Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, MD, USA.
Ann Emerg Med. 2012 Dec;60(6):790-798.e1. doi: 10.1016/j.annemergmed.2012.08.012. Epub 2012 Sep 19.
Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011.
Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed.
Of 9,360 search "hits," 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), "euthanizing" an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%).
Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of event represents a significant challenge to hospital security and effective deterrence practices because most perpetrators proved determined and a significant number of shootings occur outside the hospital building.
医疗机构中的工作场所暴力是一种常见现象。急诊部门（ED）被认为特别容易受到攻击。医院内发生枪击事件尤其令人担忧；然而，关于此类工作场所暴力的信息有限。因此，我们对 2000 年至 2011 年美国医院内发生的枪击事件进行了特征描述。
使用 LexisNexis、Google、Netscape、PubMed 和 ScienceDirect，我们在美国 2000 年至 2011 年期间对急性护理医院枪击事件报告进行了搜索。所有至少有 1 名受伤受害者的医院枪击事件均进行了分析。
在 9360 次搜索“命中”中，确定了 154 起与医院相关的枪击事件，其中 91 起（59%）发生在医院内，63 起（41%）发生在医院内。枪击事件发生在 40 个州，造成 235 名受伤或死亡的受害者。肇事者绝大多数为男性（91%），但代表所有成年年龄组。ED 环境是最常见的地点（29%），其次是停车场（23%）和病房（19%）。大多数事件涉及有坚定动机的蓄意射手，这些动机是由怨恨（27%）、自杀（21%）、“安乐死”患病亲属（14%）和囚犯逃跑（11%）等因素定义的。环境社会暴力（9%）和不稳定的精神病患者（4%）相对较少见。最常见的受害者是肇事者（45%）。医院员工占受害者的 20%；医生（3%）和护士（5%）受害者相对较少。在 ED 中与其他地点区分开来的事件特征包括年轻的肇事者，更有可能被拘留，而且不太可能与受害者（患病亲属、怨恨、同事）有个人关系。在 ED 内的 23%枪击事件中，武器是被肇事者夺走的安全官员的枪。在医院内的病死率明显低于其他地点（ED 为 19%，其他地点为 73%）。
尽管可能并非每起医院枪击事件都被发现，但与其他形式的工作场所暴力相比，此类事件相对较少。由于大多数肇事者被证明是坚定的，而且相当数量的枪击事件发生在医院大楼外，因此这种类型的事件具有不可预测性，这对医院安全和有效的威慑实践构成了重大挑战。
