With national politicians unlikely to address the issue, hospitals need to act on their own to mitigate the increasing threat of active-shooter incidents like a recent fatal gunning of a Boston cardiac surgeon, according to a commentary.

Eli Y. Adashi, MD, MS, of Brown University in Providence, RI, and colleagues wrote about the increase in hospital-based active-shooter incidents in a Viewpoint published online Feb. 26.

The U.S. Department of Homeland Security defines an active-shooter incident as one where a person actively engages in killing or attempting to kill people in a confined and populated area. According to FBI stats, the number of active-shooter incidents in hospitals increased from nine per year between 2000 and 2005 to 16.7 per year between 2006 and 2011, killing 161.

This year, Michael J. Davidson, MD, director of endovascular cardiac surgery at Brigham and Women’s Hospital in Boston, was killed on hospital premises Jan. 20.

“Rare as these events might be when considered in light of the enormity of the healthcare universe, they threaten the all-important sanctity of this benevolent and altruistic enterprise,” the authors wrote. “The political paralysis plaguing gun laws notwithstanding, hospitals are not without recourse in seeking to mitigate the threat of active-shooter incidents.”

Preventing a hospital-based active-shooter incident presents multiple problems, the authors wrote. For example, what elements of hospital access should be constrained when no single measure has proven to be a security cure-all?

The authors encouraged local advocacy to advance and enforce bills for gun-free zones in healthcare settings. While decisions on how to guard against possible shootings have to be based on local circumstances, hospitals should consider installing strategically positioned security cameras, an adequate numbers of accessible panic buttons, optional lighting, defined emergency escape routes and signs declaring the hospital a gun-free area.

More rigorous access control of entrance and exit points, authentication of visitors’ destination and delimitation of the path to the site of care might help as well. Security measures such as reliance on off-duty police officers or establishment of a hospital-based police department, deployment of handheld magnetometers and installment of walkthrough metal detectors also might be considered.

“These and related efforts must not be viewed as infallible in that a determined perpetrator is difficult to contain. Not until such time that greater attention is being paid to access to mental and behavioral health services, and to the human toll of widely available firearms, can hospital-based active-shooter incidents be expected to interrupt their apparent forward march,” the authors wrote.