A Hennepin County Medical Center employee looked for escape routes as the man bearing a gun stood above him. He considered spraying the fire extinguisher as a distraction, so co-workers could flee. Maybe he could race to the door before the gunman fired.

Tuesday’s episode was only an exercise, and the gunman was only firing balls of paint. But the “active-shooter” drill was just the latest example of the way hospitals and clinics are preparing themselves to prevent and respond to violence that is increasingly common for health care providers.

The latest example came this week, when authorities confirmed that obstetrician Stephen Larson was killed in his Orono home by a man who was said to be upset over his mother’s medical care.

“All you have to do is turn on the news,” said Mike Cole, a retired security chief for Hennepin County Medical Center (HCMC), who organized Tuesday’s drill. “I don’t think a day or two goes by that there isn’t an incident.”

While emergency room doctors and nurses have long been at risk when seeing patients who are inebriated or in psychiatric crisis, Minnesota safety officials say that the problem is spreading beyond the ER and mental health units and that assaults have been reported from the maternity ward to the pathology lab.

Federal workplace injury data show that doctors, nurses and mental health workers are more likely than other workers to be assaulted on the job. The share of health care employees who missed work due to injuries caused intentionally by others was 6.5 per 10,000 workers in 2011 — four times the overall U.S. rate.

“Hospitals used to be sacred places,” said Joy Plamann, medical care center director at St. Cloud Hospital. “They aren’t anymore.”

Injuries and deaths outside the medical setting aren’t counted as workplace incidents, but health care officials say they’re concerned about the risks reflected in Larson’s death.

Family was stunned

Larson’s eldest son said Wednesday that the shooting of the 74-year-old doctor stunned the family, who had never heard of the alleged shooter, Ted C. Hoffstrom, a 30-year-old law school graduate from St. Anthony.

“It’s a complete surprise and obviously a shock to us,” Larson’s son Christopher Larson said in an interview. “None of us had ever heard his name or are aware of any prior contact whatsoever.”

Authorities said earlier this week that Hoffstrom had expressed hostility toward Larson because of how he believed the doctor had treated his mother in an undisclosed medical situation.

“We are still trying to comprehend this sudden and tragic loss,” the Larson family said in a prepared statement. “We will always grieve the way Stephen’s life ended.”

Task force formed

Growing concerns at hospitals this year prompted the Minnesota Department of Health to form a task force on how to prevent and respond to violence.

Deaths or serious injuries in hospitals due to violence are among the 29 preventable “adverse events” that the Health Department tracks in an annual safety-improvement inventory. Since 2005, there have been only eight such incidents reported to the state. But health officials say many other assaults and threats go unreported — often because hospital workers have compassion for their patients and don’t want to get them in trouble.

“It could be the black eye or the injury that does not rise to the level of missing work,” said Diane Rydrych, the Health Department’s director of health policy.

St. Cloud Hospital, for example, reported 182 assaults or “aggressive incidents” in a 12-month period ending this June.

St. Cloud’s CentraCare health system started a safety training program in the fall of 2010 after three incidents at the hospital, including one in which a patient threw a computer at nurses. CentraCare wants employees at the hospital, clinics, nursing homes and other facilities to complete an eight-hour training session by this summer.

Caregivers who simply absorb physical or verbal threats — and don’t report or deal with them — can suffer from the stress, said Plamann, the St. Cloud executive who is leading the safety training. Some become calloused and harsh toward patients as a defensive measure; others become afraid and even suffer post-traumatic stress disorder.

Prevent stalking

Medical schools rarely teach what doctors should do when threatened, so residents assigned to HCMC’s emergency department receive advice from Dr. Jeffrey Ho, an ER physician and a part-time deputy for the Meeker County Sheriff’s Office.

Physicians’ personal information is kept private, for example, so distraught patients or relatives can’t stalk them or harass them at home. Residents also are trained in dealing with unstable or aggressive patients who often arrive at the ER in the backs of squad cars.

“[Police officers] have all been trained in these tactics,” Ho said. “But then they bring these people to my emergency department — where I have received no training and I have to take care of them?”

HCMC also trains its staff on how to talk to upset people so they don’t become violent — a concept called verbal judo — and on other safety strategies. “We talk about how to position yourself in a room … so you have an escape path,” Cole said.

More paintball training

HCMC’s active shooter training will be offered to more doctors and nurses soon.

The paintball facility, Splatball in Minneapolis, was configured to look like a typical unit at the hospital. Workers then practiced responses to a variety of threats — first when a shooter entered the room and immediately pelted them with balls of paint, and later when the shooter entered with the weapon and demanded to know why he hadn’t received his medication yet.

The use of stinging paintball pellets created urgency for the participants, who learned when to fight, hide or run, said Bill Leone, an HCMC security investigator.

Leone played the role of shooter in Tuesday’s drill, and at one point was sprayed with a fire extinguisher.

“Everybody learned a lot about themselves and how they would react,” he said.