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Preparing for an Active Shooter

Preparing for an Active Shooter

A Gunshot is Heard….

HCIS Senior Care Blog

Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS
Executive Consultant

May 24, 2016
Preparing for an Active Shooter
A Gunshot is Heard in a resident’s room, the dining area or the front entrance. Are your staff trained to respond? Will their actions include recognition and response to save lives, providing first-aid and triage in a safe and secure area, notifying key emergency response providers, and providing clear and actionable directions to residents, families and staff before emergency personnel arrive? 1Many active shooting incidents end before law enforcement officers are on the scene.2

And the Headlines Read….

News

“Married couple dead in Houston nursing home shooting
By Stephanie H. Kim, June 27, 2014. A man allegedly shot and killed his wife in a Texas nursing home before killing himself Thursday morning, police reported.


Visitor shot and killed on the grounds of an assisted living community in Kansas
By Tim Mullaney, April 15, 2014. A woman visiting her mother at an assisted living facility in Kansas was gunned down in the parking lot Sunday, in what authorities are describing as a hate crime.

Woman with dementia, comatose nursing home resident shot in possible ‘mercy killings’
By Tim Mullaney, December 12, 2013. Police arrested a man in connection with the shooting deaths of his wife, who had dementia, and his sister, who was in a coma at a nursing home, authorities in Los Angeles announced Wednesday.”3

 

Laptop and Notepad

 

Saving Lives Requires Facility Preparation and a Plan

The key elements of preparation include: assessment, planning, training, incident response, post-incident response, debriefing and psychological first-aid and response evaluation. Consider the following as a starting point when developing an emergency management plan for an active shooter incident:

  1. Conduct an annual vulnerability and security assessment of the facility. Ask healthcare team members what concerns them about the security of the facility. Review and analyze security incidents and reports of suspicious behavior.
  2. Train staff to recognize and report escalating and suspicious behavior and incidents of workplace violence.
  3. Develop a written plan for active shooter response that includes, but is not limited to (4):
    • o How to report an active shooter incident.

 

    • o An evacuation plan with policy and procedures, including when primary routes are unusable.

 

    • o Emergency escape procedures and route assignments (i.e., floor plans, safe areas).

 

    • o Lockdown procedures.

 

    • o Incident command responsibilities and location. Law enforcement may request a separate command center.

 

    • o Local/area emergency response agency phone numbers.

 

    • o Incident communication plan (internal and external) including residents, family members and staff. Provide plain language communication and directions. Include a plan for individuals with language barriers.

5

    • o “How to select effective shelter in place locations (optimal locations have thick walls, solid doors with locks, minimal interior windows, first aid emergency kits, communication devices, and telephones or duress alarms).”

6

    • o Current building information for first responders (e.g., floor plans, elevator shut- down locations, location of security cameras).

 

    o Responsibility for building access control and building access parking for emergency vehicles (e.g., first responders, family and visitors, media).

4. Develop and review the response plan with external emergency response agencies at least annually.

 

Active shooter response safety procedure banner with stick figures: run, hide or fight

5. Identify an Active Incident Response Plan for staff and key communication language – two examples are noted :

Run, Hide, Fight

Run

    • – is to immediately evacuate the area

Hide

    • – seek a secure place where you can hide and/or deny the shooter access

Fight

    • – where your life or the lives of others are at risk, you may make the personal decision to try to attack and incapacitate the shooter to survive

74 A’s Active Shooter Response

A

    • ccept that an emergency is occurring.

A

    • ssess what to do next so that you can save as many lives as possible, which depends on your location.

A

    • ct: Lockdown (lock and barricade the doors, turn off the lights, have patients get on the floor and hide or evacuate or fight back (last resort).

A

    • lert law enforcement and security

8

6. Train for an active shooter incident with emergency response agencies.
7. Establish a formal plan and responsible person for staff, resident, family and media communication during and after the event.
8. Identify a formal process for staff debriefing and psychological first-aid.
9. Develop a formal process for resident and family support post-incident.
10. Evaluate the response plan post-event and establish action steps as needed.

 

Resources available For Healthcare Organizations

• Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [Online April 2015] https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/active-shooter-planning-and-response-in-a-healthcare-setting. 5/19/2016
• U.S. Department of Health and Human Services, U.S. Department of Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation, Federal Emergency Management Agency. Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans. [2014]. http://www.phe.gov/preparedness/planning/Documents/active-shooter-planning-eop2014.pdf 5/18/2016.
• Emergency Preparedness, California Hospital Association. Planning for Active Shooter Incidents. http://www.calhospitalprepare.org/active-shooter. 5/19/2016
• Homeland Security. Active Shooter Preparedness. https://www.dhs.gov/active-shooter-preparedness. 5/19/2016

Resources available in the HCIS Senior Care Resource Center:

A Study of Active Shooter Incidents in the United States Between 2000 and 2013
Author: US Department of Justice (DOJ)
Active Shooter Planning and Response in a Healthcare Setting
Author: Healthcare and Public Health Sector Coordinating Council
Active Shooter Pocket Card
Author: US Department of Homeland Security (DHS)
Active Shooter Pocket Card – Spanish Version
Author: US Department of Homeland Security (DHS)
Active Shooter Poster
Author: US Department of Homeland Security (DHS)
Active Shooter Poster – Spanish Version
Author: US Department of Homeland Security (DHS)
Active Shooter Training Course Announcement
Author: US Department of Homeland Security (DHS)
Active Shooter: How to Respond
Author: US Department of Homeland Security (DHS)
Gun Control in Senior Housing Communities: It’s Time to Start Thinking the Unthinkable
Author: Thilman Filippini
How to Respond to Active Shooter (Flier)
Author: US Department of Homeland Security (DHS)
Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans
Author: HHS, DHS, DOJ, FBI, and FEMA
NYPD Active Shooter – Recommendations and Analysis for Risk Mitigation
Author: New York City Police Department (NYPD)
Pendulum Resource Document: Active Shooter Preparedness
Author: United States Department of Homeland Security and Pendulum, LLC
Suspicious Behavior Awareness Card
Author: Federal Bureau of Investigation (FBI) and US Department of Homeland Security (DHS)

Sources

(1)U.S. Department of Health and Human Services, U.S. Department of Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation, Federal Emergency Management Agency. Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans. [2014]. file:///C:/Users/Cyndi/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.IE5/MM447SWP/active-shooter-planning-eop2014.pdf. 5/18/2016.
(2)U.S. Department of Justice Federal Bureau of Investigation; A Study of Active Shooter Incidents in the United States Between 2000 and 2013. [Online September 16, 2013]. https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/a-study-of-active-shooter-incidents-in-the-u.s.-2000-2013. 5/18/2016
(3)McKight’s The News You Need. Shooting. http://www.mcknights.com/shooting/topic/3691/.5/18/2016
(4)Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [Online April 2015] https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/active-shooter-planning-and-response-in-a-healthcare-setting.5/19/2016
(5)Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [Online April 2015] https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/active-shooter-planning-and-response-in-a-healthcare-setting. 5/19/2016
(6)Ibid
(7)U.S. Department of Health and Human Services, U.S. Department of Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation, Federal Emergency Management Agency. Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans. [2014]. http://www.phe.gov/preparedness/planning/Documents/active-shooter-planning-eop2014.pdf 5/18/2016.
(8)Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [Online April 2015] https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/active-shooter-planning-and-response-in-a-healthcare-setting. 5/19/2016

This blog, which does not reflect any official policy or opinion for Vaaler Insurance, Inc. or Siders Healthcare Consulting, LLC, is provided for informational purposes only. It is not intended to provide legal or medical advice, nor is it intended to be an exhaustive list of all risks that need to be addressed for a healthcare organization. While every effort is made to provide accurate information, changes may occur and inaccuracies happen despite best efforts. This information is not a substitute for individual consultations with professionals in these areas and should not be relied on as such; please work with your local law enforcement, professionals, and legal counsel for a plan that is specific to your organization.
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