Topic Collection Cover Page

Workplace Violence
Topic Collection
October 15, 2019

Topic Collection: Workplace Violence

Workplace violence may occur with minimal or no advanced notice and can have devastating consequences. It is vitally important for emergency planners to have policies and procedures to prevent, mitigate and respond to incidents of workplace violence. Healthcare settings have unique vulnerabilities and obligations to patients and the public which require careful planning, education, and exercising. The resources in this Topic Collection highlight some of the most current information and guidance that can assist emergency managers tasked with developing and maintaining workplace violence prevention programs and other guidelines to ensure the resiliency of their facilities.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


Autrey, A., Hick, J., Bramer, K., et al. (2014). 3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence. (Abstract only.) Prehospital Disaster Medicine. 29(4):421-8.
The authors describe a three-phase approach used by responders to a mass shooting event that happened in Minneapolis (MN) in 2012: Enter, Evaluate, and Evacuate (or 3 Echo). 3 Echo stresses early, multi-disciplinary coordination and teaches participants about unified command, swift victim evacuation, how to establish corridors of safety, and other critical skills.
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Centers for Disease Control and Prevention. (2013). Workplace Violence Prevention for Nurses.
This short course is based on Occupational Safety and Health Administration guidance and can help healthcare providers understand, prevent, prepare for, and respond to workplace violence. Participants can earn continuing education credits.
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Division of Workers’ Compensation and Workplace Safety. (n.d.). Health Care Facilities and Workplace Violence Prevention. (Accessed 1/3/2017.) Texas Department of Insurance.
This brochure can increase healthcare facility employee and employer awareness of the risk factors for violence in these settings. The brochure also includes strategies for reducing exposure to risks.
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This webpage includes resources that can help an emergency department manager or designated team leader develop and implement a comprehensive plan that addresses needs related to managing violent behaviors in the emergency department and protecting staff.
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Jacobs, L., McSwain, N., Rotondo, M., et al. (2013). Improving Survival from Active Shooter Events: The Hartford Consensus. The National Association of Emergency Medical Technicians.
The Hartford Consensus suggests that first responders to an active shooter scene should apply the actions in the acronym THREAT: 1) Threat suppression, 2) Hemorrhage control, 3) Rapid Extrication to safety, 4) Assessment by medical providers, and 5) Transport to definitive care.
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Kirkwood, S., and Teitsort, K. (2012). Violence Against EMS Providers: What Can We Do About It? EMSWorld.
The authors provide an overview of violence against emergency medical services providers. They stress the need for: better reporting; changes in organizational culture to make it more acceptable to report; and changes in training responders on how to protect themselves from violent individuals.
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Kowalenko, T., Cunningham, R., Sachs, C.J., et al. (2012). Workplace Violence in Emergency Medicine: Current Knowledge and Future Directions. (Abstract only.) Journal of Emergency Medicine. 43(3):523-31.
The authors reviewed literature on emergency department workplace violence and found that staff face higher risk of physical assaults compared to other health settings. They offer suggestions for preventing and reducing violent incidents.
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This video provides information on preparing for and responding to an active shooter event in a healthcare setting.
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Morken, T., Johansen, I. and Alsaker, K. (2015). Dealing with Workplace Violence in Emergency Primary Health Care: A Focus Group Study. BMC Family Practice. 16:51.
This study explores how emergency primary health care organization personnel have dealt with threats and violence in the workplace.
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Occupational Safety and Health Administration. (n.d.). Workplace Violence Prevention - Health Care and Social Service Workers. (Accessed 1/3/2017.) U.S. Department of Labor.
This presentation provides an overview of the Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers published by the Occupational Safety and Health Administration (“OSHA 3148”).
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Occupational Safety and Health Administration. (2015). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. U.S. Department of Labor.
This document is an update of the Occupational Safety and Health Administration’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers.
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Occupational Safety and Health Administration. (2015). Workplace Violence. U.S. Department of Labor.
This website provides information on the extent of violence in the workplace, assessing the hazards in different settings and developing workplace violence prevention plans for individual worksites.
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Stene, J., Larson, E., Levy, M., et al. (2015). Workplace Violence in the Emergency Department: Giving Staff the Tools and Support to Report. The Permanente Journal. 19(2).
This research study examines the results of a workgroup that developed a workplace violence survey and reporting tool.
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Trotto, S. (2014). Workplace Violence in Health Care. Safety and Health Magazine.
The author discusses workplace violence in healthcare settings and provides an overview of proposed legislation to protect healthcare workers.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Active Shooter Planning and Response in a Healthcare Setting.
This document provides active shooter guidance tailored specifically to the healthcare setting.
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U.S. Department of Health and Human Services; U.S. Department of Homeland Security; U.S. Department of Justice, Federal Bureau of Investigation; and Federal Emergency Management Agency. (2014). Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans.
This document gives healthcare facility emergency planners, executive leadership, and others involved in emergency operations planning assistance with planning for active shooter incidents.
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U.S. Department of Labor. (n.d.). Department of Labor Workplace Violence Program. (Accessed 1/3/2017.)
This document comprehensively describes the Department of Labor’s Workplace Violence Program including policies and procedures, identification, prevention and response.
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The Occupational Safety and Health Administration lists violence prevention guidelines for the following healthcare settings: hospitals, residential and non-residential treatment, community care, and field work. The authors of the report also list the five “building blocks” for developing an effective prevention program: management commitment and employee participation; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation.
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Active Shooter/Mass Shooting


Autrey, A., Hick, J., Bramer, K., et al. (2014). 3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence. (Abstract only.) Prehospital Disaster Medicine. 29(4):421-8.
The authors describe a three-phase approach used by responders to a mass shooting event that happened in Minneapolis (MN) in 2012: Enter, Evaluate, and Evacuate (or 3 Echo). 3 Echo stresses early, multi-disciplinary coordination and teaches participants about unified command, swift victim evacuation, how to establish corridors of safety, and other critical skills.
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In this summary of active shooter events, the authors share research findings (e.g., location, shooter and victim demographics) and emergency healthcare training and equipment implications for first responders (primarily law enforcement in these incidents).
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* California Hospital Association. (2017). Planning for Active Shooter Incidents.
This webpage provides two pages of links to resources that can help hospitals and other healthcare facilities plan for active shooter incidents. It includes a checklist, plans, guidelines, educational videos, and other materials. Note: On this webpage, please review the Active Shooter Planning and Response in a Health Care Setting Guidance 2017. Hostage situations are addressed throughout the document, and specific procedures are outlined starting on page 93.
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Federal Bureau of Investigation. (n.d.). Active Shooter Incidents. (Accessed 1/3/2017.) U.S. Department of Justice.
This webpage describes the incidents and the agency’s efforts at prevention. The page provides links to in-depth reports, statistics, guides, after-action reports of recent incidents (including the school shooting at Sandy Hook Elementary), planning guides, and the video geared towards the general public: “Run, Hide, Fight.”
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Jacobs, L., McSwain, N., Rotondo, M., et al. (2013). Improving Survival from Active Shooter Events: The Hartford Consensus. The National Association of Emergency Medical Technicians.
The Hartford Consensus suggests that first responders to an active shooter scene should apply the actions in the acronym THREAT: 1) Threat suppression, 2) Hemorrhage control, 3) Rapid Extrication to safety, 4) Assessment by medical providers, and 5) Transport to definitive care.
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Kelly, R. (2012). Active Shooter Recommendations and Analysis for Risk Mitigation. New York City Police Department.
This report provides summary and detailed information for 281 active shooter events and includes related policy and other recommendations.
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* Kendig, J. and Mykoo, Y. (2012). Active Shooters in the Hospital Environment.
This presentation highlights the signs of potential violence, lessons learned from past incidents, and provides strategies for planning and responding to active shooter incidents.
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Los Angeles Sheriff's Department. (2015). Surviving an Active Shooter.
This video depicts active shooter scenarios and shares strategies for responding to and surviving such events.
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This video provides information on preparing for and responding to an active shooter event in a healthcare setting.
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The authors provide active shooter planning guidance under five main categories: Pre-Incident Prevention and Preparation, Management During and Incident, Post Event Management, Safety Tips for Personnel and Additional Resources.
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* Newton, E. (n.d.). Hospital Violence Active Shooter. (Accessed 11/20/2018.)
This speaker defines active shooter incidents, illustrates the problem with recent data, outlines the planning process for hospitals, and shares information related to active shooter exercises—general and specific to her healthcare organization.
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Ready Houston. (2012). Run, Hide, Fight: Surviving an Active Shooter Event. The City of Houston Mayor’s Office of Public Safety and Homeland Security.
This short video depicts active shooter scenarios and demonstrates how those affected can increase their chances of survival. Though developed for Houston, it does not contain jurisdiction-specific information, allowing it to serve as a valuable resource for all.
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The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events. (2013). Active Shooter and Intentional Mass-Casualty Events: The Hartford Consensus II. Bulletin of the American College of Surgeons.
This resource summarizes findings from a meeting of The Hartford Consensus on active shooter and mass casualty events. The group emphasizes the need for on-scene collaboration between emergency medical services and law enforcement, and highlights the supportive role that uninjured bystanders can also play in the response effort.
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The National Association of Emergency Medical Technicians. (2015). TCCC Guidelines and Curriculum.
The principles of Tactical Combat Casualty Care (TCCC) can also be applied by first responders when responding to bomb and mass shooting incidents. TCCC has three goals: 1) treat the casualty, 2) prevent additional casualties, and 3) complete the mission.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Active Shooter Planning and Response in a Healthcare Setting.
This document provides active shooter guidance tailored specifically to the healthcare setting.
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* U.S. Department of Health and Human Services; U.S. Department of Homeland Security; U.S. Department of Justice, Federal Bureau of Investigation; and Federal Emergency Management Agency. (2014). Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans.
This document gives healthcare facility emergency planners, executive leadership, and others involved in emergency operations planning assistance with planning for active shooter incidents.
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U.S. Department of Homeland Security. (2015). Active Shooter Preparedness. Web page Instructional
This webpage includes information on the subject including tips for what to do in an active shooter situation, and links to webinars, reports, training events, and informational materials (e.g., pamphlets, posters and wallet cards) in English and Spanish.
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U.S. Department of Homeland Security. (2017). First Responder.
This webpage includes links to resources geared towards first responders who may be called to an active shooter situation. Users can access "how to respond" resources (e.g., booklets, pamphlets, fact sheets--in several languages), videos, reports, and other items that can be helpful in developing plans for and responding to these types of incidents.
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This brief action guide highlights potential warning signs and response and mitigation strategies specific to an active shooter situation in a healthcare facility.
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Education and Training


Centers for Disease Control and Prevention. (2013). Workplace Violence Prevention for Nurses.
This short course is based on Occupational Safety and Health Administration guidance and can help healthcare providers understand, prevent, prepare for, and respond to workplace violence. Participants can earn continuing education credits.
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Federal Emergency Management Agency. (2015). Workplace Violence Awareness Training: IS-106.15.
The goal of this hour-long course is to teach employees how to recognize the types of workplace violence, their warning signs, and what actions they can take to prevent or minimize violence.
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Garrett, T. (2013). Safety in the Workplace. Alabama Department of Public Health.
This webinar is geared toward healthcare professionals. The speaker discusses how to identify potential risk factors in the work setting and develop a response plan in the event of a violent situation.
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International Committee of the Red Cross. (2014). Health Care in Danger: It's a Matter of Life and Death.
This e-learning training is broken into ten chapters (with links to videos and other resources) and designed to help healthcare personnel understand: the effects of violence on health care, their own rights and responsibilities, and ethical dilemmas they may face in emergencies.
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This video provides information on preparing for and responding to an active shooter event in a healthcare setting.
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National Ebola Training and Education Center. (2017). Resources and Repository.
This webpage includes links to training and other helpful resources specific to special pathogens (e.g., Ebola and MERS).
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Weidner, D. (2014). LTC Shots Fired Tabletop Exercise (TTX) Situation Manual (SitMan). Health Care Association of New Jersey.
This tabletop exercise can help healthcare facility executives and team members address key active shooter issues through a series of facilitated discussions.
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Emergency Medical Services/Prehospital Resources


Grange, J.T., and Corbett, S.W. (2002). Violence Against Emergency Medical Services Personnel. (Abstract only.) Prehospital Emergency Care. 6(2): 186-190.
An analysis of more than 4,000 calls in one month showed that some sort of violence occurred in close to 9% of encounters, half of which was directed at prehospital care providers. The authors stress the need for training, protective gear, and protocols for dealing with violent situations.
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Kirkwood, S., and Teitsort, K. (2012). Violence Against EMS Providers: What Can We Do About It? EMSWorld.
The authors provide an overview of violence against emergency medical services providers. They stress the need for: better reporting; changes in organizational culture to make it more acceptable to report; and changes in training responders on how to protect themselves from violent individuals.
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Munding, H. (2006). Violence Against Firefighters: Angels of Mercy Under Attack. United States Fire Association.
The author conducted a literature review (and a local survey) on the nature of violence against firefighters and provides a variety of suggestions for training and standard operating procedures.
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Taylor, J.A., Davis, A.L., Barnes, B., et al. (2015). Injury Risks of EMS Responders: Evidence from the National Fire Fighter Near-Miss Reporting System. BMJ Open. 5(6).
The authors reviewed 769 "non-fire emergency event" reports from the data system and categorized them. The most frequent emergency medical call was made for assaults, primarily by someone wielding a firearm.
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This white paper includes checklists and step-by-step considerations for active shooter event planning and response by pre-hospital providers, and references the framework suggested by the Hartford Consensus.
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Healthcare Settings


Beech, B., and Leather, P. (2005). Workplace Violence in the Health Care Sector: A Review of Staff Training and Integration of Training Evaluation Models. Aggression and Violent Behavior. 11(1): 27-43.
The authors discuss: workplace violence in healthcare settings, the extent of the problem, the importance of staff training, key training content, and models of training evaluation.
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* California Hospital Association. (2017). Planning for Active Shooter Incidents.
This webpage provides two pages of links to resources that can help hospitals and other healthcare facilities plan for active shooter incidents. It includes a checklist, plans, guidelines, educational videos, and other materials. Note: On this webpage, please review the Active Shooter Planning and Response in a Health Care Setting Guidance 2017. Hostage situations are addressed throughout the document, and specific procedures are outlined starting on page 93.
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Critical Incident Response Group, National Center for the Analysis of Violent Crime. (2002). Workplace Violence: Issues in Response. U.S. Department of Justice, Federal Bureau of Investigation.
This report highlights findings from a “Violence in the Workplace” symposium which featured representatives from law enforcement, private industry, government, law, labor, professional organizations, victim services, the military, academia, mental health, and others.
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Gillespie, G.L., Gates, D.M., Kowalenko, T., et al. (2014). Implementation of a Comprehensive Intervention to Reduce Physical Assaults and Threats in the Emergency Department. (Abstract only.) Journal of Emergency Nursing. 40(6): 586-591.
The authors measured the effectiveness of a workplace violence reduction program against emergency department workers. While their original hypothesis was not supported, two intervention sites did see significant decreases in violence.
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Gomaa, A., Tapp, L., Luckhaupt, S. et al. (2015). Occupational Traumatic Injuries Among Workers in Health Care Facilities — United States, 2012–2014. Morbidity and Mortality Weekly Report (MMWR).
This article examines occupational injuries in the health care sector including those injuries resulting from workplace violence.
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Judy, K., and Veselik, J. (2009). Workplace Violence: A Survey of Paediatric Residents. Occupational Medicine. 59(7): 472-475.
The authors surveyed 25 U.S. pediatric residency program directors to determine the prevalence of workplace violence in pediatric residency training programs.
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Kelen, G.D., Catlett, C.L., Kubit, J.G., and Hsieh, Y.H. (2012). Hospital-Based Shootings in the United States: 2000 to 2011. (Abstract only.) Annals of Emergency Medicine. 60(6):790-798.
The authors analyzed reports on acute care hospital shooting events in the U.S. from 2000-2011 and found 154 incidents in 40 states, resulting in 235 injured or dead victims. They provide additional demographic data (e.g., perpetrator characteristics, location of shooting).
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* Kendig, J. and Mykoo, Y. (2012). Active Shooters in the Hospital Environment.
This presentation highlights the signs of potential violence, lessons learned from past incidents, and provides strategies for planning and responding to active shooter incidents.
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Kowalenko, T., Cunningham, R., Sachs, C.J., et al. (2012). Workplace Violence in Emergency Medicine: Current Knowledge and Future Directions. (Abstract only.) Journal of Emergency Medicine. 43(3):523-31.
The authors reviewed literature on emergency department workplace violence and found that staff face higher risk of physical assaults compared to other health settings. They offer suggestions for preventing and reducing violent incidents.
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This video provides information on preparing for and responding to an active shooter event in a healthcare setting.
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This issue of Trajectories focuses on workplace violence in healthcare settings. The authors describe findings from a fall 2017 listening tour with Missouri Hospital Association groups who noted their top threats and themes for future consideration. The rest of the issue covers regulatory and programmatic topics, statistics related to the role of security in a healthcare facility, mitigation tools, and promoting a culture of safety.
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Morken, T., Johansen, I. and Alsaker, K. (2015). Dealing with Workplace Violence in Emergency Primary Health Care: A Focus Group Study. BMC Family Practice. 16:51.
This study explores how emergency primary health care organization personnel have dealt with threats and violence in the workplace.
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The authors provide active shooter planning guidance under five main categories: Pre-Incident Prevention and Preparation, Management During and Incident, Post Event Management, Safety Tips for Personnel and Additional Resources.
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Nachreiner, N., Gerberich, S., Ryan, A. (2007). Minnesota Nurses' Study: Perceptions of Violence and the Work Environment. (Abstract only.) Industrial Health. 45:672-678.
This study identified rates of violence against nurses in the State of Minnesota, and their perceptions of the work environment.
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* Newton, E. (n.d.). Hospital Violence Active Shooter. (Accessed 11/20/2018.)
This speaker defines active shooter incidents, illustrates the problem with recent data, outlines the planning process for hospitals, and shares information related to active shooter exercises—general and specific to her healthcare organization.
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Occupational Safety and Health Administration. (n.d.). Workplace Violence Prevention - Health Care and Social Service Workers. (Accessed 1/3/2017.) U.S. Department of Labor.
This presentation provides an overview of the Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers published by the Occupational Safety and Health Administration (“OSHA 3148”).
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Papa, A. and Venella, J. (2013). Workplace Violence in Healthcare: Strategies for Advocacy. The Online Journal of Issues in Nursing 18(1): Manuscript 5.
This article provides a brief overview of workplace violence, and discusses the settings where it often occurs. The authors examine the direct and indirect financial impact of workplace violence (e.g., jury awards for injuries; staff turnover rates, and increased requests for medical leaves) and suggest legislative advocacy, workplace policy, and education strategies for countering violence in the workplace.
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Peek-Asa, C., Casteel, C., Veerasathpurush, A., et al. (2007). Workplace Violence and Prevention in New Jersey Hospital Emergency Departments. (Abstract only.) Journal of Occupational and Environmental Medicine. 49: 756-763.
This report highlights workplace violence prevention programs in 50 emergency departments in New Jersey hospitals. The authors identified several challenges, including uncoordinated surveillance of workplace violence events and unsatisfactory interactions between nursing staff and security personnel.
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Stene, J., Larson, E., Levy, M., et al. (2015). Workplace Violence in the Emergency Department: Giving Staff the Tools and Support to Report. The Permanente Journal. 19(2).
This research study examines the results of a workgroup that developed a workplace violence survey and reporting tool.
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The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers.
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Trotto, S. (2014). Workplace Violence in Health Care. Safety and Health Magazine.
The author discusses workplace violence in healthcare settings and provides an overview of proposed legislation to protect healthcare workers.
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* U.S. Department of Health and Human Services; U.S. Department of Homeland Security; U.S. Department of Justice, Federal Bureau of Investigation; and Federal Emergency Management Agency. (2014). Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans.
This document gives healthcare facility emergency planners, executive leadership, and others involved in emergency operations planning assistance with planning for active shooter incidents.
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This brief action guide highlights potential warning signs and response and mitigation strategies specific to an active shooter situation in a healthcare facility.
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The Occupational Safety and Health Administration lists violence prevention guidelines for the following healthcare settings: hospitals, residential and non-residential treatment, community care, and field work. The authors of the report also list the five “building blocks” for developing an effective prevention program: management commitment and employee participation; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation.
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Washington Industrial Safety and Health Act Regional Directive. (2006). Workplace Violence Prevention in Health Care. Department of Labor and Industries, Division of Occupational Safety and Health.
This policy directive was developed as a result of legislation mandating violence prevention in Washington State hospitals. Guidance is provided in a question and answer format.
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Hostage Situations


This checklist is designed to help healthcare facilities in the decision-making process during an active shooter scenario. It also addresses hostage situations throughout the document.
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* California Hospital Association. (2017). Planning for Active Shooter Incidents.
This webpage provides two pages of links to resources that can help hospitals and other healthcare facilities plan for active shooter incidents. It includes a checklist, plans, guidelines, educational videos, and other materials. Note: On this webpage, please review the Active Shooter Planning and Response in a Health Care Setting Guidance 2017. Hostage situations are addressed throughout the document, and specific procedures are outlined starting on page 93.
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This document identifies the policies and procedures a hospital should follow during a hostage situation or an incident where an individual is wielding/ firing a weapon.
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The Center for HICS Education and Training. (n.d.). Incident Planning Guide: Hostage or Barricade Incident.
This guide introduces a scenario associated with a hospital hostage situation, and includes checklists for hospital and emergency management program staff to consider when addressing this type of incident.
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The Center for HICS Education and Training. (n.d.). Incident Response Guide: Hostage or Barricade Incident.
This guide provides checklists of tasks that should be completed by hospital staff during a hostage or barricade incident in the hospital. It includes checklists for the various response timeframes: immediate response (0-2 hours), intermediate response (2-12 hours), extended response (greater than 12 hours), and demobilization/ system recovery.
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Plans, Tools, and Templates


American Organization of Nurse Executives and the Emergency Nurses Association. (n.d.). Toolkit for Mitigating Violence in the Workplace. (Accessed 1/2/2019.)
This toolkit highlights five focus areas of a successful workplace violence prevention program and includes links to helpful resources for nurse leaders. These resources define workplace violence and demonstrate how to create prevention plans, train and deploy staff, and evaluate progress and incorporate lessons learned from exercises and incidents.
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This white paper provides supporting documentation and other information for healthcare security professionals to create and sustain a violence prevention program.
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* California Hospital Association. (2017). Planning for Active Shooter Incidents.
This webpage provides two pages of links to resources that can help hospitals and other healthcare facilities plan for active shooter incidents. It includes a checklist, plans, guidelines, educational videos, and other materials. Note: On this webpage, please review the Active Shooter Planning and Response in a Health Care Setting Guidance 2017. Hostage situations are addressed throughout the document, and specific procedures are outlined starting on page 93.
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This webpage includes resources that can help an emergency department manager or designated team leader develop and implement a comprehensive plan that addresses needs related to managing violent behaviors in the emergency department and protecting staff.
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Ingersoll Rand Security Technologies. (n.d.). Healthcare Security & Safety Assessment. (Accessed 1/2/2019.)
This tool was created to help healthcare facilities augment hazard vulnerability assessments, develop an understanding of their security gaps, and create strategies for improving preparedness.
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* Kerr, K.M. (2010). Workplace Violence: Planning for Prevention and Response. (Abstract only. Book and individual chapters available for purchase.) ScienceDirect ISBN: 978-1-85617-698-9.
The author provides a comprehensive overview of workplace violence, including chapters on how incidents affect victims, witnesses, the workforce, family members, and management. Additional chapters can help organizations to form action and response plans to manage incidents of any size.
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* Minnesota Department of Labor and Industry. (n.d.). Workplace Safety Consultation -- Workplace Violence Prevention. (Accessed 10/21/2015.)
The Minnesota Department of Labor and Industry has established a Workplace Violence Prevention Resource Center to assist the public by offering a resource library, plan templates, and other resources to assist with implementing a workplace violence prevention program.
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NJHA Emergency Management. (2018). Security Readiness Assessment Tool.
This tool can be used by healthcare facility security staff to develop or update existing security plans. It was updated in 2018 and includes general guidance for three types of facilities: acute care, long-term care, and Federally Qualified Health Centers.
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Occupational Safety and Health Administration. (2002). Workplace Violence Fact Sheet. U.S. Department of Labor.
This fact sheet identifies workplace violence, describes actions that employers and employees can take to protect themselves, and lists additional resources.
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* Occupational Safety and Health Administration. (2015). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. U.S. Department of Labor.
This document is an update of the Occupational Safety and Health Administration’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Active Shooter Planning and Response in a Healthcare Setting.
This document provides active shooter guidance tailored specifically to the healthcare setting.
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U.S. Department of Labor. (n.d.). Department of Labor Workplace Violence Program. (Accessed 1/3/2017.)
This document comprehensively describes the Department of Labor’s Workplace Violence Program including policies and procedures, identification, prevention and response.
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The Occupational Safety and Health Administration lists violence prevention guidelines for the following healthcare settings: hospitals, residential and non-residential treatment, community care, and field work. The authors of the report also list the five “building blocks” for developing an effective prevention program: management commitment and employee participation; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation.
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This white paper includes checklists and step-by-step considerations for active shooter event planning and response by pre-hospital providers, and references the framework suggested by the Hartford Consensus.
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Washington State Legislature. (2000). Workplace Safety Plan.
This policy statement mandates that Washington State psychiatric hospitals develop a plan to “reasonably prevent and protect employees from violence at the state hospital.” The statement includes plan components, such as staffing/security staffing, first aid procedures, reporting, and education and training.
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Prevention Resources


Anderson, A., and West, S. (2011). Violence Against Mental Health Professionals: When the Treater Becomes the Victim. Innovations in Clinical Neuroscience. 8(3).
The authors examine several studies regarding workplace violence in the mental health setting (e.g., what precipitates it, populations more likely to become violent) and discuss possible methods of preventing violence.
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This webpage and presentation highlight violence prevention strategies taught by the Crisis Prevention Institute.
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Division of Workers’ Compensation and Workplace Safety. (n.d.). Health Care Facilities and Workplace Violence Prevention. (Accessed 1/3/2017.) Texas Department of Insurance.
This brochure can increase healthcare facility employee and employer awareness of the risk factors for violence in these settings. The brochure also includes strategies for reducing exposure to risks.
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Gross, N., Peek-Asa, C., Nocera, M., et al. (2013). Workplace Violence Prevention Policies in Home Health and Hospice Care Agencies. The Online Journal of Issues in Nursing. 18(1): Manuscript 1.
The authors examined workplace violence prevention programs in 40 California home health and hospice agencies and discuss their findings.
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This guide provides important information to assist department and agency security planners as they develop and review Occupant Emergency Programs for the safety and security of employees and visitors at non-military Federal facilities. To further support security specialists in this effort, this guide outlines the components of an effective Occupant Emergency Program, including those items that comprise an emergency plan.
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This ISC Guide aims to provide guidance for organizations in formulating and ultimately implementing an operable and effective Facility Security Plan (FSP). A Facility Security Plan is a critical component of an effective security program and of a complete EOP. The guidelines contained in this document are based on recognized industry best practices and provide broad recommendations for the protection of Federal facilities and Federal employees, contractors, and visitors within them.
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* Kerr, K.M. (2010). Workplace Violence: Planning for Prevention and Response. (Abstract only. Book and individual chapters available for purchase.) ScienceDirect ISBN: 978-1-85617-698-9.
The author provides a comprehensive overview of workplace violence, including chapters on how incidents affect victims, witnesses, the workforce, family members, and management. Additional chapters can help organizations to form action and response plans to manage incidents of any size.
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McPhaul, K., London, M., and Lipscomb, J. (2013). A Framework for Translating Workplace Violence Intervention Research into Evidence-Based Programs. The Online Journal of Issues in Nursing. 18(1): Manuscript 4.
This article provides background information about workplace violence and offers a framework for developing comprehensive workplace violence prevention programs built on the existing scientific evidence and regulatory guidance.
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* Minnesota Department of Labor and Industry. (n.d.). Workplace Safety Consultation -- Workplace Violence Prevention. (Accessed 10/21/2015.)
The Minnesota Department of Labor and Industry has established a Workplace Violence Prevention Resource Center to assist the public by offering a resource library, plan templates, and other resources to assist with implementing a workplace violence prevention program.
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Morken, T., and Johansen, I. (2013). Safety Measures to Prevent Workplace Violence in Emergency Primary Care Centres--a Cross-Sectional Study. BMC Health Services Research. 13:384.
The authors investigated the extent to which general practitioners work alone in emergency primary care centers in Norway, and estimated the prevalence of preventive measures against workplace violence.
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National Institute for Occupational Safety and Health. (2004). Workplace Violence Prevention Strategies and Research Needs:. Centers for Disease Control and Prevention.
These conference proceedings are categorized into three categories: 1) overcoming current barriers and gaps that impede collaborative research, prevention, and communication work; 2) characteristics of effective workplace violence prevention programs; and 3) research and partnerships needed to further advance prevention.
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Occupational Safety and Health Administration. (n.d.). Workplace Violence Prevention Programs. (Accessed 1/3/2017.) U.S. Department of Labor.
This webpage of references provides guidance for preventing violence in the workplace. References are grouped into three categories: Occupational Health and Safety Administration Guidance, Other Federal Agency Guidance, and State and Local Guidance.
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* Occupational Safety and Health Administration. (2015). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. U.S. Department of Labor.
This document is an update of the Occupational Safety and Health Administration’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers.
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Occupational Safety and Health Administration. (2015). Workplace Violence. U.S. Department of Labor.
This website provides information on the extent of violence in the workplace, assessing the hazards in different settings and developing workplace violence prevention plans for individual worksites.
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U.S. Department of Agriculture. (2015). Workplace Violence Prevention.
This webpage provides access to the U.S. Department of Agriculture policies and procedures to address and prevent workplace violence. It also includes informational reports, national hotline resources, and information on reporting situations of imminent danger.
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The Occupational Safety and Health Administration lists violence prevention guidelines for the following healthcare settings: hospitals, residential and non-residential treatment, community care, and field work. The authors of the report also list the five “building blocks” for developing an effective prevention program: management commitment and employee participation; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation.
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Statistics and Data


Bureau of Labor Statistics. (2014). Census of Fatal Occupational Injuries-Archived Data. U.S. Department of Labor.
This webpage has links to tables, charts, reports, issue papers and articles in TXT or PDF formats for data on fatal occupational injuries. Data for “Assaults and Violent Acts” are included.
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Kansagra, S. M., Rao, S. R., Sullivan, A. F., et al. (2008). A Survey of Workplace Violence Across 65 U.S. Emergency Departments. Academic Emergency Medicine. 15 (12):1268–1274.
This study examines emergency department workplace violence and staff perceptions of physical safety.
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Kowalenko, T., Hauff, S., Morden, P. et al. (2012). Development of a Data Collection Instrument for Violent Patient Encounters against Healthcare Workers. Western Journal of Medicine 13(5):429-33.
The authors highlight the development process and evaluation of an instrument created to collect data relevant to violence against healthcare workers.
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National Institute for Occupational Safety and Health. (2014). Occupational Health and Safety Network. SME Comment: The webpage gives you access to the database. You can register and add data or access. Centers for Disease Control and Prevention.
The Occupational Health and Safety Network (OHSN) is a voluntary and secure electronic occupational safety and health surveillance system developed by the National Institute for Occupational Safety and Health. The network currently focuses on occupational safety and health issues in the healthcare sector. The first three modules address traumatic injury risks among healthcare personnel. Healthcare facilities can share data they already collect to track their rates and compare findings to other OHSN participants.
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Agencies and Organizations


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Federal Bureau of Investigation. Active Shooter Incidents.
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U.S. Department of Homeland Security. Active Shooter Preparedness.
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U.S. Department of Homeland Security. First Responder.
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