“Secure-Preserve-Fight” or “Run-Hide-Fight”: Expectations of an emergency department patient population during an active assailant event

Document Type

Conference Proceeding

Publication Date


Publication Title

West J Emerg Med


Objective: We sought to assess the opinions of a general emergency department (ED) patient-family population regarding healthcare providers' life-saving responsibilities during an active assailant event (the traditional “Run-Hide-Fight” paradigm [providercentric] vs the novel “Secure-Preserve-Fight” [vulnerable patient-centric]) paradigm. Design and Method: This institutional review board-approved study presented a scenario-based questionnaire to a convenience sample of ED patients and their retinues. Demographic information included prior military service, formal active-shooter training, and prior violent victimization. The randomly selected subjects evaluated four typical patient scenarios of varying severity within which an emergency physician/nurse was in immediate proximity. They were provided four responses addressing their expectations regarding the healthcare provider's actions: provider-centric (namely, Run-Hide-Fight), or patient-centric (that is, Secure-Preserve-Fight). The frequency of each response was the primary outcome. We employed a non-parametric binomial test as well as SPSS (IBM, Chicago, IL) Conclusion: For this particular ED population, a significant majority supported the patient-centric “Secure-Preserve-Fight” paradigm over the more provider-centric “Run-Hide-Fight” option. This lay public perspective should spur healthcare staff and administration to reconsider their current active shooter plans and possibly modify them to be consistent with “Secure-Preserve-Fight,” especially when dealing with the vulnerable patient.



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