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EMERGENCIES

You should have an escape route and plan in mind; leave your be subject to prosecution for a Class A misdemeanor punishable
belongings behind and be ready to keep your hands visible for law by a fine of no more than $4,000, confinement in jail for a term
enforcement. If you must hide, choose an area out of the shooter’s no greater than one year, or both. In addition, he would lose his
view, block the entry to your hiding place and lock the doors. Also, concealed handgun license for a period of five years. In Pennsyl-
silence your cell phone or pager. You should fight if your life is in vania, the “no guns” signs do not carry weight of law, but the Texas
imminent danger. You should attempt to incapacitate the shooter PC Sec. 30.06 sign does.
with physical aggression and throw items at the active shooter.
We can improve physical security, limit access, arm our security
Call 911 when it is safe to do so. You should report the location, guards, conduct drills, install cameras and do risk assessments, but
the number of shooters, their physical description, the number in the end it will be the individual on the scene at the time of the
and types of weapons held by shooters and the number of potential active killer event who is in the best position to stop the killing.
victims at the location. DHS instructs that when law enforcement The Joint Commission requires a hospital to identify its security
arrives remain calm and follow instructions, put down any items risks (JCAHOs Standard EC.2.10). CMS mandates a hospital pa-
in your hands, raise hands and spread fingers, keep hands visible, tient has the right to receive care in a safe setting (42 C.F. R.
avoid quick movements toward officers, avoid pointing, screaming 482.13(c)(2)). OSHA released guidelines in 2004 for preventing
or yelling, and do not stop to ask officers for help or directions violence in healthcare.
when evacuating.
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In their white paper, the Health Care and Public Health Sector
Coordinating Councils remind us that healthcare professionals
have a duty to care for their patients. This brings up several ethical
issues in the event of an active killer event. We must prepare in ad-
vance to address several issues. We must allocate resources fairly
with special consideration to those most vulnerable. We must limit
harm to the extent possible. We must treat all patients with respect
and dignity, regardless of the level of care that can continue to be
provided. We must prepare to decide to discontinue care to those
who may not be able to be brought to safety in consideration of
those who can. We should realize some providers and family will
choose to remain in danger. We must consider the greater good as
well as our own interests. We must strive to maximize the preser-
vation of life.

Texas Government Code Section 411.204(b) requires hospitals
licensed under Chapter 241, Health and Safety Code “shall promi-
nently display at each entrance to the hospital ... a sign that com-
plies with subsection (c) ... that it is unlawful for a person licensed
under this subchapter to carry a handgun on the premises.” Penal
Code Section 46.035(b)4 prohibits a concealed license holder from
carrying a handgun “on the premises of a hospital licensed under
Chapter 241, Health and Safety Code ... unless the license holder
has written authorization of the hospital administration...” Almost
every active killer scenario has occurred in places where concealed
license holders were prohibited from possessing firearms. These
victim disarmament zones allow killers the time to run out the
“stopwatch of death” before law enforcement can arrive. If the
event in Pennsylvania had happened in Texas, Dr. Silverman would

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