Run, hide, secure, preserve, or fight? Unpacking our Ethical Obligations during an Active Shooter Incident

In clinical ethics, we avoid making decisions at the bedside when not about the patient in front of us. However, when a “Code Silver” is announced in a hospital, we are forced to make a quick bedside and ethically laden decision. As active shooter incidents (ASI) continue to be a concern in our lives in the United States, the industry standard trains clinicians to Run, Hide, or Fight®. This recommendation and training aim to protect clinicians and others and bring unique challenges to the ethical obligations of the bedside clinician and the patients they serve. When patients are unable to be evacuated and require intensive clinical care and monitoring, bedside clinicians, often nurses, worry about abandonment if they run. This paper reviews the ethical literature and requests to shift from Run, Hide, Fight® to Secure, Preserve, Fight. It remains challenging to provide a standard response, yet preparation for such events is needed. Clinicians need to understand the obligations of discernment - in the moment, with the information known - between competing obligations of their duty to self and their duty to others.

Laura Webster, DBe RN HEC-C CEN – VP of Ethics, CommonSpirit