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.