(163) The Policy Landscape for Armed Personnel in Health Care Facilities: A Preliminary Scoping Review of State Policies

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Background: The study objective was to identify the existence of state policies that authorize or prohibit ‎weapon access for law enforcement officials (LEOs) and hospital police/security in clinical contexts. In 2021, the ‎American Association of Emergency Psychiatry released a statement regarding armed responses in the emergency ‎department (ED) emphasizing preparation and training to prevent LEO-related violence (AAEP, 2021). Little is known ‎about this policy landscape despite growing concern among professionals and the fact that firearms are the most ‎common cause of work-related homicides for health professionals (Goodman, 1994). Data on hospital-based shootings ‎suggests that EDs are the most common site (29%), and within the ED, shootings often involved armed personnel ‎using their firearm (42%) or perpetrators taking the firearm from the armed personnel (23%) (Kelen, 2012).‎

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Methods: This preliminary scoping review followed the PRISMA-ScR checklist guidelines (Tricco, 2018). State ‎policies were included if they were related to on-duty personnel's ability to carry weapons in health care settings. We ‎used the Westlaw database without date parameters (most recent: 4/2/2023), and several search terms (available by ‎request). Policies were categorized by facility, policy type, weapon, year, policy target, and summarized.‎

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Results: Out of 514 statutes/case law and 33 rules/regulations identified there were 5 statutes/case law and 2 ‎rules/regulations from 7 jurisdictions (OH/VT/IL/UT/CA/NY/WV) related to our research question. None of the policies ‎mandated a prohibition on LEO's weapons access within clinical contexts. Some policies used a broader definition of ‎weapon (n = 4) versus firearm only (n = 3). Three policies stipulated that officers could carry firearms in clinical ‎contexts (WV/IL/CA). Two policies prohibited the use of weapons and LEO-restraints on patients (OH/VT). One policy ‎allowed mental health directors to designate "secure areas" disallowing weapons, requiring storage, and prohibiting ‎weapons in the facility (UT). Finally, one policy "does not authorize" the possession of firearms for hospital police (NY).‎

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Discussion: From this preliminary scoping review, we have not identified a state policy mandating the ‎prohibition of weapons/firearms from clinical contexts. Prior to this search, there was a paucity of information ‎available on state policies related to this topic. This review has limitations; a single database, no grey literature search, ‎and limitations of the search terms. Before November, we will expand the search to include other databases, ‎additional search terms, and grey literature.‎

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Conclusion: State policies for weapons access in clinical environments for armed personnel is scant. ‎Policymakers should proactively collaborate with hospital-based leadership and professional associations to identity ‎safety concerns and develop multilevel violence prevention strategies.‎

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References: ‎
‎1. AAEP. (2021). American Association of Emergency Psychiatry Statement on Armed Responses within Emergency ‎Departments. Retrieved from: https://www.emergencypsychiatry.org/aaep-position-statements.‎
‎2. Goodman, R. A. et al. (1994). Workplace-related homicide among health care workers in the United States, 1980 ‎through 1990. JAMA, 272(21), 1686-1688.‎
‎3. Kelen, G. D. et al. (2012). Hospital-based shootings in the United States: 2000 to 2011. Annals of emergency ‎medicine, 60(6), 790-798.‎
‎4. Tricco, A. C. et al. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of ‎internal medicine, 169(7), 467-473.‎