title: Hospital-based shootings in the United States: 2000 to 2011.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, MD, USA. gkelen@jhmi.edu
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Christina L
authors.initials: CL
authors.lastname: Catlett
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Kubit
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult