While shootings in U.S. hospitals typically generate widespread media publicity, the likelihood of being shot in a hospital is less than the chance of getting struck by lightning, according to Johns Hopkins research.

In a report published Sept. 18 in the Annals of Emergency Medicine, and conducted by four researchers at the Johns Hopkins University School of Medicine in Baltimore, the investigators reviewed 11-years of data and identified some disturbing flashpoints.

Workplace violence in the hospital: A typical scenario

For one, almost 30 percent of U.S. hospital-based shootings occurred in emergency departments (EDs). And 50 percent of the ED incidents involved a police or security officer’s firearm – which was either stolen to shoot victims or used by security to fire at an assailant.

Gabe Kelen, M.D., the lead author of the report, and the director of the Johns Hopkins Department of Emergency Medicine, said an in-depth review of the 154 hospital-based shootings, which resulted in 235 dead or injured, found that such shootings are difficult to prevent because most involved a “determined shooter.”

What motivates a hospital shooter?

Another key finding, Kelen said, was that most perpetrators had a personal association with victims.

“Most of the events involved a determined shooter with a specific target,” Kelen and the other authors write in the study.

Common motives for shootings, the study found: grudge or revenge; suicide; and euthanizing an ill relative.

The latter motives all appeared to be the case in the Sept.16, 2010, shooting at The Johns Hopkins Hospital in Baltimore, in which an assailant shot a doctor, and then killed his ill mother and himself. That incident was the impetus for this study and an earlier commentary by the authors, published in the Journal of the American Medical Association in 2010.

Training can help

The Hopkins research team concludes that specialized training for law enforcement and security personnel, such as proper securing of firearms, may prove a more effective deterrent to future incidents than investment in expensive or intrusive technologies, such as magnetometers.

Such technologies may create a false sense of security, primarily because potential weapons get into hospitals by a variety of channels, and because more than 40 percent of all the shootings studied occurred on hospital property outside of buildings, the authors note. Many security experts, the authors add, view metal detectors and the like as impractical solutions in hospital settings. Hospitals typically have multiple public entrances and large numbers of visitors each day.

Zero risk "not achievable"

Kelen said that although the study found shootings at hospitals to be infrequent, no hospital is immune.

Zero risk “is not achievable,” the authors write.

The findings in the study were developed analyzing reports of shootings at acute care hospitals in the U.S. between 2000 and 2011, using LexisNexis, PubMed, ScienceDirect, Google and AOL’s Netscape.

Other authors on the study include Christina Catlett, M.D., an emergency physician at Johns Hopkins Hospital and an assistant professor; Joshua Kubit, M.D., an emergency doctor at Johns Hopkins Hospital; and Yu-Hsiang Hsieh, Ph.D., an assistant professor in the Department of Emergency Medicine.