Most people in the U.S. are painfully aware of the disturbing increase in school shootings over the past several years, but the fatal shooting of a Boston surgeon in January is a sad reminder that hospitals are not exempt from this horrific trend.

Research outlined in a new JAMA article indicates that hospital shootings are becoming increasingly prevalent. These "active shooter incidents" have gone from nine per year from 2000 to 2005, to an average of 16.7 per year from 2006 to 2011.

DOTmed News reached out to Gail Normandin-Carpio, an independent risk management consultant for Omnisure Consulting Group, to explore the strategies a hospital can use to minimize their vulnerability to these threats. Normandin-Carpio is a registered nurse specializing mental health and corrections, and also a former law enforcement officer.

Omnisure experts recommend that all health care facilities have a Disaster Preparedness and Emergency Operation Plan that includes active shooter incidents. They describe five steps that can be taken to limit the likelihood of an incident, and also mitigate the damage if an incident occurs.

Prevention

A hospital should bring in a qualified professional to conduct a Security Risk Assessment. Unique considerations must be made for individual facilities, such as whether or not mental and behavioral services are provided, as well as socio-economic factors.

"Part of the assessment is determining how well staff respect and adhere to the security measures already taken, be it locked access, wearing of IDs, and following protocols" said Normandin-Carpio. Individuals who do not follow these protocols could be inviting dangerous situations without realizing it, she said.

Protection

Metal detectors, signs prohibiting firearms, and security cameras are all helpful, but having a well-trained staff that doesn't become complacent is the most crucial safeguard.

"Hospitals with proactive programs incorporate the resources of community-based police departments and emergency response teams who have exceptional skills and response training," said Normandin-Carpio.

Mitigation

If a situation is brewing, employees must be trained to sooth tensions and defuse tempers. Normandin-Carpio points to guidelines outlined on the Crisis Prevention Institute (CPI) website that emphasize detecting anxiety in others and being mindful of personal space.

Response

Hospital employees need to act on a three-part plan: run, hide, fight. The FBI Critical Incident Response Group offers a training video that outlines these options. Whenever possible, escaping is the best thing to do during an active shooter incident. Then call the police.

If escape is not an option, then employees should be trained to hide in a secure area. Ideally locking a door, turning off the lights, and disabling the ringers on their cellphones.

Fighting should be resorted to only as a last resort and if one's own life is in danger. The FBI recommends improvising weapons out of everyday items like chairs or fire extinguishers.

Recovery

Health care facilities need a crisis communications plan that includes staff, patients, visitors, law enforcement agencies, and the media. Michelle Earle Foster, the president of Omnisure said, "After an incident, it's critical to have a plan for those affected. Not just immediate emergency medical care but ongoing support and counseling as well."

Without doing everything in their power to implement a security plan, provide employee training, and take appropriate actions to prevent, protect, and response to a shooter, health care facilities could find themselves legally liable for negligence.

No one ever thinks these kinds of tragedies will happen to them, and it's easy to become complacent, advised the experts.

According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI), the labor industry experienced 475 homicides in the work place in 2012 and 381 occurred from being shot intentionally by another person. Homicide is also the leading cause of death for women in the workplace.