The purpose of this study was to determine hospital preparedness for an internal mass casualty/active shooter event at Tennessee hospitals. Data were collected during May of 2019 by surveying the CEOs of the 86 acute care hospitals in Tennessee. The survey solicited responses about training, preparedness, and internal evaluation of procedures. CEOs of 28 (32.5%) of Tennessee’s acute care hospitals responded to the survey. Just over half (53.6%) of those responding indicated that they believed their facility was prepared or well prepared for an active shooter event. The mean responses of CEOs who had experienced an active shooter event were significantly lower than those CEOs who had not. Seventy-two percent of CEOs indicated that policies and procedures for active shooter/mass casualty events were updated at least every other year.