A man armed with a gun and ballistics shield was shot dead during a two-hour stand-off at a general practice on the NSW south coast on Wednesday afternoon.

Police said the 34-year-old produced a firearm while at his doctor’s appointment at the Junction Street Family Practice in Nowra.

A dramatic stand-off ensued when police were called to the scene around 1pm, with some ‘hostages’ managing to escape the surgery as officers attempted to negotiate.

Assistant Commissioner Peter Cotter said the drama began when the man, who was known to police and the clinic, was seeing his doctor.

Cotter said he became “extremely agitated and spoke to many alarming things.

“During that conversation, and unprovoked, he produced a firearm.”

The Junction Street Family Practice in Nowra. Photo: Google Maps

Clinic staff contacted police around 1pm and a perimeter was established around the building on the leafy street.

Up to four people escaped the surgery while police were attempting to negotiate, leaving the gunman by himself, Cotter said.

“During this time police continued their conversations with the gunman through the open door and through the walls and the windows,” he said.

‘They shot him’

The man came out of the clinic about 90 minutes later, around 2.40pm, confronting the SWAT officers and brandishing what police believe was a semi-automatic Glock pistol.

“The police at the time were holding a ballistics shield (which) was dropped during this initial confrontation and the police retreated,” Cotter said.

The man picked up the dropped ballistics shield.

“The man picked up the shield, further brandished the gun, raising it in the air and raising it at police.

“A number of shots were fired by police in the direction of the man. He was hit multiple times.”

Video filmed by a woman from a building opposite captured a barrage of shots being fired through a clinic door before the man was declared dead.

At least 12 shots can be clearly heard, seemingly from more than one gun.

The woman exclaims on the video: “Oh my god, they shot him, oh my god they shot him’.

A still from the video showing SWAT officers bunched at the clinic door as shots are fired. Photo: Facebook (David Nightingale)

A little while later the man was pronounced dead, despite the efforts of paramedics to save him.

It is not yet known for certain whether the man fired shots at police or staff.

The man is yet to be formally identified, but is believed by police to be a local south coast resident.

He does not have an extensive criminal record and is known to police largely through previous medical and psychological episodes that required intervention.

Cotter said the man was known to the medical centre and staff.

“The next of kin of this man have been informed and obviously it is a tragic time and a tragic event for all his family and all of his friends,” Cotter said.

“Police respond to protect life. They responded today in absolute good faith.”

A critical incident team from the police homicide squad is investigating the circumstances leading to the death which will also be subject to an independent review.

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-with AAP