Mass Violence / en Sat, 21 Jun 2025 18:50:53 -0500 Mon, 02 Jun 25 00:00:01 -0500 New AHA Report Finds Workplace and Community Violence Cost Hospitals More than $18 Billion Annually /press-releases/2025-06-02-new-aha-report-finds-workplace-and-community-violence-cost-hospitals-more-18-billion-annually <p><strong>WASHINGTON</strong> (June 2, 2025) 鈥� The 黑料正能量 Association (AHA) today released a new, comprehensive <a href="/costsofviolence">report</a> that measures the substantial financial resources hospitals and health systems spend on preventing and responding to violence in their facilities and communities. The report was prepared for the AHA by Harborview Injury and Prevention Research Center (HIPRC), part of the University of Washington School of Medicine. It analyzed the financial costs and broader impacts of violence and threatening behavior and found that the total financial cost of violence to hospitals in 2023 was estimated at $18.27 billion. These costs include health care treatment for victims, security staffing for health care facilities and violence prevention programs/ training, among other costs.</p><p>"It is an unacceptable reality that those who dedicate their lives to healing should face the threat of violence,鈥� said AHA President and CEO Rick Pollack, 鈥淲e know the enormous human and emotional toll violence takes on our communities and caregivers. This report goes beyond that to break down the significant related financial costs incurred upon hospitals and health systems. With the increase in violent events within clinical settings across the country, the resources needed to protect hospital workers and care for victims have grown exponentially. Every member of the health care team bears an enormous risk and burden of this violence. This report is yet another reminder we must do more to protect them.鈥�</p><p>To help provide additional protections for hospital workers, the AHA strongly supports the Save Healthcare Workers Act (<a href="https://www.congress.gov/bill/119th-congress/house-bill/3178" target="_blank" title="Congress.gov: H.R.3178 - Save Healthcare Workers Act">H.R. 3178</a>/<a href="https://www.congress.gov/bill/119th-congress/senate-bill/1600" target="_blank" title="Congress.gov: S.1600 - Save Healthcare Workers Act">S.1600</a>). Introduced last month, this bipartisan legislation would make it a federal crime to assault a hospital worker on the job.</p><p>Researchers derived the cost estimates from both pre-event violence prevention measures and post-event costs for health care and addressing the consequences of violence both in the community and in the hospital setting. Key findings from the <a href="/costsofviolence">report</a> include:</p><ul><li>Post-event costs including health care costs to treat victims, infrastructure repairs and staff productivity losses were estimated at <strong>$14.65 billion</strong>.</li><li>Pre-event efforts to prevent or protect hospital workers from violent events including violence prevention programs, training, technology and facility security investments accounted for an estimated <strong>$3.62 billion</strong>.</li><li>The total annual financial cost of violence to hospitals in 2023 is estimated at <strong>$18.27 billion</strong> ($14.65 billion post-event + $3.62 billion pre-event).</li></ul><p>Not included in the total annual financial cost of violence but highlighted in the report are the cascading effects of violence on workers and communities. These effects include psychological harm to those who experience or witness violence, challenges in staff recruitment and retention, and reduced job satisfaction. In 2022, an estimated 16,990 workers in hospitals had a violence-related nonfatal occupational injury or illness that required days away from work. Another study estimated 8,740 hospital workers had days of required restricted work activity or job transfer due to violence-related occupational injury or illness.</p><p>###</p><h2>About the 黑料正能量 Association (AHA)</h2><p>The 黑料正能量 Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA advocates on behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners 鈥� including more than 270,000 affiliated physicians, 2 million nurses and other caregivers 鈥� and the 43,000 health care leaders who belong to our professional membership groups. Founded in 1898, the AHA provides insight and education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at <a href="/">www.aha.org</a>.</p> Mon, 02 Jun 2025 00:00:01 -0500 Mass Violence The Burden of Violence to U.S. Hospitals /costsofviolence <div class="container"><div class="row"><div class="col-md-8"><div class="panel"><h3 id="findings"><span><span>KEY FINDINGS:</span></span></h3><ul><li>Violence, including workplace (in-facility) and community violence, abuse, and threatening behavior, is a significant public health issue affecting the U.S. health system and communities.</li><li>This incidence of violence has significantly increased in the U.S. over the past decade, with rising rates of assault, homicide, suicide, and firearm violence, which were further exacerbated during the COVID-19 pandemic.</li><li>This study sought to estimate the financial costs and other impacts associated with workplace and community violence.</li><li>Hospitals experience substantial financial impacts from violence.<ul><li>The total annual financial cost of violence to hospitals in 2023 is estimated at $18.27 billion U.S. dollars (USD).</li><li>Pre-event costs associated with violence in the community and within facilities are estimated at $3.62 billion (USD), primarily for prevention measures.</li><li>Post-event costs for health care, work loss costs, case management, staffing, and infrastructure repair are estimated at $14.65 billion (USD).</li><li>The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</li></ul></li><li>Additional impacts, like public perception, staff recruitment and retention, legal concerns, job satisfaction, and psychological harm to health care workers, are significant but difficult to quantify due to limited data</li></ul></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h2 id="summary"><span><small class="sm">EXECUTIVE SUMMARY</small></span></h2><p>Violence is a major public health problem impacting our health system and communities.<sup>1</sup> Over the past ten years, rates of violence have increased in the United States (U.S.), including rates of assault, homicide, suicide, and firearm violence.<sup>2鈥�5</sup> Further, violence increased during the COVID19 pandemic including rates of intimate partner violence, suicide, firearm violence, and workplace violence towards health care workers, and have not yet returned to pre-pandemic levels.<sup>6鈥�10</sup> Violence directly impacts hospitals via millions of emergency department visits and hospitalizations for fatal and nonfatal violence-related injuries each year.<sup>4,11</sup> In addition, the impact of workplace and community violence is seen within the broader health care system leading to staff turnover, absenteeism, loss of productivity, high insurance and workers鈥� compensation costs, and an increased risk of depression, post-traumatic stress disorder, and suicide.<sup>12鈥�15</sup> The 黑料正能量 Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals from all types of violence, abuse, and threatening behavior within their facilities and communities. <strong>Through comprehensively characterizing the impacts of violence on hospitals, this report highlights the magnitude of violence as a public health problem and informs future policy and research efforts to address violence impacting U.S. hospitals and the health care system.</strong></p><p>We used mixed methods that incorporated multiple data sources, including existing federal and state data sources, published literature, and primary data to quantify the impacts of violence on hospitals. Our estimates were guided by an analytic framework developed by the study team, experts in the field, and published literature. The framework incorporates financial costs and other impacts of violence, broken down by pre- and post-event costs. Beyond pre- and postevent costs, we analyzed financial cost estimates by violence type and examined other impacts resulting from violence, including staff satisfaction and productivity, staff retention and recruitment, psychological impacts, and legal and ethical concerns.</p><p><strong>Overall, we estimate the total annual financial cost of violence to hospitals in 2023 to be $18.27 billion (U.S. dollars, USD). This estimate includes pre- and post-event cost components.</strong> Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, legal costs, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>There are additional impacts of violence to hospitals that cannot be quantified at this time due to limited data availability. These far-reaching consequences include the impact of workplace violence on public perception, staff recruitment and retention, legal concerns impacting hospitals, job satisfaction for health care workers, and the psychological impacts on health care workers who experience or observe violence. These interconnected effects underscore the complex and pervasive nature of violence beyond immediately measurable costs to hospitals.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="intro"><span>1. INTRODUCTION</span></h3><h4 id="1.1"><span>1.1 BACKGROUND AND RATIONALE</span></h4><p>Violence is a major public health problem impacting health systems in the United States (U.S.).<sup>1</sup> In the past ten years, there has been an increase in the incidence of assault, homicide, suicide, and firearm violence in the U.S.<sup>2鈥�5</sup> Communities are highly impacted by violence, particularly in highpoverty and under-resourced neighborhoods.<sup>16鈥�18</sup> Additionally, the COVID-19 pandemic declared in March 2020 had direct impacts on increasing rates of intimate partner violence (IPV), suicide, firearm violence, and workplace violence (WPV) against health care workers.<sup>6鈥�10</sup> In 2022, there were 2,105,245 nonfatal and 73,989 fatal violence-related injuries that occurred in the U.S.<sup>11,19,20</sup> Violence also occurs in hospitals, where health care workers experience significant rates of violence from patients and visitors.<sup>12,13</sup> This leads to staff turnover, absenteeism, loss of productivity, high costs in disability and indemnity, and an increased risk of depression, posttraumatic stress disorder, and suicide.<sup>14,15</sup></p><p>The 黑料正能量 Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals of all types of violence, abuse, and threatening behavior within their facilities and communities. The Human Subjects Review Committee at the UW Institutional Review Board approved this study (STUDY00019266; STUDY00019881). The goal of this report was to rigorously characterize and quantify the financial costs and other impacts of workplace and community violence to hospitals and their health systems, thus producing valuable information regarding the current impact of violence as a public health problem to inform policy and future research. We used mixed methods that incorporated multiple data sources to inform this report.</p><p>This report:</p><ul><li>Estimates the financial impact of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies other impacts of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies policy and research implications for addressing the impacts identified in the report.</li></ul><h4 id="1.2"><span>1.2 ANALYTIC FRAMEWORK AND METHODS</span></h4><p>For a more comprehensive review of the financial and other costs of violence, we used the World Health Organization鈥檚 definition of violence: 鈥渋ntentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.鈥� <sup>21</sup> Figure 1 below illustrates the analytic framework used to estimate the cost of violence to U.S. hospitals and health systems. This framework was developed by the study team and was guided by input from experts in the field and by review of current literature. The framework illustrates financial and other components used to derive our cost estimates, broken down by pre- and post-event costs. As illustrated in the framework, several components encompass both financial and other costs (i.e., Infrastructure and Equipment), and pre- and post-event costs (i.e., Staff Retention and Recruitment).</p><p>Mixed methods were used to estimate the financial costs and other impacts of violence to U.S. hospitals. We conducted a scoping review of the literature to ensure we captured a comprehensive overview of existing research, knowledge, and data related to the financial and other impacts of violence to U.S. hospitals. We included articles in our review that were published after 2016, focused on the U.S. health system, and published in English. Peer-reviewed studies and government reports were prioritized. Identified studies and extracted data were managed in Covidence online systematic review software. This review informed estimates reported here of the financial and other costs of violence and gaps in knowledge about cost components meriting future research.</p><p>We further used a socioecological framework to guide rigorous synthesis of existing literature, synthesis of recent national data describing direct and indirect costs in a diverse sample of care settings and health care workers (HCW), and in primary data collection to increase understanding of the true violence-related financial and operational pressures facing U.S. hospitals and their employees and patients.<sup>22</sup> The scope of this report focuses on hospitals and their related health systems, heretofore referred to as 鈥渉ospitals鈥� unless otherwise indicated.</p><div> <div data-entity-type="media" data-entity-uuid="16389403-c8be-4030-963e-138a97e08a4e" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-1-analytic-framework-for-estimating-burden-violence.png" width="729" height="415" alt="Burden of Violence Figure 1: Analytic Framework for Estimating the Burden of Violence to U.S. Hospitals & Health Systems"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="financialcost"><span>2. FINANCIAL COST OF VIOLENCE</span></h3><p>Violence is a major public health problem in the U.S. As hospitals are directly impacted by workplace and community violence, understanding the financial costs to U.S. hospitals associated with violence is essential to guide cost-effective prevention efforts and to educate administrators, policymakers, and the public about the importance of prevention. Successful prevention relies on a comprehensive understanding of the many sides of a problem and designs complementary interventions from many angles; we have similarly structured our analysis of the financial cost of violence to hospitals to enable a comprehensive understanding of the many areas in which violence results in a financial cost, and the estimated magnitude of those costs. Although hospitals cannot address all workplace and community violence in the U.S., they are in a position to potentially have a significant impact on violence prevention in their facilities and surrounding communities.</p><table><caption><strong>Table 1. Estimated 2023 Annual Cost of Violence to U.S. Hospitals & Health Systems by Cost Category.</strong></caption><tbody><tr><td rowspan="2"><strong>Cost Category</strong></td><td rowspan="2"><p class="text-align-center"><strong>In millions of USD</strong></p></td><td colspan="2"><p class="text-align-center"><strong>Location of Violence</strong></p></td></tr><tr><td><p class="text-align-center"><strong>Community</strong></p></td><td><p class="text-align-center"><strong>Workplace</strong></p></td></tr><tr><td><span><strong>Pre-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>3,620.5</strong></span></p></td><td> </td><td> </td></tr><tr><td>Training costs</td><td><p class="text-align-right">1,403.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Security personnel and staffing</td><td><p class="text-align-right">404.3</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Violence prevention programs*</td><td><p class="text-align-right">959.2</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Policy and procedure development</td><td><p class="text-align-right">8.6</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Outreach to build public trust</td><td><p class="text-align-right">79.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Facility modification to prevent and mitigate harms</td><td><p class="text-align-right">306.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Investments in technology to monitor possible events</td><td><p class="text-align-right">459.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td><span><strong>Post-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>14,648.8</strong></span></p></td><td> </td><td> </td></tr><tr><td>Health care costs for fatal and nonfatal injuries</td><td>13,165.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Work loss costs for workers in the health care setting</td><td>79.0</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Case management</td><td>252.5</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Staffing</td><td>541.3</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Replacement & repair of damaged infrastructure & equipment</td><td>584.8</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Community interface and public relations</td><td>25.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td colspan="4"><small class="sm">Note: Values may not sum to totals due to rounding. </small><br><small class="sm">*Relates to expenses other than training</small></td></tr></tbody></table><p> </p><p>Overall, we estimated the total financial cost of violence to hospitals to be $18.27 billion (U.S. Dollars, USD) (Table 1, Figure 2). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p> </p><div> <div data-entity-type="media" data-entity-uuid="71a3be84-13ba-4e0b-94aa-6a22eb335a21" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" class="align-center embedded-entity" data-langcode="en" data-entity-embed-display-settings="[]"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-2-percentage-breakdown-estimated-2023-violence-costs.png" width="752" height="512" alt="Burden of Violence Figure 2: Percentage Breakdown of Estimated 2023 Vilence Costs to U.S. Hospitals & Health Systems (by Pre- & Post-Event and Component Costs)"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="pre-event"><span>3. PRE-EVENT FINANCIAL COSTS</span></h3><h4 id="3.1"><span>3.1 TRAINING COSTS</span></h4><p>Preparation for violent events in the health care setting requires training of workers at each clinical location. The estimated costs associated with this pre-event violence-prevention training are summarized below. Training-related costs were divided into six categories of component costs corresponding to distinct types of training occurring within hospitals and health care facilities. Together, we estimated training costs at $1.4 billion annually, with most of the cost stemming from training staff on de-escalation, emergency preparedness, and institution-specific violence-related policies and procedures (Table 2). Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�35</sup></p><table><caption><strong>Table 2. Estimated 2023 Annual Cost of Trainings within U.S. Hospitals & Health Systems in Preparation of Violence or a Violent Event.</strong></caption><tbody><tr><td><strong>Cost Category</strong></td><td><strong>In millions of USD</strong></td></tr><tr><td>Total training costs</td><td><p class="text-align-right">1,403.7</p></td></tr><tr><td>Active shooter training</td><td><p class="text-align-right">61.7</p></td></tr><tr><td>Training to respond to lateral violence</td><td><p class="text-align-right">148.0</p></td></tr><tr><td>Training in emergency and medical surge preparedness</td><td><p class="text-align-right">369.5</p></td></tr><tr><td>Training in de-escalation in hospitals</td><td><p class="text-align-right">377.4</p></td></tr><tr><td>Training on violence-related policies and procedures in the hospital</td><td><p class="text-align-right">261.9</p></td></tr><tr><td>Training for providers to identify violence-related trauma</td><td><p class="text-align-right">185.2</p></td></tr></tbody></table><p> </p><p><span><strong>3.1.1 Active Shooter Training.</strong></span> Hospitals are not immune from experiencing WPV, including active shooter events. A study identified 88 hospital shootings in the U.S. from 2012 to 2016 noting emergency departments were the most common site (30%), followed by patient rooms (21%) and parking lots (15%). <sup>36,37</sup> Additional studies described perpetrators as those with a personal grudge against their victims and of 235 victims, at least 60-80% were bystanders to the violent event, 13% patients, 5% nursing staff, and 3% physicians. <sup>36,38,39</sup> Since most events transpire within 15 minutes, before law enforcement can arrive, the Joint Commission urges hospitals to prepare staff, particularly recommending the development of a communication plan, establishing processes and procedures to ensure patient and employee safety, training and drilling employees, and planning for post-event activities (e.g., establishing debriefing procedures). <sup>40,41</sup> Hospital training sessions often recommend the 鈥淩un-Hide-Fight鈥� strategy and deliver other educational content through annual online modules or computer-based simulations.<sup>42,43</sup> To estimate the cost of providing active shooter trainings in U.S. hospitals, we assumed that across all hospital employees, trainings employ a dual learning approach (online virtual e-learning as well as in-person sessions with trained instructors).<sup>44</sup> We identified estimates from 2018 that indicate costs of blended types of training were approximately $32,100 (educational setting).<sup>45</sup> In the absence of formal cost estimates for this type of training, we estimated that costs for this type of training vary by hospital size, wherein larger hospitals have higher costs due to having more staff. Assuming a starting annual cost of $6,000 for the smallest hospitals (6-24 beds) and increasing costs incrementally by 20% according to hospital bed size (8 tiers) to $21,499 for the largest hospitals, we estimated that all U.S. hospitals (N=6,120) pay approximately $61.7 million<a title="* $61,743,166">*</a> annually for active shooter training, independent of other trainings described in this report. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�29</sup></p><p><span><strong>3.1.2 Training to Respond to Lateral Workplace Violence.</strong></span> Stressors that arise in the hospital workplace, combined with hierarchy and behavioral norms, can create environments that enable lateral violence. Lateral violence is a type of workplace violence, defined as workplace conflict arising from interpersonal relations between employees. In the U.S., up to 76% of health care workers have reported experiencing violence, with over 80% experiencing verbal violence and 33% experiencing physical violence.<sup>46</sup> Unfortunately, some of this violence is lateral violence arising from employees perpetrating abuse towards their colleagues via repeated behaviors of physical, psychological, or sexual abuse.<sup>47</sup> There are a multitude of interventions available to decrease the prevalence of workplace incivility, lateral violence, and abuse and bullying.<sup>48</sup></p><p>The Joint Commission Standard HR.01.05.03 requires that leadership, staff, and licensed practitioners participate in ongoing education and training in WPV; however, the content for each audience is determined by the hospital.<sup>49</sup> Additionally, individual states鈥� requirements for sexual harassment training (one component of lateral/workplace violence) vary considerably.<sup>50,51</sup> The length of training session and requirements can also vary by occupation.<sup>52,53</sup> To account for this variation across hospitals, occupations, state requirements, and content, we assume that 60% of the hospital workforce engage in some sort of lateral violence prevention training annually. In the absence of data on duration of training across professions or occupations, we estimated that annual training lasts an average of one hour across all hospital occupations, an estimate that also accounts for the fact that this training may be bundled with other employee training (e.g., training on policies and procedures related to violence). To estimate the cost of training, we utilized workforce and wage data for occupations employed in hospitals (NAICS Sector 62-2000)<sup>54</sup> (see Appendix).</p><p>Per these assumptions, we calculated costs as follows: 鈭�<em><sup>21</sup><sub>i=1</sub></em> 饾惛饾憱 x 饾憡饾憱 x 饾憞饾憱  , wherein i is the index representing each type of occupation group (Appendix Table 1), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the ith occupation, Pi is the percentage of institutions with lateral violence training annually (60%), and T is the time spent per year in training for the i th occupation (1 hr). Based on this approach, we estimated that training on WPV prevention (lateral violence) costs hospitals $148.0 million<a href="#" title="* $148,035,403">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�29</sup></p><p><span><strong>3.1.3 Training in Emergency and Medical Surge Preparedness.</strong></span> Medical surge preparedness describes the ability of health care systems to manage a sudden influx of patients following unplanned, large-impact events, such as mass casualty incidents, natural disasters, or a pandemic. While not all these events may involve violence, training in medical surge preparedness is also necessary to respond to large-scale events that do involve violence (e.g., mass shootings, bombings). Estimating costs of training personnel in preparing for medical surges (or for emergency preparedness in general) vary widely across the literature.<sup>55</sup> To estimate the costs of medical surge preparedness for U.S. hospitals, we estimated the average duration of the training as two hours per health care staff member per year, and two hours per protective services staff member per year. This estimate of duration is based on Department of Homeland Security Center for Domestic Preparedness Medical Surge Management course.<sup>56</sup> We recognize the duration of training may vary by occupation. For cost estimations, we assumed a training session would take staff away from regular duties for those hours. The patient-facing hospital workforce was defined as health care practitioners and technical occupations (Standard Occupational Classification [SOC] 29-0000) and health care support occupations employed in hospitals (SOC 31-0000) (Appendix Table 1).<sup>54</sup> The protective services workforce (SOC 33-0000), including security guards, was also included in this calculation. Assuming 2 hours of annual training for the occupations above, we estimated that hospitals spend a total of $369.5 million<a href="#" title="* $369,543,838">*</a> on medical surge preparedness training each year. The cost of preparing and offering the training internally was not incorporated into this estimate; therefore, we believe this is likely a conservative estimate of the total (true) costs for this training. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�29</sup></p><p><span><strong>3.1.4 Training in De-Escalation.</strong></span> De-escalation skills help mitigate the deleterious impacts of conflicts within the health care setting. De-escalation training is particularly common in the hospital setting and is listed as a requirement by the Joint Commission (HR.01.05.03).<sup>49</sup> To calculate the national costs of de-escalation training for the patient-facing hospital workforce, the duration of training was estimated at an average of two hours per health care staff member per year and eight hours per protective services staff member per year.<sup>57鈥�59</sup> We recognize that the extent of annual training likely varies by clinical specialty and location. For cost estimations, we assumed a training session would take staff away from regular duties for the training time. The actual cost of the training was not incorporated because costs vary widely and many training sessions may be developed and offered internally by health care institutions for little/no cost; our estimate is likely conservative as some hospitals may engage outside agencies to provide this training for an additional cost. See Appendix Table 1 for details on patient-facing and protective services workforce in hospitals (SOC codes 29-0000, 31-0000, and 33-0000). Assuming two hours of annual de-escalation training for patient-facing occupations and eight hours of annual training for protective personnel, we estimated hospitals spend a total of $377.4 million<a href="#" title="鈥� $377,362,634 ">鈥�</a> on deescalation training each year. Activities in this section fall under Joint Commission Standard HR.01.05.03 EP 29.<sup>26</sup> </p><p><span><strong>3.1.5 Training on Violence-Related Policies and Procedures in Hospitals.</strong></span> Training on violence-related policies and procedures is critical to ensure that the health care workforce is prepared to respond to violence within U.S. hospitals and is required by accrediting bodies such as the Joint Commission and federal agencies such as the Centers for Medicare & Medicaid Services.<sup>49</sup> Awareness of, and compliance with, policies help employees promote safety during violent events. Training covers zero-tolerance policies, reporting mechanisms, and appropriate staff roles and responsibilities in the event of a violent incident. The general policy/procedure training described here encompasses training on institution-specific policies and procedures and does not include specific training summarized elsewhere in the report (e.g., de-escalation training). We estimated the hospital management workforce (SOC 11-0000) engages in two hours of policy and procedure-related training related to violence prevention<sup>57鈥�59</sup> (e.g., monitoring, reporting, and investigating events) and all other hospital employees engage in 0.5 hours of training annually (e.g., how to report events). Based on these assumptions and wage and workforce estimates (Appendix Table 1, 21 occupations), the estimated cost of training specifically on violence-related policies and procedures in hospital was calculated as follows: 鈭�<em><sup>21</sup><sub>i=1</sub></em> 饾惛饾憱 x 饾憡饾憱 x 饾憞饾憱 wherein i is the index representing each type of occupation group (see table below), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the i th occupation, Ti is the number of hours spent per year in training for the i th occupation (described above). Based on this approach and 2023 mean hourly wage data reported by the Bureau of Labor Statistics, we estimated that training on violencerelated policies and procedures cost U.S. hospitals $261.9 million<a href="#" title="* $261,906,280">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�28</sup></p><p><span><strong>3.1.6 Training for Providers to Identify Violence-Related Trauma.</strong></span> Educating hospital personnel to recognize trauma linked to violence is crucial for interrupting the cycle of violence and helping to ensure patients receive the care they need.<sup>60鈥�62</sup> Conditions of note include child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, human trafficking, and intimate partner violence. We estimated that the patient-facing hospital workforce dedicates, on average, one hour annually for these trainings. This estimate of time commitment is based on mandated trainings for related conditions<sup>63</sup> (e.g., 6 hours every 6 years for suicide prevention training in Washington State) with the assumption that each year, providers engage in at least one hour of training related to mandated reporting or child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, and intimate partner violence. (This is likely an underestimate.) The patient-facing hospital workforce was defined as health care practitioners and technical occupations (SOC 29-0000) and health care support occupations employed in hospitals (SOC 31-0000). Additionally, we estimated four hours per year for human resources managers (SOC 11-3121) to organize and monitor the trainings and related compliance. Hourly wage estimates for 2023 were obtained from the Bureau of Labor Statistics.<sup>54</sup> We used the following equation to calculate the total cost associated with training for providers to identify violence/violent injuries: (饾惢<sub>饾惢</sub><em><sub>R</sub></em> 脳 饾憗<sub>饾惢</sub><em><sub>R</sub></em> 脳 饾憡<sub>饾惢</sub><em><sub>R</sub></em>) + (饾惢<sub>饾憙</sub><em><sub>F</sub></em> 脳 [(饾憗<sub>29</sub> 脳 饾憡<sub>29</sub>) + (饾憗<sub>31</sub> 脳 饾憡<sub>31</sub>)] wherein H<sub>HR</sub> is the hours per year human resources managers spend providing and monitoring trainings, HPF is the hours per year the patient-facing hospital workforce dedicate to this training, NHR is the estimated number of human resources managers, N<sub>29</sub> and N<sub>31</sub> are the estimated number of patient-facing providers (for each SOC group, 29-0000 and 31-0000, respectively), WHR is the estimated mean hourly wage of human resources managers, and W<sub>29</sub> and W<sub>31</sub> are the estimated mean hourly wage of each patient-facing provider group (see Appendix Table 1 for values). We estimated that each year, U.S. hospitals spend $185.2 million<a href="#" title="鈥� $185,156,223">鈥�</a> to train patient-facing providers in recognition of abuse, risk for violence, and violence-related trauma. Activities in this section fall under several Medicare Conditions of Participation Standards.<sup>23鈥�25</sup></p><h4><span>3.2. SECURITY PERSONNEL AND STAFFING</span><span> </span></h4><p>Hospitals employ security personnel to respond to incidents of violence and monitor the safety and security of the facility. Security personnel are trained to manage emergencies and work closely with health care teams to maintain a safe and secure environment. Their purpose is to prevent potential events by detecting/deterring threats while fostering a reassuring, safe environment. According to the Bureau of Labor Statistics, U.S. hospitals employed 49,280 security guards in 2023 (SOC code 33-9032). Annual mean wages for security guards in this setting is $45,080, equating to a total wage expenditure on security of $2,221,542,400. Based on previous work, assuming 18.2% of this cost is attributable to local crime rates, we estimated staffing security personnel in response to violence costs U.S. hospitals $404.3 million. <sup>64</sup><a href="#" title="* $404,320,717"><sup>*</sup></a></p><h4><span>3.3. VIOLENCE PREVENTION PROGRAMS </span></h4><p>In recent years awareness of the importance of proactive action to prevent violence, and the role of hospitals in that prevention, has grown. This focus on prevention has taken two forms; one focused on patients and keeping them safe from further violent injury while addressing psychological sequela from their current injury, and one focused on keeping employees safe. Below we described these two types of programs and estimated their costs, totaling $959.2 million annually (Table 3). However, it is important to note that we were unable to estimate the potential cost-savings these programs may create by successfully preventing violent injury. It will be important in future work to include emerging evidence about the efficacy of these programs to prevent injuries to paint a full picture of the potential cost-effectiveness of the programs.</p><table><caption><strong>Table 3. Estimated 2023 Annual Cost Associated with Violence Prevention Programs within U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Violence prevention programs (expenses other than training)</td><td>959.2</td></tr><tr><td>Hospital-based violence intervention programs</td><td>270.5</td></tr><tr><td>Workplace violence prevention programs</td><td>688.7</td></tr></tbody></table><p> </p><p><span><strong>3.3.1 Hospital-based Violence Intervention Programs.</strong> </span>There has been a growing awareness among health care providers that only treating physical wounds is insufficient to prevent downstream effects following victimization, and health care staff can and should do more to address the psychosocial needs of patients by integrating violence prevention into the delivery of health care. <sup>65,66</sup> Hospital-based Violence Intervention Programs (HVIPs) seek to mitigate and prevent recurrent violent injury (trauma recidivism) by identifying and offering victims of violent injury (stabbing, gunshot wounds, assault) a range of support services while in the trauma unit. <sup>67</sup> Following recovery or stabilization of the index injury, HVIPs then seek to link patients to community-based organizations and programs external to the hospital upon discharge with the goals of preventing the patient from experiencing a subsequent violent injury, breaking the cycle of violence, and addressing social needs. HVIPs are comprised of multidisciplinary teams including trauma surgeons, nurses, social workers, and other credible messengers. These programs operate from a trauma-informed perspective reflecting a 鈥渇undamental shift in thinking from the supposition that those who have experienced psychological trauma are either 鈥榮ick鈥� or deficient in moral character to the notion that they are 鈥榠njured鈥� and in need of healing鈥�.<sup>67</sup></p><p>A unique feature of HVIPs is that the team members approach patients at the bedside instead of waiting for patients to contact them for support. HVIP staff endeavor to engage victims of violent injury within the 鈥済olden hour鈥�: the period in which victims of violent injury are most likely to agree to engage in services. HVIP staff are trained to engage patients of violent injury and build rapport with them. According to the 2022 AHA Annual Survey, an estimated 1,143 hospitals reported having violence prevention programs for the community. (This is likely an underestimate due to survey response rate; we also assume that more hospitals would have HVIP programs in 2023, given the increasing investment and interest in these programs. However, the most recent data are 2022, thus we relied on this estimate.) To estimate the costs of these programs borne by hospitals, we relied on estimates that HVIP programs cost approximately $10,798 per participant.<sup>68</sup> Assuming that each hospital with a HVIP serves proportionally as many participants as the size of their hospital, we estimated that the smallest institutions (6-24 beds) serve two participants annually and midsize institutions (300-399 beds) serve 100 participants annually.<sup>68</sup> The number of participants per hospital was thus scaled accordingly across 8 levels of hospital bed sizes (e.g., hospitals with 25-49 beds served an average of 20 participants; those with 400-499 beds served an average of 120 participants). Assuming each HVIP program will cost an average of $10,798 per participant (recognizing that the cost per participant in smaller hospitals will be higher than larger hospitals), we summed the products of overall HVIP cost per participant across all hospitals in the U.S (see equation below). These terms were used to calculate total cost as 鈭� 饾惗饾惗 脳 饾憙饾憙饾憶饾憶 脳 饾憗饾憗饾憶饾憶 8 饾憶饾憶=1 wherein C is the average cost per participant, Pn is the number of participants per hospital scaled according to 8 levels of bed size (n) and Nn is the number of hospitals at least level of bed size. Nationally, the costs of staffing, transportation, crisis support, and operations for HVIP programs total to $901.8 million each year.<sup>68</sup> Evidence suggests expenses for HVIPs are shared across hospitals, foundations, local communities, charities, philanthropy, and federal funding.<sup>69</sup> Accordingly, we assumed that 30% of the costs of HVIP are the responsibility of the hospital, thus the total cost to hospitals for HVIPs annually is estimated at $270.5 million.<a href="#" title="* $30,060,502">*</a> Our estimate exceeds previous per-hospital HVIP costs reported in the literature, and recent investments in community violence-prevention and inflation likely account for this difference.</p><p><span><strong>3.3.2 Workplace Violence Prevention Programs.</strong></span> Programs to prevent WPV are becoming a standard practice in health care. Distinct from HVIPs, WPV prevention programs consist of strategies and policies implemented by institutions to prevent and manage violence in the workplace and foster a culture of safety.<sup>70</sup> Key components of WPV prevention programs may involve risk assessment, reporting mechanisms, incident response plans, support services, and monitoring and evaluation. They can also include several component costs discussed elsewhere in this report, such as policy development and training and education (those costs are not duplicated here). The Joint Commission requires hospitals to have a WPV prevention program (LD.03.01.01 EP9)<sup>71</sup> 鈥渓ed by a designated individual and developed and supported by a multidisciplinary team.鈥�<sup>72 </sup>Multiple states also have requirements that hospitals have WPV prevention programs.<sup>73</sup> Given these requirements, we assume that all U.S. hospitals have a violence prevention program. <a href="#" title="* Although the 2022 AHA Annual Survey suggests that only 2,894 hospitals reporting having a violence prevention program for the workplace">*</a></p><p>The cost of staffing time to lead and support hospital WPV prevention programs, including completing risk assessments, establishing and maintaining reporting mechanisms, developing and disseminating incident response plans, providing support services, and overseeing monitoring and evaluation, are not publicly available. As an estimate, we assume that one coordinator will lead the program (e.g., emergency management director, SOC code 11-9161, mean annual salary of $106,670).<sup>54</sup> This individual is supported by a threat assessment team with representation from public safety, social work, physician administrators, and nursing administrators.<sup>74</sup> This team reviews threat assessment protocol workups and identifies recurring issues, as well as discussing plans, programming, and program needs. We assume the threat assessment team will meet for one hour monthly. In addition, the WPV prevention coordinator is assumed to be supported by a collaborative WPV prevention committee, which will meet quarterly to discuss incidents, review data, and discuss trends, challenges, and root causes. The membership of this committee can include leadership from across the hospital.<sup>74</sup> For this estimate, because not all hospitals have representation from all of these areas, we assume representation in the committee will include one chief executive, one medical/health services manager, a human resource manager, an emergency medicine physician, a behavioral health provider, an occupational health and safety specialist, and an operations specialties manager. This selection accounts for a wide range in member salaries (i.e., $32.65 to $192.26 per hour) in order to account for variation in hospital and committee structures across the U.S.<sup>74</sup> We estimated staffing cost based on salary estimates from the Bureau of Labor Statistics for health care providers in hospitals (NAICS code 62-2000)<sup>75</sup> (See Appendix Table 2). Overall, we estimated the average cost of staffing a WPV prevention program is $112,532 per hospital per year, totaling to $688.7 million<a href="#" title=" $688,693,637">鈥�</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23鈥�29</sup></p><h4><span>3.4 POLICY AND PROCEDURE DEVELOPMENT</span><span> </span></h4><p>An important aspect of prevention and response to violent events in hospitals is the development of facility-specific policies and procedures. This process involves the creation of comprehensive guidelines describing the steps to be taken before, during, and after a violent incident or event. Developing these policies and procedures includes the following tasks, which require time and effort by hospital leadership: conducting risk assessments to identify potential threats, developing reporting protocols, defining personnel roles and responsibilities, and establishing protocols for post-event support services (e.g., counseling).<sup>30</sup> Effective policies and planning should involve regular training and drills (the costs of which are covered elsewhere in this report (e.g., training and violence prevention programs)). Estimates for initial policy development and revision are approximately $3,000-5,000. <sup>76</sup> After policies are in place, maintenance is approximately $1,000/year.<sup>77</sup> We assume most hospitals in the U.S. have policies developed (90%) and are in the maintenance phase; 10% still require further policy/procedure development. Assuming policy and procedure development costs $5,000, the estimated annual hospital cost for policy and procedure development and maintenance is $8.6 million. <a href="#" title="* $8,568,000">*</a> Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards. <sup>24,27,31鈥�33</sup></p><h4><span>3.5. OUTREACH TO BUILD PUBLIC TRUST </span></h4><p>Proactive engagement with the public through transparent communication, educational programs, and community partnerships helps to establish trust and credibility in the hospital and its status as a place of safety in the community. This process includes engagement with not only the surrounding communities, but also building strong relationships with law enforcement and community agencies. </p><p>To estimate these costs, we used cost data from nonprofit community hospitals as these hospitals annually report to the Internal Revenue Service (IRS) on the benefits they provide to their communities. From a review of 2020 tax filings, nonprofit community hospitals spent on average 0.1% of their total expenses on community building activities. <sup>78</sup> These community building activities could include university/school partnerships, engagements in community relations committees, environmental improvements, workforce and job development, violence prevention, childcare programs, and partnerships with local law enforcement agencies. A prior report by the AHA estimated 8.1% of community building activities were generally related to programs and activities directed to prevent violence in the community. <sup>64 </sup></p><p>Using data from the 2022 AHA Annual survey, there are a total of 2,987 nonprofit community hospitals in the U.S. Given the total facility expense for these community hospitals ($984.2 billion), it is estimated that $984.2 million was spent on community building activities (assuming that the mean community investment of 0.1 percent holds across all hospitals). <sup>79</sup> Assuming that 8.1% of hospital expenses for community building and related activities, accounting for inflation from 2022 to 2023, we estimated that $79.7 million<a href="#" title="鈥� $79,722,995">鈥� </a>dollars were spent on community building activities generally related to preventing violence. We excluded for-profit, psychiatric, long-term care, and federal government hospitals from this estimate given the lack of publicly available reporting on these expenditures. Thus, the actual amount hospitals spend on communitybuilding activities related to preventing violence is likely greater than estimated here.</p><h4><span>3.6 FACILITY MODIFICATION TO PREVENT AND MITIGATE HARMS </span></h4><p>Another pre-event cost component is the modification of hospital facilities to prevent violent events and mitigate harm. These costs may include structural changes such as redesigning floor plans to eliminate isolated areas and ensure clear lines of sight, reinforcing entry points, and creating designated safe areas. Additional components may include improving lighting and visibility in vulnerable areas, implementing secure access controls to restrict unauthorized entry, and modifying patient rooms and common areas (public spaces) to minimize the risk of weapon use. These facility-level physical modifications are important to creating a safe environment and ensuring that health care facilities are prepared to respond effectively to potential threats. <sup>80</sup> Facility modification engineering solutions include, for example, two exit routes for rooms and an alternative route for employees in case of an emergency. Providing areas for de-escalation and ensuring lighting is not harsh or causing undue glare is important. Barrier protection includes deep counters, lockable and secure bathrooms for staff members, and enclosed receptionist desks with bulletproof glass. While data on the costs of facility modification are not available, we estimated that facility modification associated specifically with the incorporation of violenceprevention modifications in the design would amount to a mean of 0.5% of a hospital鈥檚 reported capital expenditures. The 2022 AHA Annual Survey data reports a total of $61.2 billion in capital expenditures; thus, the estimated cost of incorporating violence-prevention facility modifications would be $306.0 million<a href="#" title="* $305,983,684">*</a> per year for U.S. hospitals.</p><h4><span>3.7. INVESTMENTS IN TECHNOLOGY TO MONITOR POSSIBLE EVENTS </span></h4><p>In addition to modifications to physical facilities, hospitals and health systems must make investments in technology to predict and monitor possible events. <sup>80,</sup><a href="#" title="鈥� This report does not include the cost of cybersecurity, as that is outside the scope of the report. Cyber-attacks have been called 鈥渢hreat-to-life crimes,鈥� and the AHA is leading efforts elsewhere to address this issue.81"><sup>鈥�</sup> </a>Costs associated with technology investments are primarily comprised of maintaining and upgrading security systems, such as installing surveillance cameras, body-worn cameras, and alarm systems. Additional costs may be associated with installation of panic or duress alarms or similar equipment and communication devices, weapons detection technology and the cost associated in operating the technology, artificial intelligence to identify patients at high risk for violence, and information technology infrastructure to identify or predict risk of violence.<sup>82</sup> Estimates of costs of individual technology approaches (e.g., metal detectors) are available; however, comprehensive data on the violence-prevention technology investments made by all hospitals in the U.S. are not available. Focusing solely on hospitals, where most violent events in the health care and social assistance industry occur, we estimate that ongoing technology expenses amount to 3% of hospital operating costs. <a href="#" title="鈥� This is an estimate derived from research team affiliated hospital as this data is not publicly available.">鈥�</a> We assumed an investment of 1% of reported hospital capital expenditures for half of hospitals for the expense of new violence-prevention technology installment annually. <sup>83</sup> Additionally, we assumed that hospitals dedicate an additional 0.5% for maintenance of this technology. This amounts to $459.0 million<a href="#" title="* $458,975,526">*</a> per year for U.S. hospitals. Activities in this section fall under multiple Joint Commission Standards.<sup>34,35</sup></p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="post-event"><span>4. POST-EVENT FINANCIAL COSTS </span></h3><p>This section outlines financial costs incurred following a violent event. Beyond the specific component costs detailed below, a hospital鈥檚 ability to provide patient care may be compromised immediately or shortly after such an incident. This disruption can result in unmet patient needs and a potential loss of revenue for the hospital. Although challenging to quantify, this impact should be considered in conjunction with the other costs discussed in this section.</p><h4><span>4.1 HEALTH CARE COSTS FOR FATAL AND NONFATAL INJURIES </span></h4><p>Total health care costs associated with violence borne by the hospitals were generated as the sum of the following components: costs from uninsured injuries and costs due to underpayments for patients with public insurance<a href="#" title="鈥� While other insurers may underpay, estimates of underpayment rates are variable and not easily accessible. We have included the best available data for this analysis, and estimates here are considered conservative">鈥�</a> . We estimated 23.6% of violence-related injuries treated in hospitals and emergency departments were among uninsured patients and thus hospitals would be uncompensated for this percentage.<sup>84</sup> This estimate is consistent with recent national estimates of violence-related emergency department visits and hospitalizations. <sup>85</sup> </p><p>In addition to violence-related costs borne by the hospital resulting from uninsurance, underpayments associated with set payment schedules for public insurers also generate costs borne by the hospital, rather than the patient or payer. We estimated a 12%<sup>86, </sup><a href="#" title=" 88 cents for every dollar"><sup>鈥�</sup> </a>underpayment rate for Medicaid and an 18%<sup>87,</sup><a href="#" title="搂 82 cents for every dollar"><sup>搂</sup></a> underpayment rate for Medicare, based on reporting from the AHA. We recognize these estimates are somewhat dated (2020 for Medicaid and 2022 for Medicare); however, they are the most recent data available from a reliable source. We estimated 39.8% of victims of violence were insured by Medicaid and 7.8% were insured by Medicare. <sup>84</sup> </p><p>For health care cost estimates for treat-and-release emergency department visits, nonfatal hospitalizations, and fatal injuries due to violence, we relied upon estimates from the Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS). Methodologies used to generate WISQARS estimates are reported elsewhere.<sup>88</sup> Briefly, the total health care costs are based on statistical modelling of observed injury-related medical cost data; fatal injury medical cost estimates include treatment costs as well as coroner/medical examiner costs and costs associated with ambulance transport, nursing home care, or hospice care.<sup>88</sup> Because the coroner and medical examiner costs are typically the responsibility of the patient鈥檚 family and not covered, for example, by public insurance, we excluded coroner/medical examiner costs from our estimates. It is expected that all violencerelated deaths should involve coroner/medical examiner services and the average estimated cost per exam was $3,000, which is a conservative 2018 estimate based on the U.S. Bureau of Justice Statistics reporting; the cost is likely higher now.<sup>89</sup> The estimated medical examiner/coroner amount was removed from the calculations.</p><p>The estimates for costs and total number of fatalities due to violence are derived from CDC WISQARS, which generates 2021 USD estimates. These values were adjusted for inflation to 2023 USD using the Bureau of Economic Analysis Index annual change estimate (for health).<sup>90,</sup><a href="#" title="* U.S. Bureau of Economic Analysis, "Table 2.5.4. Price Indexes for Personal Consumption Expenditures by Function" (accessed Friday, October 11, 2024)."><sup>*</sup> </a></p><p>Based on these data and assumptions, total health care cost borne by U.S. hospitals was estimated using the equation below (variable definitions and sources in Appendix Table 3). <em>1 脳 {[饾惗<sub>hospital</sub> + 饾惗<sub>饾惛D</sub> + (饾惗<sub>fatal</sub> 鈭� (饾惗<sub>examiner</sub>))] 脳 [(饾憵 脳 饾憿<sub>饾憵</sub>) + (饾憪 脳 饾憿<sub>饾憪</sub>) + (饾憶 脳 饾憿<sub>饾憶</sub>)]}</em> Using this approach, the total estimated health care costs borne by hospitals for fatal and nonfatal injuries is $13.2 billion鈥� in 2023 USD. This estimate represents only the costs for which the hospital is responsible due to un/under-reimbursed care and comprises 29.8% of the total estimated treatment costs for violence-related injuries in 2023 ($44.2 billion, Chospital + CED + Cfatal as reported by CDC WISQARS and adjusted for inflation to 2023 USD). </p><p>We also calculated costs associated with medical care for violence-related injuries for three types of violent injuries: cut/pierce, struck by/against, and firearm-related injury. Cut and pierce injuries involve an incision, slash, perforation, or puncture by a pointed or sharp instrument, weapon, or object (e.g., stabbings).<sup>91</sup> Injuries classified as 鈥渟truck by/against鈥� involve a strike by or against an object or other person.<sup>92</sup> The costs associated with these injuries which contribute to the total estimate of $13.2 billion are $4.1 billion for struck by/against injuries, $3.3 billion for firearm injuries, and $2.5 billion for cut/pierce/stab injuries. (Other injuries could be attributed to falls, inhalation, ingestion, suffocation, poisoning, or other causes.)</p><h4><span>4.2 WORK LOSS COSTS FOR HOSPITAL WORKERS</span></h4><p>The health care field accounts for approximately three-quarters of all nonfatal violence-related occupational injuries and illnesses in the U.S.<sup>93</sup> The total cost to hospitals associated with time away from work for violence-related injuries among health care workers was estimated based on the Bureau of Labor Statistics data for the U.S. health care workforce.<sup>94</sup> In 2022, an estimated 16,990 workers in hospitals had a violence-related nonfatal occupational injury or illness that involved days away from work. Another 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness.</p><p>Across all industries, occupational injuries or illnesses from intentional injury resulted in a median of 7 days away from work. The distribution of days away from work is as follows: 1 day 鈥� 14.9%, 2 days 鈥� 11.9%, 3-5 days 鈥� 19.4%, 6-10 days 鈥� 12.9%, 11-20 days 鈥� 11.4%, 21-30 days 鈥� 6.4%, 31 or more days 鈥� 23.1%.<sup>94</sup> Assuming that time loss within the health care field due to these injuries is similar to time loss across all industries and 2022 rates are similar to 2023, we estimated the costs of missed work based on the mean hourly salary for workers in hospitals: 鈭�<em><sup>7</sup><sub>i=1</sub> </em>(饾懁 脳 鈩� 脳 饾惙<sub>饾憱</sub> 脳 饾惣 脳 饾憙<sub>饾憱</sub>), wherein w is the mean hourly wage for workers in the health care and social services fields, h represents the assumed number of hours in a workday, Di is the days missed at the ith interval, I is the number of violence-related occupational injuries, Pi is the percentage of workers reported above at the ith interval. For the days away from work with ranges, we used the highcentral digit (e.g., for 21-30, we used 25 days). Together, this sums to $52.7 million<a href="#" title="* $ 52,731,466">*</a> in costs associated with time away from work due to violence-related occupational injuries and illnesses within the health care field. This estimate includes the entire workforce, including security guards.</p><p>As noted above, 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness. No published estimate exists of the cost of changes in jobs or transfer due to violence-related occupational illness or injury. For this analysis, we are assuming a minimum cost of $3,000 per employee required to restrict work activity or transfer jobs (including vocational rehabilitation) due to violence-related occupational injury or illness.<sup>95,96</sup> This estimate is thought to account for the wide range of possible restrictions and the cost of retraining employees and amounts to a total of $26.2 million.<a href="#" title="鈥� $ 26,220,000 ">鈥�</a> </p><p>Together, we estimated work loss costs for the hospital workforce injured due to violence and missing at least one day of work is $79.0 million<a href="#" title="鈥� $ 78,951,466 ">鈥�</a> per year. This is likely to be an underestimate and does not account for reduced productivity or time loss due to untreated elements of injury, such as psychological harm, work missed due to post-traumatic stress disorder (PTSD), or unreported injuries. The experience of violence is common in the hospital workplace and underreporting frequently occurs for myriad reasons.<sup>97</sup></p><h4><span>4.3 CASE MANAGEMENT</span> </h4><p>Case managers are unique health care professionals who work directly with patients to provide personalized support and guidance, including connecting to community resources and coordinating care and services. By efficiently coordinating care, case management is associated with improved outcomes, shorter lengths of stay, and lower readmissions rates. By overseeing the care of patients with violence-related injuries, hospitals can also optimize the use of resources. Previous work estimated that utilization management accounted for 2.1% of all patient care costs for hospitalized patients.<sup>64</sup> Based on an annual estimate of 1.43 million nonfatal hospitalizations due to violence-related injuries amounting to $12.0 billion (inflation-adjusted from CDC WISQARS estimate to 2023 USD),<sup>90</sup> this equates to a national inflation-adjusted hospital cost of $252.5 million.<sup>98</sup></p><h4><span>4.4 STAFFING</span> </h4><p>Violence in the workplace impacts workers beyond injuries and illnesses. WPV can be associated with employee absenteeism, loss of productivity, and turnover. Each of these component costs is summarized below. Together, these costs equate to an estimated $541.3 million annually (Table 4).</p><table><caption><strong>Table 4. Estimated 2023 Annual Cost Associated with Staffing in U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Staffing</td><td>541.3</td></tr><tr><td>Absenteeism</td><td>139.2</td></tr><tr><td>Loss of productivity</td><td>183.8</td></tr><tr><td>Turnover</td><td>218.3</td></tr></tbody></table><p> </p><p><span><strong>4.4.1 Employee Absenteeism.</strong></span> Exposure to violent incidents can lead to not only physical injuries, but also emotional trauma, heightened levels of stress, reduced morale, and burnout. These effects may contribute to an increase in employee absenteeism. Costs associated with employee absenteeism include increased expenditures on temporary staffing or overtime to account for absent workers and potential loss of revenue. Absenteeism associated with time loss for an occupational injury or illness was discussed earlier; this estimate focuses on health care worker absenteeism resulting from exposure to violence within the workplace or in the community, including within their own circle (e.g., IPV). This absenteeism can take place in the form of sick days or unpaid days, both of which impact the health care system. Estimates of absenteeism for victims of violence range from 5 to 25 days.<sup>99</sup> According to the Bureau of Justice Statistics at the U.S. Department of Justice, the rate of violent victimization (including rape, sexual assault, robbery, aggravated assault, or simple assault) was 23.5 victimizations per 1,000 persons in 2022.<sup>100</sup> Specific occupations, such as patient-facing occupations (e.g., health care practitioners or health care support occupations) face higher rates of exposure to violent events. For this estimate, we assumed a 2.35% WPV exposure rate for most occupations in hospitals.<sup>100</sup> For patient-facing occupations and security/protective services occupations, we assume an exposure rate of 62%.<sup>101</sup></p><p>Based on an estimated 6.2 million people working in hospitals in the U.S. and WPV exposures rates noted above, we estimated 146,515 hospital workers may be exposed to/victims of violence each year. Assuming that among those who experience violence, approximately 15% have 8 hours (1 day) missed from work annually.<sup>102</sup> This is a conservative assumption: some research suggests up to 5 days.<sup>102</sup> We estimated that the cost of absenteeism due to violence is $139.2 million.<a href="#" title="* $139,217,404">*</a></p><p><span><strong>4.4.2 Employee Loss of Productivity.</strong> </span>A frequent outcome of exposure to violence is loss of productivity in the workplace, which can be characterized by poor decision-making and attitude, disengagement, and overall low morale. In the health care setting, this can also result in poor patient outcomes. Costs associated with loss of productivity include the need to increase staffing to account for loss of revenue. Given the complexities of occupations and job tasks within hospital settings, loss of productivity is challenging to estimate. Among the estimated 2.8 million hospital workers estimated to experience violence annually, we conservatively assume one in twenty experience a reduction in productivity of 3% on average (approximately 60 hours per year for a full-time worker). Based on estimated annual salaries specific to each occupation and anticipated exposure to violence (varying by occupation time), we estimated that costs due to lost productivity amount to $183.8 million<a href="#" title="鈥� $183,761,981 ">鈥�</a> annually. </p><p><span><strong>4.4.3 Employee Turnover.</strong> </span>Similar to employee absenteeism and loss of productivity, the physical and psychological toll of exposure to violence in hospital employees can contribute to high absenteeism rates, which can in turn strain remaining staff. Increased staff burden can lead to further burnout and turnover, ultimately impacting the quality of patient care and overall operational efficiency of the health care facility.鈥� Research reveals that exposure to WPV impacts turnover intention among health care providers.<sup>103</sup> This is only one factor contributing to turnover, and it is challenging to estimate the sole impact of violence in the workplace or community on health care professional turnover, despite recognizing that this extrinsic influence exists and contributes to decision-making. We calculated the estimated turnover rate for employees in the health care sector as the average monthly total separation<sup>104</sup> divided by the average monthly employment.<sup>105</sup> For 2023, the turnover rate was calculated as 3.31% (712,250 梅 21,525,325). This estimate was used for all workers except health care practitioners and technical occupations (SOC code 29-0000) and health care support occupations (SOC code 31-0000), which tend to have higher rates of turnover. For these occupations, we assumed a turnover rate of 5%106 which is likely an underestimate given that home health and nursing home employees have higher turnover rates.107,108 Based on these turnover rates, we estimated 1.1 million people working in the health care and social assistance fields in the U.S. will leave their jobs annually. We assume that a small percentage of these are associated with violence (1.5% based on previous research and increases in the incidence of violence over time)<sup>109</sup> for all occupations other than health care practitioners and technical occupations, health care support occupations, and protective services occupations (SOC code 33-0000), which we assumed had a higher rate of violence exposure and thus a higher contribution of violence to turnover (3.0%). On average, the cost of turnover in health care equates to approximately 6-9 months鈥� worth of workers鈥� salaries.<sup>110</sup> Using occupationspecific mean estimates of monthly salaries,<sup>111</sup> this would equate to a range of costs from $174.7 million to $262.0 million (using 6- and 9-month salaries as cost multipliers, respectively), averaging to $218.3 million* annually.<sup>111</sup> This estimate relates specifically to turnover among hospital employees exposed to in-facility or community violence.</p><h4><span>4.5 REPLACEMENT AND REPAIR OF INFRASTRUCTURE AND EQUIPMENT </span></h4><p>Violent events and incidents result in damage to hospital/health care facility infrastructure and equipment (i.e. security equipment, walls, furniture, medical equipment, and supplies), requiring their replacement or repair.<sup>112</sup> Estimates of the actual costs of damage to infrastructure are not available. However, research has shown that rates of violent crime increase in proportion to population size.<sup>113</sup> Assuming this pattern extends to hospital facilities within communities, we estimated that damage to hospital infrastructure varies by location. Specifically, we project that metropolitan hospitals (n=4,231) experience proportionally more damage than micropolitan (n=859) or rural (n=1,103) hospitals (values based on 2022 AHA Annual Survey estimates). We estimated that each year, metropolitan hospitals are responsible for replacement and repair of infrastructure and equipment equating to 1% of their reported capital expenses. We estimated that micropolitan and rural hospitals are responsible for 0.5% and 0.25%, respectively, of their capital expenses for repairs and replacements resulting from violence within the facility and surrounding community.<a href="#" title="We confirmed that capital expenses are correlated with hospital bed size (overall and within each level of urbanicity).">鈥�</a> Accounting for this differentiation across hospitals, we estimated that the annual cost of replacement and repair of infrastructure and equipment due to violence is $564.6 million in metropolitan hospitals, $16.8 million in micropolitan hospitals, and $3.5 million in rural hospitals, equating to a total cost of $584.8 million.<a href="#" title=" $584,846,515"> 鈥�</a></p><h4><span>4.6 COMMUNITY INTERFACE AND PUBLIC RELATIONS</span> </h4><p>Hospitals, as pillars of their communities, have a public health responsibility to address violent events that occur within and outside health care facilities. This may include post-event debriefing, public health communications, relationship building with communities, and media relations. Public relations managers and specialists at hospitals play key roles in these duties. In 2023, there were 1,340 public relations managers and 4,290 public relation specialists working with hospitals, with average annual salaries of $141,820 and $75,000 dollars, respectively. 114 Assuming 5% of public relations managers鈥� and specialists鈥� time is spent on duties relating to post-violent event public relations,<sup>115,116</sup> the cost to hospitals for community interface and public relations due to violence was $25.6 million<a href="#" title="搂 $25,589,440"><sup>搂</sup></a> dollars.</p><p>In addition to public relations managers鈥� and specialists' time spent on community interface and public relations addressing violent events, there are also costs attributed to materials (i.e., print and digital materials), equipment, and infrastructure for these public relations. These hospital costs are incorporated in the other cost estimates above.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="other-impacts"><span>5. OTHER IMPACTS OF VIOLENCE </span></h3><p>Data limitations restricted our ability to provide financial estimates for all identified areas in which violence affects U.S. hospitals and health care workers using the comprehensive definition of violence provided above. Most importantly, we were not able to quantify financially the full toll of violence on the psychological and emotional health of workers beyond the outcomes of absenteeism, productivity, and staff turnover. The presence of such broader mental health effects are apparent in a multitude of studies documenting correlations in exposure to violence and various mental health and workplace satisfaction outcomes in workers. In lieu of providing financial estimates for the following components, we describe more comprehensively the incidence of workplace violence in different settings to provide the best available understanding of the magnitude of exposure in health care workers. We then provide summaries of data currently available describing associations between exposure to violence, mental health, and employee satisfaction in U.S. health care settings. While we were not able to generate reliable comprehensive financial estimates of associated costs for these components, an understanding of the incidence of exposure to violence and data on related mental health outcomes yields valuable insight and comprises an essential part of a comprehensive evaluation of the true burden of violence to U.S. hospitals and hospital workers.</p><h4><span>5.1 INCIDENCE OF WORKPLACE VIOLENCE</span> </h4><p>In hospitals, WPV most often occurs in psychiatric departments, emergency departments (ED), waiting rooms, and geriatric units, with rural areas having higher prevalence rates than urban areas.<sup>117,118</sup> However, HCWs from across different geographic and clinical locations, specialties, and roles can all experience WPV. One estimate suggests WPV prevalence ranges from 24.4% to 59.3% for physicians, 9.5% to 62.1% for nurses, 15.1% to 68.4% for receptionists, and 24.5% to 40.0% for technicians.<sup>118</sup> Prevalence rates ranged from 14.0% to 57.4% for threats, 2.5% to 5.7% for bullying, 0.5% to 15.9% for physical assault, and 0.2% to 9.3% for sexual assault and harassment for HCWs in this study.<sup>118</sup> Registered nurses (RNs), nursing assistants, and patient care assistants experience particularly high rates of WPV.<sup>119鈥�121</sup> At a South Florida community hospital, certified nursing assistants were found to experience the highest rates of workplace incivility compared to RNs and other clinical and non-clinical staff.<sup>119</sup> According to a 2024 report, half of U.S. nurses have reported being either verbally abused, physically assaulted, or both by a patient or a patient鈥檚 family member within the previous two years.<sup>122</sup> More than one in four of these nurses reported being likely to leave their positions as a result.<sup>122</sup> Additionally, among 9,150 RNs in Michigan surveyed in 2022 regarding WPV concerns, 43% reported emotional abuse, 26% reported workplace bullying, 22% reported physical abuse, and 10% reported sexual abuse in the past 12 months.<sup>120</sup> In another study that surveyed 138 RNs and patient care assistants, respondents experienced higher rates of verbal aggression than physical aggression by both patients and staff.<sup>121</sup> </p><p>Medical residents, nurses in training, and other health care trainees are also impacted by WPV. Out of 119 emergency medicine residents in New York state, 66% reported experiencing at least one act of physical violence during an ED shift. Of that sample, 97% experienced verbal harassment, 78% endorsed verbal threats, and 52% reported sexual harassment.<sup>123</sup> Female medical residents and nursing trainees experience higher rates of sexual harassment and nonphysical WPV than their male counterparts.<sup>124,125</sup> Out of 195 junior- and senior-level nursing students in the midwestern U.S., 82.6% had experienced verbal aggression, 60.5% experienced sexual harassment, and 52.3% experienced physical violence at some point during their training.<sup>125</sup> These experiences can lead individuals to question their decision to join the health care workforce and negatively impact their psychological well-being.<sup>126鈥�128</sup> In fact, among 7,409 general surgical residents from 262 different general surgical residency programs, 30.2% had experienced verbal abuse, 38.5% reported experiencing burnout symptoms at least once a week, and 4.5% endorsed having suicidal thoughts in the past year.<sup>127</sup></p><h4><span>5.2 PSYCHOLOGICAL AND EMOTIONAL IMPACT OF VIOLENCE</span> </h4><p>Witnessing or experiencing violence in the hospital can lead to short and long-term psychological and emotional effects, including compassion fatigue, PTSD, and other mental health concerns, in addition to general satisfaction with one鈥檚 job. (We describe below compassion fatigue and PTSD, while acknowledging that the mental health impacts of exposure to violence may extend beyond these conditions.)</p><p><strong>5.2.1 Compassion Fatigue. </strong>Compassion fatigue occurs when HCWs experience burnout and secondary traumatic stress and can result in low job satisfaction and emotional detachment from one鈥檚 work.<sup>129</sup> Frequent exposure to WPV has been found to increase levels of burnout among HCW. Burnout adversely impacts workers鈥� physical and mental well-being, and often impairs their ability to effectively carry out workplace duties.<sup>130,131</sup> Secondary traumatic stress is a stress response to hearing or witnessing the traumatic experience of another. The symptoms mimic that of PTSD and are intricately connected with those of burnout.<sup>132</sup> In fact, high levels of distress, compassion fatigue, and low perceived institutional support have contributed to higher levels of stress among HCWs who experience mistreatment from patients.<sup>133</sup></p><p><strong>5.2.2 Post-Traumatic Stress Disorder.</strong> According to Hou (2024), experiencing violence in any form can lead to the development of PTSD, characterized by sleep disturbances, irritability, difficulty concentrating, feelings of frustration and powerlessness, intrusive recollections of the traumatic event, and emotional distress.<sup>134</sup> Among 132 ED staff surveyed in McGuire et al., 21.3% respondents had experienced symptoms of PTSD due to WPV, and 18.5% reported considering leaving their position as a result.<sup>135</sup> Similarly, Konttila et al. reported that psychiatric nursing staff who were repeatedly exposed to various forms of violence, including sexual attacks, non-verbal intimidation, and verbal threats, experienced significantly increased psychological distress and fear.<sup>136</sup></p><p><strong>5.2.3 Employee Satisfaction.</strong> In addition to the psychological, emotional, and physical impacts of exposure to violence, HCWs also experience reduced job satisfaction.<sup>137鈥�140</sup> For example, HCWs can experience a decreased desire to interact with patients and their families after experiencing WPV.<sup>137</sup> This effect was found to be more pronounced among those working in an inpatient versus outpatient setting.<sup>137</sup> ED nurses, in particular, have reported that continuous exposure to aggressive patients has negatively impacted their attitudes about their profession, affecting their ability to care for and desire to interact with patients.<sup>138,140,141</sup> Lateral violence between health care worker colleagues also contributes to job dissatisfaction.<sup>119,141,142</sup> Out of 91 ED attending physicians, residents, and mid-level providers in Detroit, 22.2% reported a specific instance of lateral violence in the preceding 12 months that negatively impacted their ability to provide care for their patients.<sup>142</sup> Over 10% reported that lateral violence affected their personal health, led them to consider quitting their job, made them feel unsafe at work, or caused them to dread going to work due to fear of bullying.<sup>142</sup></p><h4><span>5.3 LEGAL AND ETHICAL CONCERNS</span></h4><p><span><strong>5.3.1 Legal Costs.</strong></span> Costs related to abuse or violence within hospitals, such as patient abuse, legal expenses for addressing community violence, and regulatory compliance issues are significant. However, comprehensive data on legal costs and citations are not publicly available. </p><p><span><strong>5.3.2 Reporting Workplace Violence.</strong></span> Underreporting WPV remains a significant barrier for understanding its true prevalence.<sup>118,134,135,138,143,144</sup> A common reason HCWs do not report WPV is due to unclear and unstandardized reporting channels.<sup>118,145,146</sup> Additional reasons for not reporting WPV include fear of retribution or not being believed and not wanting to get involved in litigation.<sup>126,143,146</sup> It is essential for HCWs to have access to resources that prepare them to respond to WPV and to ensure workers are empowered to report it.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="limitations"><span>6. LIMITATIONS</span> </h3><p>All financial costs in this report are estimates and may not reflect the true cost of workplace and community violence to U.S. hospitals and health systems. Many cost calculations include assumptions as there is limited published literature and data on interested cost components; the study team had to rely on the most recent data available or related data to calculate cost estimates. Assumptions for each cost calculation are included in the corresponding cost component section in this report. It is important to note that all assumptions were made so to be largely conservative in nature, suggesting that the actual financial burden of workplace and community violence to U.S. hospitals and health systems is likely much greater.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP 鈬�</a></p><hr><h3 id="discussion"><span>7. DISCUSSION </span></h3><p>This report estimates the financial and other impacts of violence on hospitals in the U.S. The total financial cost of violence to hospitals is estimated to be $18.27 billion (USD). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, violence prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care (namely workers鈥� compensation and unreimbursed costs), staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>Beyond the financial burden, there are many other costs of violence to hospitals and health care workers. Health care workers who experience or witness violence can experience many psychological impacts that affect their well-being as well as impact the health system. These psychological impacts lead to reduced workplace satisfaction and productivity, and recruitment and retention challenges, further impacting the burden of violence to hospitals. </p><p>Overall, violence is a growing public health problem affecting our communities and health systems. In the current report, we estimated a significantly higher cost of violence to U.S. hospitals compared to a 2016 report which estimated that violence costs $2.7 billion (USD).<sup>64</sup> Reasons for the large increase in costs estimated in this report include use of a more expansive definition of violence and components costs than the prior report, and an increase in violent event incidence which impacts post-event costs. Overall, this updated estimate demonstrates the significant burden born by hospitals as a result of violence and costs attributed to treat and prevent violent injuries in the U.S.</p><p class="text-align-center"><a href="/system/files/media/file/2025/05/The-Burden-of-Violence-to-US-Hospitals.pdf#page=26"><strong>REFERENCES</strong></a></p><p> </p></div><div class="col-md-4"><p><img src="/sites/default/files/2025-05/costs-of-violence-report-cover.png" alt="The Burden of Violence to U.S. Hospitals PDF Page 1" width="604" height="786" title="click to download research report: The Burden of Violence to U.S. Hospitals"></p></div></div></div> Wed, 28 May 2025 08:50:13 -0500 Mass Violence AHA issues statement in response to shooting at a Pennsylvania hospital /news/headline/2025-02-24-aha-issues-statement-response-shooting-pennsylvania-hospital <p>A shooting at UPMC Memorial Hospital Feb. 22 in York, Pa., left the suspected gunman and a police officer dead and injured others, according to multiple outlets. AHA President and CEO Rick Pollack Feb. 23 issued the following <a href="https://www.linkedin.com/feed/update/urn:li:activity:7299479157090959360">statement</a> in response:   <br><br>鈥淲e are deeply mourning the tragic loss of life in yesterday鈥檚 horrific hospital shooting at UPMC. Our hearts go out to the victims, their families and the entire UPMC community. Hospitals are sanctuaries of healing, where dedicated nurses, physicians, and other team members work tirelessly to care for patients. We cannot allow these types of violent acts to persist. As a nation, we must unite and take decisive action to end this relentless cycle of violence.鈥� </p> Mon, 24 Feb 2025 16:01:37 -0600 Mass Violence New AHA resources for managing public health emergencies /news/headline/2024-09-06-new-aha-resources-managing-public-health-emergencies <p>The AHA has released five new <a href="/aha-clear/tipsheets">tip sheets</a> designed to fortify crisis leadership competencies during emergency events such as cyberattacks, natural disasters and mass violence incidents. Part of the <a href="/aha-clear">Convening Leaders for Emergency and Response</a> initiative鈥檚 resources, all tip sheets highlight best practices and practical insights from health care leaders for navigating a public health crisis.</p> Fri, 06 Sep 2024 14:40:31 -0500 Mass Violence CLEAR Crisis Leadership Tip Sheets /aha-clear/tipsheets Fri, 26 Jul 2024 10:38:24 -0500 Mass Violence DOJ extends support for health care resource center for mass violence victims /news/headline/2023-10-11-doj-extends-support-health-care-resource-center-mass-violence-victims <p>The Medical University of South Carolina鈥檚 National Mass Violence Victimization Resource Center Oct. 11 received an $8.9 million <a href="https://ovc.ojp.gov/funding/awards/15povc-23-gk-00555-aerx">grant</a> from the Department of Justice鈥檚 Office for Victims of Crime to continue to develop evidence-based best practices, training and other resources to help communities prepare to provide timely behavioral and mental health services to victims of mass violence incidents. As part of the three-year grant, AHA鈥檚 <a href="/hospitals-against-violence/human-trafficking/workplace-violence">Hospitals Against Violence initiative</a> will continue to work with the center to develop resources for hospital and health systems to support victims and communities impacted by mass violence incidents. The DOJ office provided funding to establish the center in fiscal year 2017.</p> Wed, 11 Oct 2023 14:32:48 -0500 Mass Violence Remembering the Highland Park Mass Shooting: Reflections and Lessons in Emergency Preparedness /advancing-health-podcast/2023-09-15-remembering-highland-park-mass-shooting-reflections-and-lessons-emergency-preparedness <p>The 2022 mass shooting during the Fourth of July parade in Highland Park, Illinois killed seven people, wounded another 48 and traumatized an entire community. In this emotional conversation, Gabrielle Cummings, president of NorthShore Highland Park Hospital, discusses how the hospital team responded head-on to an unfolding crisis and kept not only the Highland Park community together, but the health care staff as well.</p><p>This episode was produced through the <a href="/aha-clear" title="Convening Leaders for Emergency and Response (CLEAR)">CLEAR initiative</a>.</p><hr><p></p><div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> 路 <a href="https://soundcloud.com/advancinghealth/remembering-the-highland-park-mass-shooting-reflections-and-lessons-in-emergency-preparedness" target="_blank" title="Remembering the Highland Park Mass Shooting: Reflections and Lessons in Emergency Preparedness">Remembering the Highland Park Mass Shooting: Reflections and Lessons in Emergency Preparedness</a></div><p> </p><details class="transcript"><h2 title="Click here to open/close the transcript."><span>View Transcript</span><br> </h2><p>00;00;00;29 - 00;00;25;04<br>Tom Haederle<br>The senseless and tragic mass shooting during the Highland Park, Illinois 4th of July parade in 2022 killed seven people, wounded another 48, and shocked and traumatized an entire community. Highland Park Hospital played a pivotal role not only in treating the victims, but in managing the aftermath of an event that left many residents in disbelief that something like this could happen in their peaceful community.</p><p>00;00;25;07 - 00;00;50;27<br>Tom Haederle<br>The steps taken and guidance provided by hospital President Gabrielle Cummings described in this podcast played a big role in keeping not only the shaken Highland Park community together, but her health care staff as well.</p><p>00;00;51;00 - 00;01;32;27<br>Tom Haederle<br>Welcome to Advancing Health, a podcast from the 黑料正能量 Association. I'm Tom Haederle with AHA Communications. In today's podcast, Highland Park President Gabrielle Cummings speaks with the AHA's Ben Wise about the importance of boosting morale, prioritizing staff wellbeing and cultivating resistance in the face of adversity and tragedy. This episode also highlights AHA's "Convening Leaders for Emergency and Response," or Clear Initiative, a funded partnership between the Administration for Strategic Preparedness and Response and AHA鈥檚 Health Research and Educational Trust that is committed to fostering collaboration between health care and public health to strengthen our nation's emergency management systems.</p><p>00;01;33;00 - 00;01;36;18<br>Tom Haederle<br>With that, let's join Ben and Gabrielle.</p><p>00;01;36;20 - 00;01;47;23<br>Ben Wise<br>Gabrielle Cummings, thank you so much for being here with us today. I was wondering if you can maybe provide some background on the Highland Park community as well as the events that took place at that tragic 4th of July parade.</p><p>00;01;47;26 - 00;02;11;25<br>Gabrielle Cummings<br>Hi Ben and hi to everyone listening to the podcast. So the Highland Park community is a really tight knit community that sits in the northern suburbs of the Chicago land area. We have quite a few of the communities that surround Highland Park, like Highwood, Northbrook and a variety of other communities that are closely intermingled with the Highland Park community.</p><p>00;02;11;28 - 00;02;37;28<br>Gabrielle Cummings<br>There are a lot of different activities that happen here throughout the year, whether it be in downtown Highland Park for festivals or meetings or shopping. But Highland Park really is a tight knit community. I think what shook all of us was that the shooting that took place was during an event that was meant to really celebrate time to gather independence, friends and family and, you know, the middle of summer.</p><p>00;02;37;28 - 00;02;52;24<br>Gabrielle Cummings<br>And so it was a very challenging time for all of us, given how close the community is. Not just those of us that live in the community, but also those of us that work, because quite frankly, many of the employees that work at Highland Park Hospital or at North Shore e Age also live in the communities where they work.</p><p>00;02;52;24 - 00;03;02;00<br>Gabrielle Cummings<br>And so many of our physicians, nurses, other EBS team members also live in the community, are in close proximity to the Highland Park community.</p><p>00;03;02;02 - 00;03;10;16<br>Ben Wise<br>Would you mind taking me back to that moment and where you were when you when you learned about the shooting and maybe what some of your immediate next steps and actions were?</p><p>00;03;10;18 - 00;03;32;12<br>Gabrielle Cummings<br>Sure. So I don't live in Highland Park. I live in downtown Chicago. It was a holiday. So obviously on a holiday for most administrative leaders, you have the day off. As I jokingly tell people, I was enjoying my last few hours of free time before preparing to enter into checking emails and getting back into work. I was watching a TV series.</p><p>00;03;32;12 - 00;04;00;19<br>Gabrielle Cummings<br>I was excited because the last episode of just posted and as I sat on my couch to begin hitting play, I got a series of text messages from my operations leader on the campus. The first text message said to me, There is someone who's been shot that's coming to our hospital ED. And I knew at that moment that something wasn't right, because we don't receive very many penetrating trauma or gunshot wound victims at Highland Park Hospital.</p><p>00;04;00;22 - 00;04;35;25<br>Gabrielle Cummings<br>We did several years ago, but it was a very unique event. So when I received the first text, it put me on high alert. And then when I received the second and third text about more shootings and the fact that there was a shooter in the neighborhood, obviously that put me on beyond high alert. And I began to pull my team together over the phone so we could do a quick assessment of what was happening and put a plan in action to make sure we can mobilize support for the folks that were already on the campus while we took time to get there, because all of us were geographically dispersed.</p><p>00;04;35;27 - 00;04;52;01<br>Gabrielle Cummings<br>I was in downtown Chicago. One team member was doing a bike ride with her family. Another team member was at a family event. And so we had to come together and coordinate who could get to the hospital the fastest and who was going to take on what role until we got to the hospital.</p><p>00;04;52;04 - 00;04;58;08<br>Ben Wise<br>And how long do you think it took before you realized the magnitude of the situation or what fully had happened?</p><p>00;04;58;11 - 00;05;25;05<br>Gabrielle Cummings<br>You know, being on the phone and planning with my team, because we've done exercises like this as part of our emergency preparedness activities many times before. And when you're sitting in a conference room or doing an exercise with what we call inserts with the pieces of paper that your emergency preparedness team put in front of you to say that someone has arrived, you know, my mind was a little bit on autopilot in terms of what are the infrastructure components that we need to have set up and ready to go for the day.</p><p>00;05;25;08 - 00;05;45;25<br>Gabrielle Cummings<br>And so it was a little surreal still at that point. I think when I realized that this was a major event was what I was going the speed limit for downtown Chicago to Highland Park. I won't tell you how fast I was going, but when there were police cars passing me as if I was sitting still, it made me realize that this was a serious event.</p><p>00;05;45;27 - 00;06;04;28<br>Gabrielle Cummings<br>And then when I pulled in to the Highland Park neighborhood and made my customary left turn onto the hospital street and I saw police officers with assault rifles, long barreled guns out, I knew that it was a serious situation.</p><p>00;06;05;01 - 00;06;19;00<br>Ben Wise<br>I can't imagine that that sounds so intense. And I also think about the training and background that your employees have had. What were their immediate needs when you got there? What kind of things were you seeing?</p><p>00;06;19;03 - 00;06;47;28<br>Gabrielle Cummings<br>Yeah. So I think even before I showed up to the hospital, there were a lot of immediate needs that we needed to get into play. So that the benefit of Highland Park being the part of a larger system is that I had the knowledge, the support and the wisdom of a multitude of other hospital administrators and physician leaders and clinical leaders calling me, offering assistance and support, and setting up what we would call the large incident command.</p><p>00;06;47;28 - 00;07;04;13<br>Gabrielle Cummings<br>So control command, the part of incident command structure for those of us that are all in health care, that are dealing with the kind of higher level functions of what do we need to have ready to go, what resources do we need to get mobilized, what workforce we need to get in place? What do we need to do in terms of handling media?</p><p>00;07;04;16 - 00;07;29;25<br>Gabrielle Cummings<br>I was so fortunate to have a team of colleagues who came to my assistance and a), to form another incident command structure, which is called Area Command, so that they could focus on the higher level things while I was dealing with the activities on the ground here at Highland Park Hospital. And so those phone calls and conversations began as I was going the speed limit on the highway to Highland Park from downtown Chicago.</p><p>00;07;29;27 - 00;07;52;20<br>Gabrielle Cummings<br>When I arrived on site, my my operations leader was here first. She was closest. She was actually out on a bike riding her bike to the hospital. And, you know, hearing from her, the first thing that we needed to do is make sure that the emergency department had all the equipment and supplies that they needed because there were so many gunshot wound victims in the emergency room.</p><p>00;07;52;22 - 00;08;16;05<br>Gabrielle Cummings<br>We had victims that had received injuries from ricochets from bullet fragments that occurred, from hitting the ground or hitting other parts of buildings. We had individuals that had injuries from glass flying all over the place. We quite frankly, had people who were here just terrified and mortified from being in the middle of a mass shooting. And so we needed to have a lot of X-ray equipment available.</p><p>00;08;16;05 - 00;08;36;27<br>Gabrielle Cummings<br>So we were focused on making sure that we had enough mobile x rays out and about to take care of people, making sure they had the basic medical supplies that they need to take care of the community and take care of the patients. So our number one concern was to make sure the emergency department and the clinical team in the ED had the equipment, the supplies, the support they needed to care for the patients.</p><p>00;08;37;00 - 00;08;56;05<br>Gabrielle Cummings<br>I arrived to the hospital campus about 20 minutes after my operations leader and my nursing lady was here. She actually my CNO was actually in the E.D. and went directly into nursing care. She was caring for patients and care for actually one of the most one of the most tragic patients that we had to care for that day.</p><p>00;08;56;07 - 00;09;12;29<br>Gabrielle Cummings<br>But when I got here, I then began to focus on...I had to try to fly out a little bit. So I flew out. I mean, I had to take an opportunity to fly higher and to think about, okay, my team is in the E.D., we're dealing with patient care. I need to now deal with what's happening outside of the city.</p><p>00;09;13;02 - 00;09;43;09<br>Gabrielle Cummings<br>So there were dozens of people in the parking lot of the hospital, family members asking questions about their loved ones. I'm sorry. And so I had to focus on one being strong for them and making sure that I created a sense of of safe space and peace for them while also being aware of the security risk. Because at that moment in time when I got here, the shooter was still on the loose.</p><p>00;09;43;09 - 00;09;57;11<br>Gabrielle Cummings<br>We didn't know where he or she was. We didn't know if it was a male or a female, but we didn't know where the person was. And so I had to think about I've got dozens of people in the parking lot concerned about their family members, but every one of these people is a security risk to this hospital.</p><p>00;09;57;11 - 00;10;17;24<br>Gabrielle Cummings<br>And I have to think about how do I make sure that I treat them with compassion, but also getting them screened for security threats. And so I have a wonderful public safety team. And our public safety team created a perimeter and created a screening process where we screened every person in the parking lot to get them to the hospital because it was it was July 4th.</p><p>00;10;17;24 - 00;10;40;00<br>Gabrielle Cummings<br>So it was a very warm summer day. And most clinicians and those of us on health care know that when it's a warm day and you have high stress situations, people can have a variety of different complex issues that take place. And so I needed to get people from outside of the hospital inside. So that was one of my first actions, was to take care of the individuals that were in the parking lot and get them screened and safely inside.</p><p>00;10;40;00 - 00;10;59;22<br>Gabrielle Cummings<br>And once we got them inside, we had volunteers, we had other patient advocates that were meeting with each of the individuals to let them know that we're trying to find out what's going on with their family members. And so that was that was step one for me. I then went into the mode of thinking about, okay, what other resources do we need to think about?</p><p>00;10;59;22 - 00;11;33;12<br>Gabrielle Cummings<br>So, you know, in the middle of the shooting, I still have a hospital full of patients and a hospital full of clinicians that are caring for patients that are in beds or family members that are coming here for other outpatient tests. So I had to then think about how do I what I need to do to lock down this campus? Because at this point, anyone walking in or out of this circumference of our campus could be the shooter or could be a victim of a shooting because we didn't know if he was going to come back to have round two or to do whatever it is that he wanted to do.</p><p>00;11;33;12 - 00;11;56;00<br>Gabrielle Cummings<br>And so my next line of thought was I needed to put the campus on lockdown and create an external perimeter around the campus where no one could come into the campus that wasn't clinically in need of care. So that was another key step that I took in short order after getting here. I don't know how long it took for us to figure that out, but that was something that we had to do quickly.</p><p>00;11;56;02 - 00;12;16;06<br>Gabrielle Cummings<br>Another strategy and tactics that I developed with my team was it was it was also what was a long day. So I got here about 10:30, 10:40 in the morning, and we were here until seven or 8:00 at night because a suspect was apprehended, I think until about seven or eight at night. And that's in the middle. You know, you have shift changes.</p><p>00;12;16;06 - 00;12;34;27<br>Gabrielle Cummings<br>You have family members or team members who need to go home to their families and take care of their loved ones. So I had to then decide from an HR perspective and a people's safety perspective, do I let my team members go home or do I ask them to stay and shelter in place? And obviously we followed direction from the city about sheltering in place.</p><p>00;12;34;27 - 00;12;55;09<br>Gabrielle Cummings<br>And we we did have some team members who elected to leave the campus and to go be with their families and their loved ones, which I completely understand. But there is a level of concern that you have as a leader with letting your team members leave. Right? You want them to be with you. You want them to be with their family members, but you also don't want them to get hurt because at that point we didn't know where the shooter was</p><p>00;12;55;09 - 00;13;06;07<br>Gabrielle Cummings<br>as I've said a number of other times, and I didn't want anyone else to get hurt. So that was another key component that we had to focus on and that I focused on in short order when I arrived.</p><p>00;13;06;09 - 00;13;37;04<br>Ben Wise<br>You know, it's so interesting to talk about, you know, this high functional support and setting up this incident or area command center. And it sounds like you're just you're in the moment, you're balancing these clinical needs, these security needs. And of course, as you're talking about and and showing the emotional needs of. If you could just tell us about how you and your fellow leadership staff addressed the emotional well-being of the staff, both during that long day and in the immediate aftermath that followed as well.</p><p>00;13;37;10 - 00;13;40;19<br>Ben Wise<br>How did you check in on them? How did you care for them?</p><p>00;13;40;21 - 00;14;19;08<br>Gabrielle Cummings<br>Yeah, so I think the day one, the 4th of July, you know, food always brings comfort. I think we didn't realize how much comfort food was bringing us, but there was a lot of food, right? A lot of chocolate bars, lunch snacks, water, hydration, etc.. Some people were eating, some people didn't. So I think the importance of having nutrients or nutritional food available was really important to providing people with just in time support, because at that point we were still in full fledged incident area command, but we weren't thinking about the emotional well-being of one another.</p><p>00;14;19;08 - 00;14;48;18<br>Gabrielle Cummings<br>We were thinking about the emotional well-being of the patients, of the family members, of the community, of the police officers that we all work with, and the paramedics that we all work with that were out there in the field taking care of the patients who were getting brought to our respective hospital campuses. I think just having open, honest dialog with one another and being in a room together and rounding together and respecting each other's roles and knowing that our roles changed every moment of every day.</p><p>00;14;48;20 - 00;15;06;28<br>Gabrielle Cummings<br>For those of you that are familiar with an incident command, at least in our structure, you have this whole theory that you break open your incident command box and you put on your vest that says, I'm the incident commander. And my team was following protocol and wanted to set that up. And I said, No, we don't have time to set up the box.</p><p>00;15;07;05 - 00;15;24;03<br>Gabrielle Cummings<br>And the phones and the vests. We need to focus on being out and about on the campus, making sure that the folks that are here taking care of patients, whether they be in the E.D., or on the floors, see us visible and know that they are leaders here. There are other colleagues here to support them and keep them keep them safe.</p><p>00;15;24;07 - 00;15;40;11<br>Gabrielle Cummings<br>How are you going to define safety that day? So the day of it was it was very much more just in the moment, blocking and tackling. How do we manage the media message, how do we handle what's happening with the community, how do we handle our team members to make sure that they have food if they want food?</p><p>00;15;40;12 - 00;16;04;22<br>Gabrielle Cummings<br>How do we handle that? The only members that are here on our campus and are really challenged with what's going on. We also had one patient who was severely injured and we had to to get that patient helo transported out of the campus. And so how do you handle a heliport transportation in a mass casualty incident? So that was the day of. The days after</p><p>00;16;04;25 - 00;16;27;12<br>Gabrielle Cummings<br>I think, you know, it was it was kind of surreal. It's surreal that it's already been a year. But we folks, we were laser-focused on the fifth and thereafter on making sure that the team members had plenty of support. And I can go into that now if you'd like me to, or we can save that for another segment of our conversation.</p><p>00;16;27;17 - 00;16;36;09<br>Ben Wise<br>No, no, please. I'm so interested. Both team support, team morale and how you observed that? Measured it. Fostered it? Yeah.</p><p>00;16;36;11 - 00;17;14;03<br>Gabrielle Cummings<br>Yeah. So in the days that followed, I knew when I was driving home that night that when I needed to make sure that I had support for myself as a leader because in order to support the rest of my team, I wouldn't be able to support them if I didn't have my own safety net. Right? So I, I maybe subconsciously, I immediately called people that are closest to me to get support and to have that safe place to land while I was driving home that day because I knew I had a long road, I and my colleagues in leadership had a long road ahead of us</p><p>00;17;14;04 - 00;17;43;29<br>Gabrielle Cummings<br>after we came back the days that followed. When I got my safety net and had my sister circle or my social circle there to support me and my family circle, their support me, I immediately thought about the fact that we needed to have as many emotional well-being counselors on site as possible. We needed to really create an environment where team members could get access to mental health support on site as well as virtual if they so choose chose.</p><p>00;17;43;29 - 00;18;01;26<br>Gabrielle Cummings<br>But it was important that the support was on site. So, in the days to follow for at least a solid two weeks across all shifts. Because even though there may have been people that weren't here that day, this kind of event really impacts everyone who's connected to the team members that are here and units connected to the community.</p><p>00;18;01;26 - 00;18;26;26<br>Gabrielle Cummings<br>And so I made sure that we had mental health counselors here multiple hours of multiple days, Monday through Sunday, so that they could be available on site. I also had the counselors walk with me on the floors because I realized that health care professionals are very strong people, and sometimes people see counseling as a sign of weakness when I think counseling is actually a sign of strength.</p><p>00;18;26;29 - 00;18;46;16<br>Gabrielle Cummings<br>And I realized that if I walked or if another leader walked with the counselors on the floors or in the hospital, that it created the safe space for individuals to say, okay, it's okay for me to talk to the counselor. I also was very intentional about telling my my colleagues and my team members in the hospital that I was actively going to go to counseling as well because this is going to impact me.</p><p>00;18;46;18 - 00;19;17;14<br>Gabrielle Cummings<br>And I think that that gave team members and other individuals permission to know that it's safe and it's not considered a failure or a sign of weakness to get help and support in that environment. We also launched at NorthShore before this event happened, a group called Rise, which stands for Resilience in Stressful Events. So our RISE Team members are comprised of mental health counselors, other team members that have gone through a very discrete training to help each other recover and deal with tragic and serious events.</p><p>00;19;17;14 - 00;19;41;14<br>Gabrielle Cummings<br>And so we had members of the Rise Team from all over our system come to Highland Park Hospital to be available to round in, to talk and to have decompression sessions. There were certain groups that wanted to have a decompression session with either a RISE member or a mental health counselor. Collectively, like our team, it was very important to them to have a decompression session as a collective team and to reflect and to heal together.</p><p>00;19;41;17 - 00;20;06;15<br>Gabrielle Cummings<br>There were other team members or other individual roles I can think distinctly of one of our public safety officers who wanted to have one-on-one time with a counselor by himself. And so what was important to me and to my team, to my colleagues and leadership, that we created a space where team members could access what they needed in a way that worked for them, not in a way that I thought was going to work for Gabriel or Buffy or Barb.</p><p>00;20;06;15 - 00;20;23;01<br>Gabrielle Cummings<br>That's my operations leader and Barb was my CNO and the way that's going to work for them. And so we did take feedback. We took just in time inside what we needed to do. One of the things that I learned is we needed to have a Spanish speaking mental health counselor, despite the fact that everyone on this campus can speak English.</p><p>00;20;23;07 - 00;20;53;17<br>Gabrielle Cummings<br>English is not the first language for everyone. And there were some of my team members who can converse in English, but they're most comfortable with their native tongue, which for this particular incident we needed to make sure that we had Spanish speaking mental health counselors available. We added Spanish speaking counselors to our rotation and towards us towards the latter half of our two week period after it was brought to our attention that there were some team members who felt more comfortable healing and talking and conversing in their first language.</p><p>00;20;53;19 - 00;21;15;09<br>Ben Wise<br>Really make sense that that these things would come up. And it sounds like you really were able to, to lead by example and address some of those kind of immediate concerns and and offer a lot of support and services for your staff as well as having some things in place. Fourteen months later, how would you describe kind of the long term recovery efforts and how are you all feeling today?</p><p>00;21;15;11 - 00;21;38;23<br>Gabrielle Cummings<br>Yeah, I think we were already a really close team at Highland Park Hospital and at NorthShore and now NorthShore. And so I think this event, it's just brought us closer together and just reaffirmed the importance of connection and knowing one another not just out of work level, but at somewhat of a personal level. And by personal level, I mean at least knowing people face-to-face.</p><p>00;21;38;23 - 00;22;01;05<br>Gabrielle Cummings<br>So I may not know how many children you have, but I know that you have children. And so I think as a leader, it's always been very important to me to connect with team members in a way that is deeper than just, Oh, that's an employee. Like, I want to know that's Lala EBS employee or that's Michael, our EBS employee, and know a little bit about their their personal background because a sense of connection is is important</p><p>00;22;01;05 - 00;22;20;13<br>Gabrielle Cummings<br>I think to leadership. I've learned actually quite a bit having one on one conversations with frontline team members versus hearing it secondhand to some of my leaders. And so I think, you know, we'd already, as I alluded to, created really strong connections and have really strong connections as a hospital campus. And so I think we're just closer today than we ever were.</p><p>00;22;20;15 - 00;22;41;05<br>Gabrielle Cummings<br>The other thing that was really important is we had really close connections with members of our community. And I'm not sure that things would have gone as smoothly that day if I didn't have a strong relationship with the mayor, with the fire chief, with the police chief, with other civic and community leaders who knew how to get to me and meet with them so we could deal with managing the situation just in time.</p><p>00;22;41;07 - 00;23;11;00<br>Gabrielle Cummings<br>And so the culture here is still really solid. It's really strong. I would say a year plus later, it's going to always be in our minds. It will always be with us. But it has made us stronger as a clinical team, stronger as people, and has really reinforced the importance of being here for our community in whatever way they need us to show up that day, that hour. The other thing I think that's important to share is unfortunately mass shootings are all too common in our country.</p><p>00;23;11;02 - 00;23;34;11<br>Gabrielle Cummings<br>You know, you can't watch TV without hearing about a mass shooting occurring almost every day. And there was a potential another event around the geography close to Highland Park Hospital that took place several months ago. And it generated a lot of anxiety with the team to have to get back in to kind of, you know, fight or flight mode, the fighting mode of just coming out of this maybe months ago.</p><p>00;23;34;11 - 00;23;53;02<br>Gabrielle Cummings<br>And so I think while we are strong and we are healing from it, it is always a wound that is there and that we're aware of. The one year anniversary was really important for all of us. It was very important to me and to my leadership team that we had a memorial event that was specifically focused on us as health care leaders and providers, right?</p><p>00;23;53;02 - 00;24;19;27<br>Gabrielle Cummings<br>There were a lot of different city events or external events which we attended and got involved in, but it was so critically important to have a time where we as health care leaders could get together and just emote, just allow our emotions to flow, to heal, to reflect as a care community that was here that day. And even folks that weren't here that day, but helped us do recovery and helped to manage situations over the phone if they weren't able to be here in person.</p><p>00;24;19;27 - 00;24;40;27<br>Gabrielle Cummings<br>But it was important that we got together as a collective health care community and we had a memorial ceremony for multiple shifts, like two or three shifts. I think. And we also commissioned a beautiful piece of artwork that is now installed in our healing garden outside of the campus that employees can go and reflect on and look at any time that they want.</p><p>00;24;40;29 - 00;25;03;28<br>Gabrielle Cummings<br>It's a beautiful memorial. It's a beautiful piece of artwork, but I think it created closure for us so that the team could heal and put that behind them and use that as a platform to grow and to continue to be strong. But if people want to go and reflect and remember what happened that day and what we did as a collective health care team that day, that they could go and have a safe place to reflect and remember.</p><p>00;25;04;00 - 00;25;28;15<br>Ben Wise<br>Well, I think that's fabulous. And I so appreciate you sharing all of this. I guess, you know, lastly, as a leader now who has been through this and gotten to work so closely with your community on on such a tragic event, what advice might you offer to other health care leaders in your position, both for preparing for mass casualty incidents and also supporting your workforce after this type of incident?</p><p>00;25;28;17 - 00;25;49;02<br>Gabrielle Cummings<br>Yeah, so I think a few things to share with my colleagues in the health care community. I always would laugh and joke with my emergency preparedness leaders about the, you know, the Sharknado drills. They would have us do that. We call them tabletops where we simulate an event, thought it was comical or it was kind of, Oh gosh, we got to spend 4 hours doing this.</p><p>00;25;49;04 - 00;26;13;06<br>Gabrielle Cummings<br>I would say to everyone on this podcast, please do your drills. The one thing I am certain of that made this event go so smoothly was for us the Highland Park Hospital and NorthShore is that we understood the emergency preparedness dynamic. We understood what Incident Command was. We understood what levers to push pull because of the number of drills and exercises we've done throughout our time in our years in the organization.</p><p>00;26;13;06 - 00;26;46;24<br>Gabrielle Cummings<br>So that's one key takeaway I would like to share with the groups. The second is please don't underestimate the importance of community connection, the importance of relationships with community leaders and fostering those relationships because they benefit you in more ways than you could ever imagine, in ways that you couldn't imagine at all. The other point I would love to to make for for leaders, especially for those that are in leadership positions, is that you need to take time to heal and acknowledge that you as a leader need to maintain strength in order to provide strength to others.</p><p>00;26;46;26 - 00;27;04;28<br>Gabrielle Cummings<br>Because if you don't, you could implode unintentionally. I distinctly remember my colleague Sean O'Grady saying to me about a week after kind of running 300 miles an hour was like break, you need to take some time off. And I'm like, I don't have time...I don't have time to take off work. I got to stay focused.</p><p>00;27;05;00 - 00;27;28;12<br>Gabrielle Cummings<br>But he knew that I needed some space to heal so that I didn't implode. And he was right because when I took time off, like all of the emotion started to come over me and I was reflecting and thinking about what I saw my team members faces, what I saw on the family members'faces. So as a leader, please take time to heal and acknowledge that healing and the importance of healing as a leader.</p><p>00;27;28;14 - 00;27;47;08<br>Gabrielle Cummings<br>And then the only other thing that I would would share is that unfortunately, I want folks to know that we are in a health care community that are here to serve and to take care of one another and know that you can always reach out to another hospital leader if you need help or support or insights on how you handle the situation</p><p>00;27;47;08 - 00;28;11;06<br>Gabrielle Cummings<br>during a mass shooting, I was really blessed and fortunate to be contacted by a number of health care leaders across the country who have been through similar things. They wrote me letters. They called me to offer their support and I say just thank you to all of those individuals, but also continue to be there for one another to help all of us get through these challenging these challenging times when it comes to having to recover from a mass incident or mass casualty.</p><p>00;28;11;08 - 00;28;24;10<br>Ben Wise<br>Gabrielle, thank you so much for your time today and your openness in our discussion. I know these are very difficult things to discuss and a very tough subject, and so your openness and honesty is so appreciated.</p><p>00;28;24;18 - 00;29;07;04<br>Tom Haederle<br>Presented as part of Cooperative Agreement five Hi tap 210047-02-00. Funded by the Department of Health and Human Services Administration for Strategic Preparedness and Response, ASPR. The Health Research and Educational Trust, An 黑料正能量 Association 501c nonprofit subsidiary, is a proud partner of this cooperative agreement. The contents of this publication are solely the responsibility of the health research and educational trust and its partners, and do not necessarily represent the official policies or views of the Department of Health and Human Services or of the Administration for Strategic Preparedness and Response.</p><p>00;29;07;06 - 00;29;13;29<br>Tom Haederle<br>Further, any mention of trade names, commercial practices or organizations does not imply endorsement by the U.S. government.</p></details> Fri, 15 Sep 2023 07:52:45 -0500 Mass Violence Hospitals Will Always Offer Healing and Hope as We Stand Up Against Violence /news/perspective/2023-03-03-hospitals-will-always-offer-healing-and-hope-we-stand-against-violence <p><strong>Ninety-five</strong>. That鈥檚 the number of mass shootings that have occurred in the United States during the first two months of this year, according to the <a href="https://www.gunviolencearchive.org/" target="_blank">Gun Violence Archive</a>.</p> <p>Last year, there were <strong>647</strong> mass shootings in our nation. And gun violence overall claims more than <strong>40,000</strong> Americans annually. These numbers are staggering.</p> <p>But we cannot resign ourselves to the notion that mass violence of any kind must be accepted as a fact of life.</p> <p><strong>As caregivers and healers, hospitals and health systems are the antithesis of violence. They are in the business of treating patients, healing communities and saving lives.</strong></p> <p>At the same time, care teams experience firsthand the crippling effects of violence as they care for victims when they arrive in our emergency departments and other care facilities. They also are the ones delivering difficult news to families and comforting them during these heart-wrenching moments. It takes a toll.</p> <p><strong>We must continue to stand up against violence. We must continue to push back and share solutions. And, we must vow to never accept violence as normal.</strong></p> <p>Hospitals and caregivers are taking a stand in a number of ways. For example, this week more than 100 individuals, including hospital and health system leaders, policymakers, clinicians and researchers participated in Northwell Health鈥檚 fourth annual <a href="https://preventgunviolence.com" target="_blank">Gun Violence Prevention Forum</a> in New York City. The forum鈥檚 purpose is to create alliances, drive strategy and elevate the national conversation around gun violence as a public health emergency. This year鈥檚 sessions focused on actions to address some of the underlying causes of this crisis.</p> <p>In addition, AHA鈥檚 <a href="/hospitals-against-violence/human-trafficking/workplace-violence" target="_blank">Hospitals Against Violence (HAV)</a> initiative continues to shine a light on how hospitals and health systems are working to heal victims of violence as well as their communities, prevent further acts of violence, and address violence in the workplace.</p> <p>As part of the HAV initiative, we have been sharing resources and strategies to: support victims and communities of mass violence incidents; implement a public health approach to address gun violence; combat human trafficking; and enhance workplace violence prevention.</p> <p>These resources cover a broad range of issues, including dealing with active shooter incidents in health care settings, coping with anger and aggression in the workplace, and encouraging parents to ask family and friends if firearms are safely stored in their home, just to name a few.</p> <p>At the same time, hospitals and health systems are focused on the safety of health care workers who dedicate their lives to caring for others. Hospitals are taking a number of actions to enhance safety, including raising risk awareness, improving information-sharing and reporting, and investing in security, surveillance, training and alert notifications.</p> <p><strong>But more must be done</strong>. Last year, the AHA drafted, secured sponsors and worked with Congress on legislation to give health care workers the same legal protections against assault and intimidation that flight crews and airport workers have under federal law. We are working to get similar legislation introduced <strong>and passed during this Congress</strong>.</p> <p>We must continue to take action to stop acts of violence in our nation. As places of healing, hope, safety and security, hospitals and health systems have an important role to play.</p> Fri, 03 Mar 2023 08:56:41 -0600 Mass Violence FBI Active Shooter Resources /cybersecurity-government-intelligence-reports/2022-06-02-fbi-active-shooter-resources Thu, 22 Dec 2022 16:53:48 -0600 Mass Violence Webinar July 14 on victim-centric response to mass violence incidents聽 /news/headline/2022-06-30-webinar-july-14-victim-centric-response-mass-violence-incidents <p>The Justice Department鈥檚 National Mass Violence Victimization Resource Center will host a July 14 Town Hall webinar on victim-centric response to mass violence, which will also feature speakers from the Office for Victims of Crime, FBI and American Red Cross. The webinar will identify effective strategies to assess and address the needs of mass violence victims, survivors and community members. <a href="https://musccom.zoom.us/webinar/register/WN_qT1fjkgiQc692eJD1A9oUw">Register here</a>. AHA is a principal partner of the NMVVRC, established by a grant from the Justice Department. <br />  </p> Thu, 30 Jun 2022 15:21:36 -0500 Mass Violence