The recent rise of active shootings calls for adequate preparation. Currently, the ‘Run, Hide, Fight’ concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the ‘Run, Hide, Fight’ concept application in hospital, a review of currently available data is needed.

A systematic review was done focusing on the ‘Run, Hide, Fight’ concept using multiple databases from the last 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept.

One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the ‘Secure, Preserve, Fight’ concept, as a response protocol to active shootings in hospitals.

The effectiveness of the ‘Run, Hide, Fight’ concept in hospitals is questionable. The ‘Secure, Preserve, Fight’ concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the ‘Run, Hide, Fight’ concept.