A federal agency is encouraging nursing homes to take a refresher course on preparing for active shooters after a deadly incident at a Chicago hospital last week.

An emergency room doc, pharmacist and police officer all died after gunman Juan Lopez opened fire at Mercy Hospital and Medical Center on the afternoon of Nov. 21. In the aftermath, the Office of the Assistant Secretary for Preparedness and Response encouraged all providers to review its planning and response guide for active shooter incidents, as well as other resources issued by the agency.

Five shootings have already occurred in or around healthcare facilities this year, ASPR noted in an email to providers last week. In one July incident, a Texas man shot his father and stepmother before killing himself at the Retama Manor Nursing Center in Robstown, TX.

“The unfortunate reality is that all hospitals and communities are vulnerable,” the office said in its email. “While we can’t predict such an event, we can improve our awareness. It is critical for you to prepare your facility and staff as thoroughly as possible for the threat of an active shooter through your emergency response planning.”