Practice Management Alert

Make plans now to avoid loss of life from shooting events.

Americans have, for years, lived with the threat of being gunned down while conducting normal, routine business. While some gun violence situations are large-scale and saturate news reports, like the recent tragedy in Las Vegas, workplace violence involving a gun is even more common and happens every day.

“In today’s ever-changing environment, no business or organization is immune from violence. Whether it is a church, movie theater, mall, or healthcare setting the need to plan for an active shooter event is of paramount importance. The incident rate of violence against EMS and healthcare workers is a problem that is significantly underreported but affects thousands of workers across the country,” says Paul Brennan, president of International Association of Emergency Medical Services Chiefs, in Washington, D.C., in a presentation on active shooter situations for healthcare service providers and workers.

The FBI released a study in 2014 of 160 active shooter incidents from 2000-2013, and found that majority of incidents occur in the workplace: 138 took place in a workplace of some kind, including four in healthcare facilities; 73 in commercial environments; and the remainder in educational environments, government and military properties, and houses of worship.

Consultants hired by healthcare companies and facilities to train staff and prepare plans for active shooter scenarios offer stark warnings in their prep talks. “The possibility of an active shooter incident is no longer a question of if, but rather when and where,” says Steven Crimando, MA, BCETS, CHS-V, principal at Behavioral Health Applications, in a presentation titled “Active Shooter Preparedness and Response in Healthcare.”

“Incidents can occur at any time and at any place. No type of location or geographic area is immune,” he says.

First, it may be helpful to brush up on some language basics of security professionals and first responders, so you and your practice can be specific in your planning and preparedness, as well as provide law enforcement with the information they need, should this happen:

• “‘Active shooter’ is a term used by law enforcement to describe a situation in which a shooting is in progress and an aspect of the crime may affect the protocols used in responding to and reacting at the scene of the incident,” says the FBI in a 2015 report. These situations may be premeditated.
• A “shooting incident,” on the other hand, is usually emotionally driven and spontaneous, Crimando says.

Active shooter events in a healthcare setting present unique challenges, Brennan explains, including:

• a potentially large vulnerable patient population;
• hazardous materials (including infectious disease);
• locked units; and
• special challenges, such as weapons and magnetic resonance imaging (MRI) machines. “These machines contain large magnets which can cause issues with firearms, or remove it from the hands of law enforcement, as well as caregivers who can respond to treat victims,” he says.

“There is no single method to respond to an incident, but prior planning will allow you and your staff to choose the best option during an active shooter situation, with the goal of maximizing lives saved. The best way to save lives is to remove potential targets from the shooter’s vicinity,” Brennan adds.

Consider Your Facility’s Design

Look toward infrastructure and practice space when you or team members are evaluating risks and coming up with plans and procedures for shooting incidents. Pay special attention to entries and exits from your practice, and within your practice’s building, including doors, windows, stairs, and elevators, where applicable.

While shatter-resistant window film or security bars or grills at windows may seem like a practical way to keep the “bad guys” out, it could also prevent victims from escaping an active shooter scenario, says Michael Finklestein in a 2015 article in Security Magazine. Consider doors, too: Fewer doors means fewer access points, it also means fewer routes for evacuation. “The proper application of this practice would be limited exterior doors with both the ingress and egress function. Several other doors should be egress-only emergency exits with no external hardware or hinges,” Finklestein says.

Don’t forget about your actual practice office, too. Do your exam room doors and personnel office doors have locks? If not, consider finding space in your budget to change the knobs out to include interior locks — while it may be inconvenient to have to search for a key if you’re locked out, doors with locks could save lives in a shooting incident.

If you don’t already have an alert system so your receptionists or front of office personnel know when someone’s coming in the door, consider installing one. Security cameras are also helpful for law enforcement officials. When putting together your plans and procedures for shooting incidents, contact your local law enforcement officials or representatives to ask whether they can come through your practice and alert you to any particular challenges or contingencies unique to your space (or your region).

Evaluate, Talk, Practice

While no one wants to have to handle a shooting events, everyone should be prepared. Once you establish your policies, plans, and procedures for active shooters and shooting incidents, make sure your staff is trained to know what to do.

“Active shooter events at a healthcare facility present unique challenges; healthcare professionals may be faced with decisions about leaving patients; visitors will be present; and patients or staff may not be able to evacuate due to age, injury, illness, or a medical procedure in progress,” Brennan says.

As healthcare workers, you may have patients in the office or be in the midst of exams or other medical procedures. Include these routine aspects of your workday and practice into your plans. Know where you will direct patients, how you will contact law enforcement, how you will shelter in place or evacuate (depending on the situation). Conduct drills before or after your office opens, so staff know the way to the different evacuation points.

Make sure your plans account for a range in patient mobility, as well as other realities that could make it difficult to follow emergency instructions from staff, like hearing loss, vision loss, or requiring the assistance of a caregiver.

“Healthcare professionals have a duty to care for the patients for which they are responsible. Since incidents such as an active shooter scenario are highly dynamic, some ethical decisions may need to be made to ensure the least loss of life possible. Every reasonable attempt to continue caring for patients must be made, but in the event this becomes impossible without putting others at risk for loss of life, certain decisions must be made,” Brennan says.