Preparing for the Unthinkable

Mass shootings are unfortunately a fact of life in the United States. Being prepared for such an emergency as well as other forms of workplace violence is critical to keeping staff, patients, and clients safe. This article looks at some ways to prepare for the worst.

By Maureen Blaney Flietner

Active Shooters and Violence at Work

In January 2023, there were only eight days in the United States without any “mass shooting,” as defined by the nonprofit online Gun Violence Database. By mid-February, there were 22 more mass shootings year to date than any of the last three years. Those numbers do not include incidents where fewer than four were killed or wounded, not including the shooter. Now add in whatever nongun violence or crime that can occur with distraught or angry clients, disgruntled staff or former staff members, and others.

Veterinary team reviewing escape plan

“The way the world is today, prevention is the best medicine. There are so many more benefits than costs.”

—Cherie Scheurich, hospital administrator and director of client relations at Absecon Veterinary Hospital, Absecon, N.J.

It may make you wonder: Is it time to review your active shooter and violence prevention plans?

Cherie Scheurich, hospital administrator and director of client relations at the AAHA-accredited Absecon Veterinary Hospital, Absecon, New Jersey, put an active shooter plan in place late last summer to help her staff stay safe.

The busy emergency and general practice hospital of 140 employees sees an uptick in traffic May through October as visitors flock to the South Jersey shore. “Lots of people come down this way with their pets in the summer, and the hospital takes in overflow from all over,” she explained. The hospital is familiar with its local police department as calls for assistance are not uncommon. “For people who love their animals, emotions can escalate quickly,” said Scheurich.

Not wanting to start off on the wrong foot and waste hours on an improper strategy, Scheurich contacted the local police for help with an active shooter plan. An officer surveyed the building and offered a template she customized. “We held small group training sessions. Everyone had to review the plan and take the quiz. New hires get trained as soon as they are on board. The plan is reviewed once a year. Everyone gets a copy in their email, at training sessions, and it is available anytime on a shared drive,” said Scheurich.

Design for safety

In a holistic approach to safety, even hospital design plays a role.

“It’s the world we live in,” said Heather Lewis, a licensed architect and principal at Animal Arts Design Studios, Inc., Boulder, Colorado. “It’s better to prepare for dangerous situations. There is a risk for every business, and veterinary care is not immune. It may not help in an active shooter situation since that person has already set their course, but it can help with de-escalating a threatening person.”

She offered these ideas:

  • Have an entry vestibule—two sets of doors. It both prevents escapes in case a pet gets loose in the lobby and, if set up correctly, allows the front desk to control the inner doors, which works particularly well for 24/7 emergency hospitals.
  • Have a safe space behind the reception area. “It’s bad design if a receptionist has to come out front and then run,” said Lewis.
  • Because veterinary hospitals can be targets for drug-seeking behavior, consider enclosing pharmacies instead of having them in hallways, and use inventory management systems like CUBEX for dispensing pharmaceuticals.
  • Add a panic button at the front desk that can not only call the police but make a loud noise to disorient an aggressor.
  • Place the manager’s office near the lobby so that person can assist or call the police if someone’s actions are getting out of hand.
  • Consider glass with an embedded break detection system that sends an alert when broken.
  • Consider a few two-door exam rooms for difficult conversations. A room that has a door to the exterior, such as one used for euthanasia, could be an option.
  • “Have a hospital that is open, welcoming, and nonjudgmental,” she suggested. “Design with safety—not fear—in mind. You don’t want a concrete bunker. That’s just going to make people angrier and more frustrated.”

In addition, the hospital has installed panic buttons, and staff members have learned that they should use their PA system to announce if there is an active shooter in the building. “As per police psychological profiles, intruders are not expecting an announcement, and it throws them off. They also don’t expect people to fight back,” Scheurich explained. “Everybody should create a plan, especially in areas that have a lot of tourism. The way the world is today, prevention is the best medicine. There are so many more benefits than costs.”

At Valley Veterinary Care based in Friendswood, Texas, Meghan S. Bingham, CVPM, senior operations manager, created an active shooter protocol after she was asked about one several times by a customer service representative. That team member had worked at the hospital before Valley Veterinary Care acquired it and had experienced a lockdown after a robbery attempt escalated in its strip mall location.

“It seemed important to her, so I sat down and created a standard operating procedure (SOP) before we left that day. Since then, we’ve fleshed it out and shared it across the group’s 14 general practices and nine emergency clinics—17 AAHA accredited,” explained Bingham.

Bingham’s education about security measures began when she accompanied her mother, a teacher, to an in-person active shooter protocol course. “I tagged along and applied what I learned there to create a comprehensive guide for our practices. When we initially rolled out the plan, we had the practice managers train on the protocol during a staff meeting. We also post our SOP near the alarm keypad and review it yearly as part of our ongoing OSHA training.”

Front desk area at VCA VancouverThis front desk area at VCA Vancouver provides a place for staff to retreat back in the event of a threat, instead of having to come forward around the desk to escape.

The plan is just another competency in the hospital’s safety skill set. “Unfortunately, the nature of emergency medicine lends itself to emotionally charged visits, and a few of our practices have experienced aggressive or threatening behavior from clients,” Bingham said. “Luckily our staff are trained for situations like that and are usually able to calmly de-escalate the situation.”

“A few of our regional managers were lucky enough to attend in-person de-escalation training from KimberlyAnn Mackey, CVPM, a former practice manager and a longtime parole supervisor for the Commonwealth of Pennsylvania, which they shared with their practice managers and staff. The Veterinary Hospital Managers Association has also hosted webinars on de-escalation, and our in-house OHSA training covers violence prevention and response.”

“Part of our customer service training is to know when to walk away or pass an angry client on to someone who can help defuse the situation. Beyond that, we will always support our staff refusing service or reaching out to authorities when necessary. If anyone expresses a safety concern, we act upon it as soon as possible,” said Bingham.

The hospital also reviews how to use its security systems and panic buttons and makes sure all security cameras work properly and are directed toward the appropriate areas. “No one wants to think it’ll happen to their practice, but ignoring it doesn’t protect your staff,” said Bingham. “Proactive training is always better than reactive training. It’s just like any other skill we train for: The more you’ve practiced or planned for something, the better your reaction will be.”

Getting better? Getting worse?

It can be difficult to understand what is happening because of how gun violence and other crimes are categorized and counted.

The FBI calls “active shooter” incidents as those where one or more individuals are actively engaged in killing or attempting to kill people in a populated area. However, the agency does not include gang violence, drug violence, and residential or domestic disputes. Its reports are only intended to provide a baseline understanding of active shooter incidents with no mandated database collection or central intake point for reporting active shooter incidents as exists for other crimes.

The Gun Violence Archive, a nonprofit online database of gun violence incidents in the United States, considers “mass shootings” as incidents in which four or more people are either injured or killed, not including any shooter. Its extensive database provides data on mass shootings as well as any gun violence in the last 72 hours and gun violence by state and district. Check out its numbers here:

As for crime in general, a full picture is not available.

The FBI’s Uniform Crime Reporting Summary Reporting System (SRS), used since 1930, was an aggregate monthly tally of 10 major crimes. It was found to be technologically and procedurally outdated decades ago. The solution was a National Incident Based Reporting System (NIBRS) and the transition to it was supposed to be complete by January 1, 2021. The NIBRS can dive deeper and into more data for more types of crimes, including animal cruelty, identity theft, and computer hacking. However, participation is voluntary.

For 2021, the FBI reported that it only received data from 9,881 or 53% of the 18,818 law enforcement agencies (LEAs) in the country. Because that fell short of its 60% threshold, it only released 2021 quarterly data from “individual city agencies with populations of 100,000 or greater” but noted that it would not release state-level estimates if the participating LEAs in a state cover less than 80% of the state population.

For its 2022 statistics, the FBI has decided to accept SRS data submissions from any agency that has not yet completed its NIBRS transition.

One veterinary hospital that has experienced violence is Maplewood Animal Hospital in Bellingham, Washington.

David Rabkin, DVM, owner and medical director, recalled how in 2014 on a Thursday morning—his day off—a client came in to talk to a veterinarian about his cat that had unexpectedly died the night before. “They were sitting on a bench in the waiting room when the client pulled out a knife and stabbed the vet several times,” he explained. “The man then left the hospital and drove to another local veterinarian who had previously seen his cat and attacked a receptionist there.”

Most survey respondents not having problems

A January 2023 survey report on crime and violence in the veterinary practice recorded 175 responses by the Veterinary Hospital Managers Association:

  • 80% have not experienced any crime; 6% vandalism; 2% equipment theft; 5% money theft; 1% unknown; and 6% “other,” including attempted break-in, phoned-in death threat, and person high on meth harassing staff and clients and trying to break into the clinic and a car.
  • 89% have experienced no incidences of violence against a person at their practice; 5% have a staff member who was a victim of violence at the practice; 1% did not know; and 5% “other,” including threats but no acts and verbal abuse without physical contact.
  • 51% provide facility safety or awareness training; 37% do not; 4% contract with a third-party consultant to provide training; 3% don’t know; and 5% “other,” including OSHA safety only and fire safety and evacuation plans.
  • Of 174 responses, 28% have a written policy or procedure for an active shooter situation; 67% do not; 1% don’t know; 4% “other,” including having panic buttons and a policy not written but reviewed at multiple staff meetings.

“Hospitals sometimes don’t see that they have an issue or just ignore and hope it never comes up.”

—KimberlyAnn Mackey, CVPM, a former practice manager and a longtime parole supervisor for the Commonwealth of Pennsylvania

Rabkin explained that the veterinarian who was attacked was only a few years out of veterinary school and so traumatized by the incident that she left the field for several years. “After that incident, we worked on developing evacuation plans and made sure everyone was aware of the locations of panic buttons,” said Rabkin. “We had the local police department come in to do a talk and training. We facilitated counseling for the employees interested in that modality. Thankfully, no further incidents have occurred since that event. I would say that every practice should have in place response/evacuation plans in the event of this type of assault and reinforce these plans on a regular basis.”

Vestibule entryway at Adobe Animal Hospital in California.A vestibule—two sets of doors—can prevent a loose pet from escaping but also, if set up correctly, allows the front desk to control who can enter. This vestibule is at Adobe Animal Hospital of Petaluma, California.

From her unique perspectives of law enforcement and veterinary care, Mackey said she believes that more hospitals are seeing the need to look at security.

“Up until 2020, many veterinary practices didn’t have a lot of incidents where people were as vocal and physical as they are now,” she said, noting that veterinary practices’ access to controlled substances, both for pet owners and staff members, means security isn’t only about active shooters.

“Hospitals sometimes don’t see that they have an issue or just ignore and hope it never comes up. Practices think of themselves as family oriented and don’t think anybody would do anything violent,” said Mackey, who offers Zoom sessions and in-hospital training on conflict de-escalation. She suggested that veterinary hospitals develop a relationship with their local police and ask for their help in creating an active shooter plan or have them refer you to an agency that could. “Get the police familiar with your hospital by offering discounts for their pets or their K9 officers.”

De-escalation training can help in difficult situations, advised Mackey. She noted that staff members can learn to read the body language of someone who might be upset or a threat, listen to clients and not talk over them, and use their own voice and body stance to help calm others. She shared these ideas for security considerations:

  • Have working security cameras in several areas, including the pharmacy and waiting room.
  • Consider having a safe room with a steel door.
  • Conduct CPR/first-aid training and have a first-aid kit available.
  • Consider interteam communication devices.
  • If there is an incident, immediately write down a clear physical description and details before memories get clouded.
  • If a hospital uses curbside service, have a plan to ensure the safety of any staff member who has to go outside to interact with clients.
  • Consider having code words for potentially dangerous situations, including ones that would prompt someone to call 911.

Absecon Veterinary HospitalAbsecon Veterinary Hospital worked with its local police department and rolled out its active shooter plan late last summer.


  • The Veterinary Hospital Managers Association is offering a preconference workshop: “Understanding, Preventing and Responding to Violence and Conflict in the Workplace” from 8 a.m. to 4 p.m. Sept. 20, 2023, featuring Ray McGury and Mike Zegadlo from RJM Strategy Group. The VHMA Annual Meeting and Conference runs Sept. 21–23 in Glendale, Arizona.
  • The FBI offers active shooter training for businesses. Reach out to your local FBI field office, and ask for the Active Shooter Coordinator.
  • US government agencies have many active shooter planning resources online, including: The FBI’s realistic, informative video on suggested “Run, Hide, Fight” tactics at
  • The Cybersecurity and Infrastructure Security Agency’s fact sheet for businesses: and emergency action plan guide and template:
  • The Department of Homeland Security’s “Active Shooter: How to Respond” guide:

At Maplewood, Kristina Laux, hospital manager, noted how the pandemic “really brought out the worst in some people, and we were taking the brunt of people’s frustrations. People were upset that they couldn’t come in, that they had to wear a mask, that the wait time was so long.”

She said the hospital has put up in-house signs and added call-waiting messages that focus on respect and zero tolerance for aggression. “They have really made people think a bit more, and overall, I believe it’s working,” she said. “I really feel that we need to spread as much positivity as possible, as it’s so easy to spread negativity and hate. We’re here to be healers and help in any way possible.”

Maureen Blaney Flietner is an award-winning writer living in Wisconsin.

Photo credits: Peter_visual/iStock via Getty Images, PeopleImages/iStock via Getty Images, Photo courtesy of Tim Murphy, FotoImagery, Photo courtesy of Absecon Veterinary Hospital



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