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EMERGENCIES

THE UNTHINKABLE:

AN ACTIVE SHOOTER IN A HOSPITAL

By John Edeen, MD

On July 24, 2014, a psychiatric outpatient with a long criminal history and a history of suicide at-

tempts attacked a case worker and psychiatrist at the Mercy Fitzgerald Hospital in Darby, Pa. He shot the
case worker, Theresa Hunt, twice in the face, killing her. He then wounded Dr. Lee Silverman, a concealed
license holder, in the head. However, Dr. Silverman was able to access his own firearm and shoot the killer
three times. The killer was then tackled and disarmed by another doctor and case worker when he attempted
to flee. He was found to have 39 more rounds of ammunition. If Dr. Silverman had not violated hospital
policy, he would be dead and many more staff, patients and family members would be dead or injured. The
killer, a convicted felon who had already served prison time as a felon in possession of a firearm, walked right
by the hospital’s “no guns allowed” signs to execute his evil plan.

FIVE PHASES search, the average RMM lasts about six minutes. Unfortunately,
The active killer goes through five phases in planning and exe- the delay in notifying law enforcement also averaged six minutes.
He developed the term “Stopwatch of Death” to describe the num-
cuting his act, according to veteran police trainer Lt. Dan Marcou. ber of murder attempts per number of minutes. At Sandy Hook
The first is fantasy. This includes picture drawing, website postings Elementary, the death rate was five deaths per minute and at Vir-
and possible discussion with others. Second is planning. He may ginia Tech, it was eight.
put his plan in writing and discuss with others. Third is prepara-
tion. He acquires weapons and ammunition and may notify others Time is the key element in preventing the death of innocents. If
not to go to school or work that day. Fourth is approach. He the response occurs from within the building, two or three people
moves toward target carrying tools. And finally, implementation. may be killed; if the response is from outside the building, the death
The killing starts. toll balloons to 12 to 15. Police response is hampered by delay in
notification, distance, communication of the location within the
Rapid Mass Murder (RMM) is defined by police trainer and hospital where the incident is occurring, unfamiliarity with the lay-
student of mass murder Ron Borsch as “within 20 minutes, four out of the hospital, and access to keys held by security. All these fac-
or more people are intentionally killed at the same time and in a tors lead to delay in police response even under the best of
public location.” Such incidents have happened in a wide variety circumstances. All the while, the stopwatch continues to tick.
of public places — a coffee shop, a casino, elementary schools,
middle and high schools, university campuses, a rural one-room ‘RUN. HIDE. FIGHT.’
school house, a library, shopping malls, churches, hospitals, nurs- The Department of Homeland Security defines an active
ing homes, a pharmacy, post offices, restaurants, grocery stores, an
island in Norway, military bases, urban daycare center and miscel- shooter as “an individual actively engaged in killing or attempting
laneous workplaces. They are chaotic and occur with frightening to kill people in a confined and populated area, typically through
speed. In the shooting of Congresswoman Gabrielle Giffords, six the use of firearms.” DHS recommends that if an active shooter
people were killed and 13 wounded in an incident that lasted 15 (killer) is in your vicinity, you should attempt to evacuate. If that
seconds. However, the incident in Norway lasted over an hour and is not possible, then hide out. At last resort, take action. “Run.
resulted in 69 killed and 60 wounded. According to Borsch’s re- Hide. Fight.”

14 San Antonio Medicine • March 2015