But after recent events like the shooting at the movie theater in Aurora, Colo., in July 2012, and at Sandy hook Elementary School last December, HCA hospitals such as Medical Center of Trinity have reconsidered their policies to include preparing for a gunman on their hospital campuses, although up to this point, there's never been an incident.
To determine their strengths and weaknesses in handling the unthinkable, Medical Center of Trinity recently participated in an "active shooter drill" in partnership with the Pasco Sheriff's Office SWAT team and the chief forensic investigator and SWAT tactical commander, James Steffens.
"With all the events going on in the country and the world lately, the question has become when and not if," said Thibaut van Marcke, the chief operating officer and incident commander at the Medical Center of Trinity.
The drill was designed to be as realistic as possible, with an "armed" suspect entering through a side door after obtaining an employee's swipe badge. The gunman's weapon was loaded with blanks and although hospital employees and patients were given a heads up about the drill, the sound of shots in the hallways was unnerving and frightening.
After the gunman "shot" a couple of hospital employees, resulting in their "deaths," he moved on to take the hospital's CEO, Leigh Massengill, hostage in the administrative offices. Hostage negotiators were called in to reason with the shooter, with resulted in him releasing Massengill and then taking his own life, according to the drill's scenario.
Unlike other drills, which involve first responders running to the scene of the accident to help victims immediately, van Marcke said, hospital employees need to run away from the shooter and hide in order to stay safe and help prevent patients and other employees from becoming victims. It goes against the instincts of nurses and doctors, which is why the drill is so important.
"Having (SWAT members and the shooter) in character and in uniform and looking outside to see the lights flashing - it raised gooseflesh," van Marcke said.
The drill took four hours to complete, but in a real active shooter scenario the incident could take several more hours or even days to resolve.
"You had to get into it because it was very real," said Massengill, who felt anxious and tense while portraying a hostage, despite knowing it was a drill.
Hospital employees are now required by HCA to complete online training modules related to policies created to handle active shooter situations, van Marcke said, so the drills will need to happen on a consistent basis to keep employees trained and on their toes.
"We plan for the bad day, hoping of course, that it never comes," Steffens said.
Van Marcke said the active shooter drill will likely take place a couple of times a year, along with regular drills for hurricanes, hazardous spills, fires and an influx of victims in the emergency room from shootings elsewhere in the county.
"Drills are not new to us," he said.
Medical Center of Trinity holds shooter drill