By Susie Weeks, RN, CPHRM, CPHQ

Active shooter incidents in healthcare settings are becoming more prevalent with several incidents reported within the last few weeks. These terrifying events are unpredictable, evolve quickly and present unique challenges in various healthcare settings nationwide. The Joint Commission (TJC), reports that 39 accredited organizations experienced shootings that resulted in 39 deaths from the timeframe of 2010-2020. Because active shooter situations many times do not last long, and may end before law enforcement arrives, it is beneficial for healthcare organizations to prepare for the active shooter situation.1

The implementation and use of plain language codes is designed to reduce code confusion, with the purpose of effectively communicating emergency situations quickly, clearly and to mobilize assistance and resources immediately. The concept of plain language codes in the healthcare setting is based on United States Department of Homeland Security recommendations and is founded on Incident Command System principles. Nationally TJC urges standardizing emergency codes and adopting plain language, a recommendation supported by numerous private and governmental agencies such as the U.S. Department of Health and Human Services, the American Hospital Association and numerous state hospital associations.

Plain language is communication that everyone can understand the first time they see or hear it. When applied to the healthcare setting, plain language communicates important information in a manner that all listeners easily understand. Uniformity in emergency alerts enables the healthcare team to mobilize and respond appropriately to an emergency, which enhances the safety of patients, visitors, and employees. We know from experience that in crises, seconds count!

Plain language alerts provide transparency and can be clearly understood without further explanation. Those hearing or seeing the alert know immediately what actions are required based on the information received. The use of plain language increases the efficiency of responses by eliminating the need for further interpretation. From the risk management perspective, there are several additional perceived advantages:
  • Improved compliance.
  • Reduced enforcement cost.
  • Decreased likelihood of legal challenges.
  • Decreased waste of time.
  • Reduced costs for the public.2
Consider the following when developing a plain language emergency alert system:

1. Develop three types of alerts:
  • Facility Alert – Provides for the safety and security of patients, employees and visitors, including the management of essential utilities and the impact of weather events.
  • Security Alert – Protects patients, employees and visitors from any situation or person posing a threat to the safety of any individual within the facility.
  • Medical Alert - Provides medical care and support to patients and incident victims while maintaining care and safety of patients, employees, and visitors within a healthcare facility during an incident.
2. Define the following key sections for each type of alert identified above:
  • Event – Identifies the type of emergency or situation such as fire, active shooter or missing person.
  • Location – Identifies the area responders should report to, or where others should stay away from.
  • Directions – May be added when indicated, and at the discretion of your organization. For instance, in an active shooter alert notification you may want to add the direction to evacuate a specific floor or location, or to shelter in place.

3. As every organization is different because of size, location, patient population, etc. emergency response planning, communication and simulation training is essential. Some key considerations for extensive planning include:
  • Require active participation by your healthcare organization’s senior leaders and emergency response team.
  • Consider involving local law enforcement and/or fire department in your planning to familiarize them with your facility design, policy, procedures and communication strategies.
  • Assess and prepare your building as needed should there be the need to secure a location, limit access to a location or do a facility wide lockdown.
  • Conduct simulation trainings for each type of alert. Include local law enforcement/fire rescue when appropriate.

During this time, when violence in healthcare settings is on the rise and as healthcare organizations embrace enterprise risk management, implementing a plain language alert system is certainly one way to promote safety and reduce harm.


1. The Joint Commission. Quick Safety Issue 4: Preparing for active shooter situations. (Updated June 2021).

2. Selecting an Approach to Overhead Emergency Communications; ECRI; 1/20/2021


Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.