providers, support staff, and visitors. The Occupational Safety and Health Administration estimates that nearly 75% of about 25,000 workplace assaults reported annually happen in healthcare settings. Many healthcare workers face threats on a regular basis, despite the fact that most healthcare organizations have a zero-tolerance policy. Workplace violence may occur with minimal or no advanced notice and can have devastating consequences. It is vitally important for emergency planners to have policies and procedures to assess threats and prevent, mitigate, respond, and recover from incidents of workplace violence. Healthcare settings have unique vulnerabilities and obligations to patients and the public which require careful planning, education, and exercising.
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Key Healthcare Sector Recommendations:
Strengthen Security Protocols - Work closely with facility and local law enforcement to strengthen protocols; consider creating a multidisciplinary threat assessment team.
- Provide staff with panic buttons and apps that provide them a way to report suspicious behavior.
- Reevaluate physical security at all sites.
- Ensure external and internal areas provide clear visibility and are "visually connected" (i.e., security/cameras can view most/the entire area).
- Confirm staff know where "safe rooms" are located and are familiar with related signage.
Enhance Emergency Preparedness - Review and update emergency response plans, evacuation procedures, and internal/external communication protocols.
- Provide training in de-escalation and self-defense. Conduct scenario-based drills with staff, facility security, and local responders where appropriate.
- Meet with local first responders and provide leaders with a campus map with potential hotspot areas identified (e.g., ED, ICU, labor and delivery, nursery, pediatrics, oncology).
- Place hemorrhage control kits w/AEDs and fire extinguishers in select areas; periodically remind staff and provide training.
- Develop pre-messages (with details added, repeated, and updated) for paging and computer-based notification systems.
- Ensure facility security and clinical and support staff are aware of who to notify externally and what information to share when reporting active shooter/active violence.
Support Workforce Mental Health and Retention - Offer counseling services and psychological support to affected staff.
- Determine timeline and mechanism for communicating degree of injury/ death particularly if staff member injured/killed in conjunction with family notification(s); determine who will make notifications.
- Have social workers debrief staff and patients 48 hours and 2 weeks after the incident.
- Consider asking the CEO to greet employees at the door the day after to show safety and support.
- Foster a workplace culture that encourages reporting suspicious behavior without fear of retaliation.
Promote Information Sharing - Monitor updates from official sources such as U.S. Federal Bureau of Investigation, U.S. Department of Homeland Security, and HHS.
- Monitor threats via social media, major media, law enforcement partnership, health care coalitions, and threat assessment team.
- Share validated threat information with relevant partners and stakeholders.
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Relevant ASPR TRACIE Topic Collections and Resources:
ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE) is a healthcare emergency preparedness information gateway that meets the information and technical assistance needs of ASPR stakeholders.- Active Shooter and Explosives Topic Collection: The resources in this Topic Collection can help emergency medical professionals plan for and respond to the changing nature of mass shootings and explosive events.
- Disaster Behavioral Health Resources Page: Disaster behavioral health (DBH) includes the provision of mental health, substance abuse, and stress management services to disaster survivors and responders (ASPR ABC, 2012). Incorporating DBH into all phases of emergency management can ensure resident and responder preparedness, an effective, compassionate response effort, and a more resilient community moving forward. The resources on this page can help stakeholders accomplish these goals.
- Healthcare Workplace Violence Speaker Series: A collection of recorded presentations focused on preventing, preparing for, responding to and recovering from health care workplace violence incidents.
- Mass Violence Resource Page: Mass violence incidents require efficiency and coordination among multiple response entities. These ASPR TRACIE-developed resources based on lessons from multiple jurisdictions can help stakeholders prepare for, respond to, and help their communities recover from these traumatic events.
- On-Campus Health Care Facility Armed Assailant Planning Considerations: Health care planners can use this checklist to help prepare their facilities to mitigate, respond to, and recover from an active shooter or armed assailant situation on campus.
- Workplace Violence Topic Collection: The resources in this Topic Collection highlight some of the most current information and guidance that can assist emergency managers tasked with developing and maintaining workplace violence prevention programs and other guidelines to ensure the resiliency of their facilities.
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Disclaimer: ASPR provides the above sources of information for the convenience of the HPH Sector community and is not responsible for the availability or content of the information or tools provided, nor does ASPR endorse, warrant or guarantee the products, services or information described or offered. It is the responsibility of the user to determine the usefulness and applicability of the information provided.
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