In a workplace dedicated to saving lives, hospital workers like the Dayton VA Medical Center employee who was shot by a retired co-worker earlier this week face greater risks than many of the patients they care for.

The risk of workplace violence in a hospital setting stems in large part from the heavy traffic and the unrestricted movement of the public, which is difficult to regulate no matter what type of security protocol is in place.

The Dayton VA has its own police force that regularly undergoes training to stop active shooters or hostile intruders, but they can’t be present everywhere on the massive hospital campus, said Ted Froats, a spokesman for the medical center.

“We’re open to the public 24 hours a day,” he said. “We have many anchors with many buildings. We can’t possibly have armed guards at every building 24 hours a day.”

Experts say hospital workers are most at risk during times of increased activity, such as mealtimes, visiting times and when staff are transporting patients.

The victim in the VA shooting, Paul Burnside, was shot in the ankle with a .38 caliber revolver during a lunchtime card game in a basement break room. His alleged assailant, Neil R. Moore, brought the weapon into the hospital unimpeded, based on his statement to police.

Moore, who has been charged with assault with a deadly weapon, among other crimes, told police he brought the gun to the card game to intimidate two ex-coworkers who were involved in intimate relationships with his wife and his daughter, who both work at the hospital. Burnside was shot trying to wrestle the gun away from Moore, according to police reports.

Mark Stusek, a former Dayton police officer and founder of the security consulting firm, G2G Solutions, said the confrontation might have been avoided if hospital workers paid closer attention to the workplace rumor mill.

“Usually in a case like this there are some warning signals out there, and by warning signals I mean there is some discussion going on about people doing things and somebody being upset,” Stusek said. “As a leader and a manager, I need to call those people in and let those people know that what they’re doing could have consequences. And if there is something out there, I would hope somebody would have said, ‘If you see Mr. so-and-so, and he comes on the grounds, you might want to keep and eye on him.”’

Froats said the VA encourages its employees to remain vigilant, but no matter what precautions are taken, it’s nearly impossible to achieve zero-risk security at any facility open to the public.

“We do tell employees specifically, and certainly our security forces, to be on the lookout; if something looks weird to you, report it,” he said, acknowledging no preventative measures are full-proof. “You just have to find the most realistic solution possible.”

At the VA, those solutions include a public broadcast system to notify all employees and patients when an active shooter is on the premises and guide them to take immediate shelter where they are; an automated email system that goes out to all employees notifying them of the situation; and an automated text-messaging system.

Hospital shootings are rare, according to the U.S. Bureau of Labor Statistics’ Survey of Workplace Violence Prevention. But they occur more often in hospitals today than they did a decade ago, and the shooters often share many characteristics, based on a study conducted by physicians at Johns Hopkins Hospital in Baltimore.

The majority of perpetrators were men; about a third were in current or estranged intimate relationships; and more than a quarter were current or former patients or former employees, based on a review of 11 years of data published September 2012 in the Annals of Emergency Medicine.