Two recent attacks in Canada illustrate anew how vulnerable hospital staff and emergency departments are. Active-shooter protocols must be in place everywhere.

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In the past few weeks, there have been two shootings in Canadian hospitals, marking the intersection of two major concerns for Canada’s emergency physicians: the prevalent and rising tide of violence in our emergency departments and the failure of the Canadian government to adequately address the ability of disturbed individuals to inappropriately obtain and use a firearm.

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Both shootings highlight the failure of hospitals or regional health authorities to provide a safe environment for medical staff and patients and to pre-emptively prevent horrific acts of violence.

To be perfectly blunt, hospitals are no longer safe sanctuaries of healing, and with the current and historic laxity towards hospital security in most hospitals in Canada, anybody could walk in with a loaded gun and perform acts of unimaginable savagery.

In the Thomson, Man. incident on Christmas Eve, a man pointed a rifle at staff and shot out a window in the hospital’s chapel. Media reports have suggested that nurses in the region have been calling for an active-shooter protocol for some time but one has yet to be implemented.

The London, Ont. shooting took place in mid-December and involved multiple gunshots through the ER doors at Victoria Hospital. After the incident, the administration considered installing metal detectors.

These two cases highlight the after-the-fact approach to hospital violence in general, and gun violence in particular.

Sadly, hospital shootings, though uncommon, are not unheard of in Canada. Here are some media headlines from the recent past:

“One man shot dead by police in Hope hospital emergency room” — Vancouver Sun, June 28, 2023.

“Shots fired inside Kingston, Ont., emergency room” — CBC News November 19, 2018.

“Police shootout in Ontario hospital (Cobourg) leaves elderly man dead after wife shot in head” — National Post, October 28, 2017.

There have been at least 14 hospital and clinic shootings in Canada between 2003 and 2018. Violence is sadly pervasive in the Canadian emergency department and hospital shootings represent the tragic apex of that violence.

Health-care providers have an estimated fourfold-higher rate of workplace violence than other professions, and fully half of such attacks occur in the emergency department. Disturbingly, the level of ED violence can reasonably be expected to continue to increase in the future due to the changing nature of the population in emergency departments and the prevalence of guns in Canada.

For decades, Canada’s emergency physicians have called attention to our concern about rising gun violence and in particular the ability of disturbed individuals to inappropriately obtain firearms. Canada’s proposed Red Flag laws — under which anyone can apply to a court to temporarily remove a firearm from a person who may pose a risk — fails to address this issue completely by refusing to acknowledge the value of medical reporting of individuals at risk.

These two most recent shootings should be a wake-up call for all hospital administrations, regional health authorities and governments. It is finally time to get serious about violence against health-care workers and act swiftly to prevent any further such incidents.

Canada’s emergency physicians have called for a zero tolerance policy for any hospital administration that fails to proactively consider the absolute safety of its emergency physicians, nurses, paramedics and indeed patients.

Locally, hospital administrations must provide a respectful and collaborative environment in which the threat of violence is meaningfully addressed through the provision of safe and secure hospital environments, and active-shooter protocols are incorporated and practised.

The prevention of violence against hospital staff must become a priority, uniform across all hospitals and with mandated active-shooter protocols, in which staff are taught the best ways to protect themselves and their patients. Ontario did it in 2016; others should follow suit.

Nationally, the government should encourage a best-practices approach, in conjunction with security experts, to build a national consensus on how best to protect hospitals, their staff and their patients, including active-shooter protocols.

But more importantly, the federal government needs to rework its flawed Red Flag Law to allow for early identification and reporting of medically at-risk individuals from inappropriately gaining access to a firearm.

Alan Drummond, MD, is Emeritus Chair of the Canadian Association of Emergency Physicians Public Affairs Committee.

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