Mass Shootings in the United States: Hospital Experiences in Preparedness, Response, and Recovery

Abstract

The United States has more mass shootings than any other developed nation worldwide. These events are of particular concern to healthcare systems because they can result in many victims with complex, penetrating injuries that require extensive, time-sensitive care. Further, the US healthcare system continues to grapple with unprecedented staffing limitations, supply shortages, and capacity issues. The current context of converging challenges within US healthcare systems impairs their ability to respond to emergencies including mass shootings, stressing a critical need to better understand how hospitals can develop adequate emergency management plans to help them effectively respond to and mitigate the effects of these disruptive events. This study aimed to address two questions: 1) What can we learn from the experiences of hospitals that have responded to recent mass shootings in the US? 2) What unique challenges do community hospitals, whose experiences with mass shootings have not been studied, face in preparedness, response, and recovery for mass shooting incidents? These questions were explored with a series of qualitative interviews with first responders to six mass shootings and one mass casualty event across the US, as well as analysis of five incident preparedness toolkits developed by national expert organizations. Five major needs were identified that must be addressed when planning for, responding to, and recovering from mass shootings: 1) engaged leaders who advance preparedness; 2) mass casualty plans based on realistic assumptions and that consider the current healthcare system; 3) timely and consistent communication to combat misinformation during a hospital’s response and recovery; 4) rapid regional coordination for family assistance and reunification centers; and 5) robust support and mental health services for patients and staff. Adequate and realistic planning at organizational and regional levels is essential to optimize and coordinate response to unexpected mass casualty events. An appropriate preparedness plan ensures that responsibility, accountability, and roles are clarified in advance and facilitates efficient communication, resource utilization, and safety of staff and patients—helping hospitals and healthcare systems better respond to and mitigate the effects of emergencies such as mass shooting events.