​​​​​While treating the victims of a mass school shooting, doctors at a Florida hospital soon had another patient brought to their emergency department (ED)—the shooter. Their account was detailed in a February 20, 2018, article in the New York Times. The shooter, a 19-year old former student at the school, killed 17 people (see HRC Alerts, February 21, 2018: Florida School Shooting: Hospital Had Just Drilled for an Active Shooter Situation). “Dealing with trauma patients, you're always going to have to deal with the bad guys, too," the hospital's trauma director said. “You have to be professional and do your job." Still, the arrival of a gunman after a mass shooting is unusual, the article said. Many die during the crime either by committing suicide or by being killed by those trying to stop them. When the Florida gunman arrived, the hospital arranged to treat him for potential gunshot wounds. A team of two nurses and two doctors, including the trauma director, were assigned to the shooter's room in the ED. “We just picked people we know can stay cool," the trauma director said, adding that it was important to select providers who would not become emotional. The hospital had already been locked down, with its entrances, exits, and trauma rooms guarded by security. They took the shooter in through a back entrance and treated him in an isolated part of the ED that none of the victims' families or relatives could access. “We did it in a way that they wouldn't even know the shooter was in the hospital," the trauma director said. The trauma director followed hospital protocol, cut off the shooter's shirt to locate any injuries, and examined the patient from head to toe. He found no gunshot wounds and the patient's vital signs were stable, the article said, so the director turned the care over to an emergency physician and returned to treating other trauma patients. Doctors are bound by both professional ethics and the Emergency Medical Treatment and Labor Act (EMTALA) to treat emergency patients without regard to any other factors. A few hospital staffers were upset, the trauma director said, but no one said the shooter should not be treated. The shooter was released within 40 minutes, the article said, and taken in a wheelchair to a police car, while still wearing his hospital gown. Staff members then returned to treating other patients.

HRC Recommends: EMTALA not only requires hospitals to conduct appropriate screening and stabilization procedures, it also requires that such measures be administered in a uniform fashion to all patients. Risk managers should evaluate and review EMTALA policies and procedures on an ongoing basis as well as provide periodic training for all individuals working in the emergency department and other relevant departments about EMTALA obligations. Training should emphasize the importance of following established protocols consistently and equitably as well as keeping appropriate documentation. In addition, healthcare organizations must be prepared to respond to mass casualty and active shooter events that may occur in the community as well as those that may occur on their own campuses. Organizations should examine how effectively their own all-hazards emergency plans might respond to such events, develop an appendix for these particular events if they do not already have one, and consider their potential role in educating and training the public. Risk managers may wish to review the Hartford Consensus III and Hartford Consensus IV reports, which discuss strategies to aid preparation for active shooter and intentional mass casualty events.