back to blog roll

In early May 2018, two women were shot outside of Mount Sinai Hospital (Chicago) while waiting for news on a relative who was shot earlier in the day.  In June 2017, a gunman shot one doctor and injured five other people at Bronx-Lebanon Hospital Center (New York). These unfortunate tragedies and other events over the past year, specifically “active shooter events” (ASE) or “acts of terrorism” have made us all aware of the need for vigilance and preparation.  As Safety Directors we develop and implement Emergency Procedures for fire, oxygen toxicity, communication failure etc… but what we do in an “ASE”? 

As the Safety Director of a hyperbaric facility, your role is to ensure that processes and systems are in place to proactively reduce risk and ultimately… the occurrence of catastrophic events.  The challenges of the Hyperbaric Director are well documented; those challenges are generally associated with “what can or can not go into the chamber”. 

Hospitals or healthcare facilities are unique work environments, as healthcare providers we have the professional obligation to care for and ensure the safety of our patients. The hospital or healthcare facility where you work should and likely does have a work-place violence policy and/ or an ASE plan. 

The intent of this safety discussion is NOT to insight fear or to provide policy elements,

but rather to encourage discussion of (possible) action steps necessary to protect those in our care.

It is important to recognize that the nature of shooting incidents

 in hospitals and health care environments is significantly different in many ways

and these differences should be reflected in all aspects of preparedness and response planning.

Researchers at Johns Hopkins “Hospital-Based Shootings in the United States: 2000-2011” [1] analyzed 154 hospital-related incidents involving 148 hospitals in 40 states.  From 2000 – 2005 an average of 9 incidents per year occurred.  From 2006-2011 the occurrence average increased to 16.7 incidents per year.  The total number injured or killed period reviewed was 235.  Other facts and findings that emerged:  

  • 59% the shooting incidents occurred inside the hospital
  • 41% outside of the hospital.
  • 29% of incidents occurred in the Emergency Department
  • 23% in parking lots
  • 19% in patient rooms.

The study also noted a close relationship between the shooter (94% of shooters were male) and his victim.

  • 32% of victims were current or estranged intimate relationships
  • 25% of victims were current or former patients
  • 5% of victims were current or former employees
  • 13% no obvious association between the shooter and victim could be identified.

As previously mentioned the intent of this safety topic is to initiate discussion that will hopefully result in the development of strategies that will be incorporated into policies and procedures in an ASE. 

Consider the following:

  • Does your program limit access to the hyperbaric suite?
  • What is the visitor policy for the hyperbaric and or wound care facility?
  • If an ASE occurred while patients are in the chamber… Would you ascend them?
  • If so, at what rate… 3 psi/minute, 5 psi/ minute perhaps emergent decompression?
  • If ascending the patient(s) in an ASE, do you have standing physician orders?
  • Who are the vital contacts or team members required to develop and implement the HBO specific ASE policies?

We have learned through our own individual experience and the recounted experiences and documented mishaps within hyperbaric facilities that being proactive in our preparation and actively practicing safety procedures is paramount to ensuring the safety of the staff and patients.


The WoundReference Hyberbaric Oxygen Therapy Knowledge Base features guidelines to promote high standards of patient care and operational safety within the hyperbaric program and other important tools. The WoundReference Curbside Consult gives you actionable, specific answers from our expert panel in a timely manner. 

For customized safety programs and other wound care and hyperbaric medicine consultation services, visit MidWest Hyperbaric

This government page describes what to do if you find yourself in an active shooting event, how to recognize signs of potential violence around you, and what to expect after an active shooting takes place. 


We thank Julie Rhee ScM, for style editing

About the Authors

With over four decades of healthcare experience, Jeff currently holds the position of Principal Partner at Midwest Hyperbaric LLC and the Co-founder and Chief Clinical Officer of Wound Reference. Jeff has excelled in critical care throughout his career, devoting almost a decade as a Flight Respiratory Therapist/Paramedic for the Spirit of Kansas City Life Flight. In 1993, Jeff transitioned into the field of Hyperbaric Medicine and Wound Care, where he committed 21 years of his career to serving as the Program Director for a 24/7 Level 1 UHMS Accredited facility with Distinction. In this role, he continued to provide patient care while overseeing all administrative, clinical, and daily operations within the Wound Care and Hyperbaric Facility. Jeff is a Registered Respiratory Therapist and a Certified Hyperbaric Technologist (CHT). He has also undergone training as a UHMS Safety Director and a UHMS Facility Accreditation Surveyor. Jeff currently serves as a member of the UHMS Accreditation Council, the UHMS Accreditation Forum Expert Panel, and the UHMS Safety Committee. Additionally, he is an esteemed member of the NFPA 99 Hyperbaric and Hypobaric Facilities Technical Standards Committee. Jeff's dedication to the field has earned him numerous prestigious awards. In 2010, he received the Gurnee Award, which honored his outstanding contributions to undersea and hyperbaric medicine. Three years later, in 2013, he was awarded the Paul C. Baker Award for his commitment to Hyperbaric Oxygen Safety Excellence. Most recently, in 2020, Jeff was honored with "The Associates Distinguished Service Award (UHMSADS)," a recognition reserved for exceptional Associate members of the Society who have demonstrated exceptional professionalism and contributions deserving of the highest accolades.
An Advanced Certified Hyperbaric Registered Nurse and Certified Wound Specialist with expertise in billing, coding and reimbursement specific to hyperbaric medicine and wound care services. UHMS Accreditation Surveyor and Safety Director. Principal partner of Midwest Hyperbaric LLC, a hyperbaric and wound consultative service. Tiffany received her primary and advanced hyperbaric training through National Baromedical Services in Columbia South Carolina. In 2021, Tiffany received the UHMS Associate Distinguished Service Award. "This award is presented to individual Associate member of the Society whose professional activities and standing are deemed to be exceptional and deserving of the highest recognition we can bestow upon them . . . who have demonstrated devotion and significant time and effort to the administrative, clinical, mechanical, physiological, safety, technical practice, and/or advancement of the hyperbaric community while achieving the highest level of expertise in their respective field. . . demonstrating the professionalism and ethical standards embodied in this recognition and in the UHMS mission.”
Explore our Wound Care and Hyperbaric Solutions