Although active shooter incidents are less common than other violent acts in hospitals, they often result in death. Moreover, these events happen so quickly that there is rarely time for law enforcement to intervene. Healthcare employees must act fast to keep themselves, co-workers, and patients safe. However, this can only be accomplished with ongoing training and education.
As a public health professional, you can increase employee awareness and vigilance with a comprehensive approach that uses risk management software, training programs, and transparent procedures. Learn how to develop an active shooter response plan to prepare for, respond to, and recover after an incident.
Active Shooter Incidents on the Rise
Between 2007 and 2019, the FBI reported 333 active shooter incidents. Gun violence peaked in 2017 with 30 events before falling to 27 and 28 in 2018 and 2019, respectively. Yet, gun violence hit a new high in 2020, with the FBI designating 40 incidents as active shooter events. These figures don't include self-defense, gang or drug violence, crossfire, residential, or hostage situations.
Likewise, the Cybersecurity and Infrastructure Security Agency (CISA) said that between 2000 and 2017, "there were hundreds of hospital-related shootings, and active shooter incidents continue to increase." The Joint Commission (TJC), which certifies over 22,000 organizations and programs per year, reported 39 shootings at accredited facilities resulting in 39 deaths between 2010 and 2020.
Here are the facts behind these 39 shootings and subsequent deaths:
- Twenty-one victims were healthcare employees: Patients shot ten staff members, visitors shot five, family members shot four, and a current or former co-worker shot two.
- Eighteen targets were patients: A family member shot 15, two were shot by a visitor, and another patient shot one.
- Out of the 39 shootings, 12 were considered murder-suicides, often resulting in the death of the patient and shooter.
Preparing for Active Shooter Incidents
Workplace violence prevention in healthcare requires a well-rounded approach covering all bases, including a security vulnerability assessment. Use insights from your evaluation to design or improve your safety protocols and emergency response plan. Additionally, work with local public service agencies to develop an active shooter training program.
Conduct a Security Vulnerability Assessment
A proactive approach is critical to preventing gun violence and protecting lives if and when an incident happens. The first step is to conduct a security vulnerability assessment. An evaluation helps you identify gaps in your security management and weaknesses in your facility, such as under-staffed entries, poorly lit corridors, and dead spots with cameras.
Furthermore, your security assessment should describe the potential threats to human lives, continuity of operations, and assets. Many healthcare organizations hire a third party to collect and analyze data. After which, the consultants, together with hospital leaders, develop a list of recommended actions.
Employ Safety Protocols
Having strategies in place can help your organization act quickly during an active shooter situation. Learn about the new and revised TJC workplace violence standards and review resources from the U.S. Department of Justice and the International Association of Emergency Medical Services Chiefs. Then work with your safety team and department leaders to devise a cohesive and thorough program.
The Joint Commission recommends developing plans that address the following areas:
- Work with local law enforcement
- Designate a comprehensive communication plan
- Document your facility's lockdown procedures
- Decide how you'll account for people in your building
- Plan for patient care continuity
- Provide ongoing training through drills and awareness programs
- Identify resources and a process for post-event debriefing and victim support
Developing an Active Shooter Emergency Action/Response Plan
Healthcare organizations need a custom active shooter emergency action/response strategy. This plan is your immediate response, such as the general recommended approach of Run - Hide - Fight. The U.S. Department of Homeland Security and CISA can offer resources like posters and informational sheets for your training booklets.
Design an Active Shooter Training Program
Take a four-step approach to your training, focusing on awareness, preparedness, emergency drills and exercises, and evaluations and improvements. It should be personalized to match your custom emergency response plan, so your staff follows facility and organization-specific protocols and processes.
In addition, courses should be specific to employee roles and departments, accounting for the types of patients, equipment, and vulnerabilities in each area. It's also imperative to involve leaders in your training program and complete an active shooter training course for all new employees.
Responding to Active Shooter Incidents
Your well-developed response strategies and ongoing training programs will improve the chances of survival for your staff, patients, and visitors. There are distinct differences in reactions between trained and untrained staff. Ongoing education will help your teams develop a survival mindset, which is critical to staying safe.
Trained vs. Untrained Response
Employees who are trained are ready to respond. Although they may feel anxious, repetitive training helps muscle memory actions kick in, and they act by moving into the positions they learned. In contrast, unprepared staff members may feel frozen with fear, panic, or deny that the emergency is genuinely occurring.
Maintain a Survival Mindset
A survival mindset refers to finding ways to stay safe, such as finding potential weapons of opportunity and hiding places while adding barricades to entries. During an active shooter event, your staff should leave their things behind and head for the nearest exit away from the intruder. Moreover, it's vital to call 911 and describe the situation, including your location and suspect details. Never assume another person has called – 911 is equipped to handle multiple calls and provide additional helpful information.
Recovering from Active Shooter Incidents
Once the danger has passed, your hospital has much work. Ensure that you cover your bases with a detailed list of follow-up actions and contacts. Establish policies and define who is accountable for each step. Leverage guides and tools from organizations like the National Mass Violence and Victimization Resource Center to prepare your toolkit.
Your post-incident recovery plan should provide resources for the following:
- Crisis management assistance
- ACT/biohazard clean up
- Public relations
- Legal counsel
Plan Ahead for Compliance
Prepare your healthcare organization to handle any crisis by assessing your active shooter protocols. Doing so will ensure that you meet TJC's new and revised workplace violence prevention requirements and are qualified to respond and recover after an incident. Learn more by requesting our whitepaper: Does Your Security Management Software Help You Meet Compliance and Create a Safer Workplace.
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