Archive Staff & Patient Safety 2017

What Would You Do If Bullets Started to Fly?

Q&A with Lenworth M. Jacobs, MD, MPH, FACS, trauma surgeon and proponent of preparing for active shooter events.

Lenworth Jacobs

Lenworth Jacobs, MD, MPH, FACS


Lenworth M. Jacobs, MD, MPH, FACS

What inspired you to focus on
responses to mass casualty events?

I took part in dealing with the aftermath of the Sandy Hook Elementary School massacre. That was profoundly distressing, and the experience changed me forever. That's when I began working with the American College of Surgeons to develop ways to improve survival rates after mass shootings and other trauma events involving major bleeding.

How have the stakes been raised in recent years?
Active shooter events are happening more frequently, and the automatic weaponry is more alarming. Medical professionals have been putting themselves at risk for a long time. The dangers are different now — bullets, not just bacteria — but the philosophical issues are the same. What is your responsibility to the patients in your care? Should you protect them at the expense of your own well-being? What if you have a young family at home? When researching the impact of active shooter events and asking healthcare professionals about the topic, it became clear to me that they had not strongly considered the moral and ethical issues involved.

Is there a right way to react to active shooter events?
That's an intense and profound personal decision all healthcare providers face. I believe very strongly that you can't be thinking about what to do when the event happens. You must have a response plan in place, and put policies into effect that will allow for the best possible outcomes.

How can surgical professionals prepare for the unthinkable?
Nurse and physician leaders must have conversations about what they will do and what guidance they will give to the people who work for them. They must consider different scenarios, decide how they'll deal with each one and have plans in place that are based on serious deliberation among the entire care team.

What should those discussions involve?
You can't leave an unconscious patient in the OR unattended. Should you tell the nurses and circulators to stay, or should anesthesia providers and surgeons be the only ones charged with protecting patients? When you start asking those types of questions, you'll quickly realize it's a difficult situation to plan for. But you must drill down to those underlying issues during group discussions and active shooter drills. Never assume you'll figure things out on the fly during a real event, because there's no way you will when someone is blasting away with a gun. OSM

Dr. Jacobs ( is vice president of academic affairs, chief academic officer and director of the Trauma Institute at Hartford (Conn.) Hospital.

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