​Four people—an emergency department (ED) doctor, a pharmacy resident, a police officer, and the gunman—were killed in a shooting at a Chicago hospital on November 19, 2018, according to news reports. The shooting began when the gunman got into an altercation with his ex-fiancée, an ED doctor, in the facility parking lot, according to a November 19, 2018, article in the Chicago Sun-Times. The shooter, who had a history of threatening domestic violence and had once been disciplined for “improper conduct toward women," shot his ex-fiancée, who called police before she died. He ran inside and fatally wounded the pharmacy resident and police officer, according to the Sun-Times. It was unclear if the shot that killed the shooter was from police or self-inflicted, the Sun-Times said. The shooter, who had previously worked as a security guard at a different hospital, had purchased his gun legally, the Sun-Times said. After the shooting began, the hospital announced a "Code Silver," meaning an active shooter situation. Staff members who attempted to keep patients calm during the incident described the scene as "chaos." When the gunman entered the facility he began shooting "at random," according to a November 20, 2018, article in the Chicago Tribune. An environmental services worker quoted by the Tribune said he hid with others in a break room across from the ED, which had a combination lock. Close to 200 patients were being treated in the hospital, the Tribune said, but only the ED was evacuated. The hospital's emergency plan includes provisions to barricade doors and ensure patient safety, the Tribune said. Police officers rushed the hospital, locked the stairway, and began searching rooms, including the nursey, for victims, the Tribune said. It was the worst fatal shooting in Chicago involving a police officer since 1988, according to the Sun-Times. The hospital issued a statement shortly after the shootings stating that the hospital remained in lockdown during the investigation and that the ED would remain closed until the next day. The hospital said it regularly plans for emergencies and had completed an active shooter drill a month earlier.

HRC Recommends: Because they have public spaces and EDs are open to the public 24 hours per day, hospitals and other healthcare organizations are at risk for active shooters. Organizations should conduct a systematic assessment to identify gaps in current readiness and put in place measures to fill those gaps. All staff members should be trained on how to respond during an active shooter event, and procedures should be reviewed regularly.