Clinical

Trauma physicians offer new hospital response to active shooters

Trauma specialist Ken Mattox, M.D., co-authors editorial suggesting “secure, preserve, fight”


Dr. Ken Mattox Kenneth L. Mattox, M.D., chief of staff and surgeon-in-chief at Harris Health System’s Ben Taub Hospital, has seen what happens when gunfire erupts in a medical care setting.
By Britni R. McAshan | August 23, 2018

Active-shooter events and mass shootings have visited hospitals across the country in recent years, Texas Medical Center institutions have not been immune to this trend.

Kenneth L. Mattox, M.D., chief of staff and surgeon-in-chief at Harris Health System’s Ben Taub Hospital, has seen what happens when gunfire erupts in a medical care setting.

“A cardiac surgeon was operating in our hospital. The tubes were still in the heart and the pump tech—who runs the heart-lung machine—wanted to go out and get a cup of coffee,” Mattox recalls. “That’s a normal thing to do, but when the surgeon sent a nurse to call for the pump tech, no one returned.”

Because of an active-shooter situation in the hospital, the whole area had been shut down.

To address the need for an effective and ethically responsible response to an active-shooter situation in a hospital, Mattox teamed up with three other trauma specialists to write a new plan to help hospitals prepare for mass shootings. Their editorial—“Active-Shooter Response at a Health Care Facility” — was published this month in the New England Journal of Medicine. And their new plan can be summed up in three words: secure, preserve and fight.

Mattox’s co-authors are Kenji Inaba, M.D., professor of surgery and director of the general surgery program at the Keck School of Medicine of the University of Southern California who practices at the Los Angeles County + USC Medical Center; Alexander L. Eastman, M.D., M.P.H., medical director and chief of the Rees-Jones Trauma Center at Parkland Hospital in Dallas who is an assistant professor of surgery at UT Southwestern Medical Center as well as deputy medical director of the Dallas Police Department; and Lenworth M. Jacobs, M.D., M.P.H., professor of surgery and professor of traumatology and emergency medicine at the University of Connecticut.

“The best infrastructure for a disaster program is an organized trauma program,” explained Mattox, who is also a distinguished service professor at Baylor College of Medicine. “The individuals that are co-authors on this paper have worked on trauma systems and health policy for the nation and military for years, and each of our hospitals have had an active shooter event.”

Mattox also noted that trauma surgeons Inaba and Eastman are trained as police officers.

For years, the widely accepted practice of “run, hide, fight” has been taught as the preferred method for protecting oneself from an active shooter. The procedure has been implemented in schools, malls and other public places.

But, Mattox said, that plan presents a problem for health care providers.

“We have all taught the FBI securities course on ‘run, hide, and fight.’ That is the best we could do in this country and we have taught it in this hospital,” he said. “We as well as other people in hospitals, nurseries, day care centers, have faced the ethical dilemma—if this happens and they run to save their life—they leave and abandon the person who cannot take care of themselves. They cannot run because they are delivering a baby, they are in shock, they are unconscious, they are paralyzed.”

Teaching health professionals to flee creates a moral and ethical issue, Mattox said, that forces doctors and nurses to ask themselves: “Can I abandon my patient and put them in harm’s way, or should I stay here and possibly make my child an orphan?”

Because of the vulnerable patient population in hospitals and facilities with quasi-open layouts, Mattox and his co-authors suggest hospitals implement a “secure, preserve, fight” procedure instead. That would redirect the immediate response to an active-shooter scenario to securing patient areas where treatment is provided and taking measures to preserve life before—and as a last resort—attempting to fight off the shooter.

“We are not trying to abandon “run, hide, and fight,” but to build on it for those areas where there is vulnerability,” the Houston surgeon said. “The active-shooter in the hospital is a very special issue because despite your practicing, that person can extend injury with a gun. Having 100 people or 1 million people read this article meets our objective because people start talking about it.”

The following is an excerpt from the original editorial dated August 9, 2018, outlining the new procedural standard suggested by the emergency medicine and trauma experts:

“… we believe that the “run, hide, fight” directive should be followed by any health care professionals, hospital workers, patients, and visitors who are able to comply with it. That category may include the vast majority of occupants of both outpatient and inpatient facilities. But for professionals providing essential medical care to patients who cannot run, hide or fight owing to their medical condition or ongoing life-sustaining therapy, a different set of responses should be considered—secure the location immediately, preserve the life of the patient and oneself and fight only if necessary (“secure, preserve, fight”). The elements of this response could be further elucidated in the context of the widely accepted principles of emergency management: mitigation, preparation, response, and recovery.”




Social Posts

profile_image

University of Houston

@UHouston

RT @UHpres: Welcome back, students! Campus feels alive and vibrant...so happy to see you! https://t.co/h68xC7bi8L

36 mins ago
profile_image

Veterans Affairs

@DeptVetAffairs

On World Photography Day, today’s #VeteranOfTheDay is Army Air Corps Veteran Roger Hal McKain, who served as a photographer during World War II: https://t.co/BIKTlFZ53w

39 mins ago
profile_image

BCMHouston

@bcmhouston

RT @BCMCancerCenter: Did you know we currently offer 86 different kinds of cancer clinical trials? Learn more. https://t.co/JEawX7F5Mv #cli…

54 mins ago
profile_image

BCMHouston

@bcmhouston

RT @health_crawford: On a typical night, 550,000 people are homeless in America. Dr. Fabrizia Faustinella of @bcmhouston @TXMedCenter filme…

54 mins ago
profile_image

BCMHouston

@bcmhouston

RT @BCMHouston_News: #ListenNow: @bcmhouston's Dr. @hassansamee1981 discusses his algorithm to predict DNA shape and how that shape impacts…

54 mins ago
profile_image

TexasHeartInstitute

@Texas_Heart

RT @CWRUmsaprogram: Meet Brijette, a second-year #CWRU MSA student in Houston. Brijette recently completed a two-month rotation at Texas He…

1 hour ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

“Finding out my cancer had been caused by #HPV – which can now be prevented – was surprising,” says Jeff Deatsman. He shares why he advocates for the HPV vaccine: https://t.co/60zRSzp7vA @mekupferman @CD_fuller #hncsm #endcancer

1 hour ago
profile_image

Rice University

@RiceUniversity

RT @RiceUNews: "I've been waiting for this day for a long time."The @RiceUniversity Class of 2023 kicked off their first day of #RiceOWee…

1 hour ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

@laveaux777 Your nephew is in our prayers, Maria.

1 hour ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

@ridaisygirl Sending positive vibes your way. Please let us know if there's anything we can do for you while you're here.

1 hour ago
profile_image

University of Houston

@UHouston

RT @UHDOS: Welcome back #CoogNation!Campus right now 👇 https://t.co/K1xRe1H5fz

1 hour ago
profile_image

University of Houston

@UHouston

RT @EnrollatUH: Hey Coogs! Monday is the last day to add a class in the regular session. Make sure you make those changes ASAP! https://t.c…

1 hour ago
profile_image

TexasHeartInstitute

@Texas_Heart

RT @AmerMedicalAssn: A @JAMANetworkOpen study suggests that practicing mindfulness may reduce stress and improve well-being and performance…

2 hours ago
profile_image

Rice University

@RiceUniversity

RT @davidleebron: Incredible atmosphere and engagement at tonight’s matriculation ceremony, culminating in procession through the Sallyport…

2 hours ago
profile_image

Rice University

@RiceUniversity

@DeonSelf6 A week-long orientation experience for incoming freshmen.

2 hours ago