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Am J Disaster Med. 2014 Winter;9(1):39-51. doi: 10.5055/ajdm.2014.0140.

Active shooter in the emergency department: a scenario-based training approach for healthcare workers.

Author information

Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
Chief, Education, Certification, & Technology, New Jersey Department of Health, Office of Emergency Medical Services, Trenton, New Jersey.
Research Assistant, Newark Beth Israel Medical Center, Newark, New Jersey.
Professor, Program Director, Criminal Justice & Homeland Security, Georgian Court University, Lakewood, New Jersey.
Program Director, Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey; Adjunct Associate Professor, Rutgers University School of Public Health, Piscataway, New Jersey.



An active shooter in the emergency department (ED) presents a significant danger to employees, patients, and visitors. Very little education on this topic exists for healthcare workers. Using didactic and scenario-based training methods, the authors constructed a comprehensive training experience to better prepare healthcare workers for an active shooter.


Thirty-two residents, nurses, and medical students participated in a disaster drill onboard a US military base. All were blinded to the scenarios. The study was approved by the institutional review board, and written consent was obtained from all participants. Each participant completed a 10-item pretest developed from the Department of Homeland Security's IS:907 Active Shooter course. Participants were exposed to a single active shooter scenario followed by a didactic lecture on hostage recovery and crisis negotiation. Participants were then exposed to a scenario involving multiple shooters. Many of the participants were held hostage for several hours. The training concluded with a post-test and debrief. Paired Student's t-test determined statistical significance between the pretest and post-test questionnaire scores.


Paired Student's t-tests confirmed a statistically significant difference between the pretest and post-test scores for the subjects, as a whole (p < 0.002 [-0.177, -0.041]). There was no difference in scores for nurses (p = 1 [-1.779, 1.779]). The scores for resident physicians (p < 0.01 [-0.192, -0.032]) and medical students (p < 0.01 [-0.334, -0.044]) were found to be significant.


Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.

[Indexed for MEDLINE]

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