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A Gun Shot Is Heard… Preparing for an Active Shooter

A Gun Shot Is Heard… Preparing for an Active Shooter

HCIS Senior Care Educational Post

March 2018

A Gun Shot is Heard…

Mary has worked in your dietary department for the past seven months. She is known to be quiet and reserved with a warm and caring personality. Today Mary comes to work with significant bruising on the right side of her face and she has a black eye. She is wearing a long-sleeved turtle neck shirt, which is unusual for Mary because the dietary department is often very warm. You ask Mary if she is OK and she tells you that she slipped down the stairs at home carrying a basket of laundry and hit her face. She assures you that her face looks worse than it feels and she is prepared to complete her work shift. You encourage her to let you know if there is anything that you can do for her.

About two hours into the shift, Mary asks to see you in private. She explains that her husband is planning to eat lunch with her today. Mary tells you that her husband has been angry at home lately and she is hoping that he does not yell at her while they are together. You ask Mary if her husband is violent at home. She says he has a short fuse and often has angry outbursts, but he is not physically violent.

You suggest that perhaps it would be better if he came another day. Mary quickly tells you that changing the plans will make him very angry. You thank Mary for sharing this information with you, knowing that sharing personal information such as this can be very difficult. You remind Mary that safety is a priority at the organization; her safety as well as the safety of other staff, residents, and family members. Mary is asked to immediately notify a supervisor if she feels unsafe or concerned about her husband being in the facility.

Mary’s husband arrives and signs in as a visitor. He is pleasant and has casual conversation with the person at the desk. Mary is notified that her husband has arrived. As Mary approaches the front entrance, her husband pulls a handgun out of his coat pocket and shoots Mary. The team member at the welcoming desk is also shot as she screams and picks up the phone to call the police.

Preparing for an Active Shooter

Gunshots are 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?1 Many active shooting incidents end before law enforcement officers are on the scene.2

 

Shooting at nursing home in Chagrin Falls kills two”

WKBN First News 27 (March 24, 2016)

CHAGRIN FALLS, Ohio (AP) – Authorities say a kitchen worker at an Ohio assisted living facility has shot and killed two housekeepers and shot and injured himself in a domestic dispute that spilled over into the workplace.”3

Nursing home resident, 77, kills one and wounds two others at Wyoming senior center shooting”

Daily News (September 14, 2016)

CHEYENNE, Wyo. — A gunman shot three people — killing one — at a senior citizen apartment complex in Cheyenne on Wednesday morning before killing himself as officers closed in on him, police said.”4

 Officials: Gunman killed police chief before shooting 2 others at nursing home, self.CBS News (May 12, 2017)

KIRKERSVILLE, Ohio — An Ohio police chief was fatally shot by a gunman who then opened fire in a nursing home Friday morning, killing two others before turning the gun on himself”5

 

Saving Lives Requires Facility Preparation and a Plan

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

  • Conduct an annual vulnerability and security assessment of the facility. Ask healthcare team members what concerns them about the security of the facility. Regularly review and analyze security incidents and reports of suspicious behavior. Report event trends and action plans through the safety committee.
  • Train staff to recognize and report escalating and suspicious behavior and incidents of workplace violence.
  • Develop a written plan for active shooter response that includes, but is not limited to:6
    • How to report an active shooter incident
    • Local/area emergency response agency phone numbers
    • Lockdown procedures
    • An evacuation plan with policy and procedures, including when primary routes are unusable
    • Emergency escape procedures and route assignments (i.e., floor plans, safe areas)
    • Incident command responsibilities and location. Law enforcement may request a separate command center.
    • 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.7
    • Selecting “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).”8
    • Current building information for first responders (e.g., floor plans, elevator shut- down locations, location of security cameras).
    • Responsibility for building access control and building access parking for emergency vehicles – e.g., first responders, family and visitors, media
  • Develop and review the response plan with external emergency response agencies at least annually.
  • Train for an active shooter incident with emergency response agencies.
  • Establish a formal plan and responsible person for staff, resident, family, and media communication during and after the event.
  • Identify a formal process for staff debriefing and psychological first-aid.
  • Develop a formal process for resident and family support post-incident.
  • Evaluate the response plan post-event and establish action steps as needed.

 

 

 

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 survive9
  • 4 A’s Active Shooter Response –
    • Accept that an emergency is occurring.
    • Assess what to do next so that you can save as many lives as possible, which depends on your location.
    • Act: Lockdown (lock and barricade the doors, turn off the lights, have residents get on the floor and hide, as able) or evacuate or fight back (last resort)
    • Alert law enforcement and security10

 

Resources for Healthcare Organizations:

Resources available in the HCIS Senior Care Resource Center:

Author: US Department of Justice (DOJ)

Author: US Department of Homeland Security (DHS)

Author: Healthcare and Public Health Sector Coordinating Council

Author: Thilman Filippini

Author: US Department of Homeland Security (DHS)

Author: US Department of Homeland Security (DHS)

Author: US Department of Homeland Security (DHS)

Author: HHS, DHS, DOJ, FBI, and FEMA

Author: US Department of Homeland Security (DHS)

Author: New York City Police Department (NYPD)

Author: US Department of Homeland Security (DHS)

Author: United States Department of Homeland Security and Pendulum, LLC

Author: US Department of Homeland Security (DHS)

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]. http://www.phe.gov/preparedness/planning/Documents/active-shooter-planning-eop2014.pdf
  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.
  3. Shooting at nursing home in Chagrin Falls kills two. WKBN First News 27. March 24, 2016. http://wkbn.com/2016/03/24/shooting-at-nursing-home-in-chagrin-falls-kills-two/
  4. Nursing home resident, 77, kills one and wounds two others at Wyoming senior center shooting. Daily News. September 14, 2016. http://www.nydailynews.com/news/crime/wyoming-nursing-home-resident-77-kills-wounds-article-1.2792771
  5. Officials: Gunman killed police chief before shooting 2 others at nursing home, self. May 12, 2017. https://www.cbsnews.com/news/police-officer-shot-after-man-opens-fire-in-nursing-home/
  6. Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [2017] https://www.fbi.gov/file-repository/active_shooter_planning_and_response_in_a_healthcare_setting.pdf/view [3/1/2018]
  7. Ibid
  8. Ibid
  9. 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 3/2/2018.
  10. Healthcare and Public Health Sector Coordinating Council. Active Shooter Planning and Response in a HealthCare Setting. [2017] https://www.fbi.gov/file-repository/active_shooter_planning_and_response_in_a_healthcare_setting.pdf/view [3/1/2018]

 

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 legal counsel and business advisor(s) for a plan that is specific to your organization. © 2018 Vaaler Insurance, Inc. 

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