Practice Management Alert

Plan and train now.

If your healthcare facility ever experiences gun violence, your employees and patients will also experience the aftermath of gun violence.

“As we have said repeatedly since declaring gun violence a public health crisis in 2016, gun violence is out of control in the United States, and, without real-world, common-sense federal actions, it will not abate,” said Gerald E. Harmon, MD, president of the American Medical Association (AMA), in response to the recent Tulsa hospital shooting.

Here’s what several federal agencies — U.S. Departments of Health and Human Services (HHS), Homeland Security, Department of Justice (DOJ), FBI, FEMA — recommend healthcare facilities plan and execute in the moments and days after gun violence.

Assign Roles, Account for People

Important: “It is important to note that once the active shooter is apprehended or incapacitated, the situation and the location will be an active crime scene. Nothing should be touched unless it involves tending to the wounded,” the federal agencies say.

If your healthcare facility is a place designated to accept victims as patients in a mass casualty event, plan for an influx of people and emergent needs.

Once an active shooter is no longer a threat, human resources (HR) or a person in management should start accounting for the people known to be in the facility at the time. This includes patients, staff, and vendors. (This kind of scenario is a good reason for your organization to have stringent protocols around staff clocking in and anyone else signing in.)

The person in charge of this accounting should be counting people, noting whether anyone is injured or missing, and then coordinating with first responders.

The federal agencies note that it would probably be up to HR or a manager or administrator to contact the families of anyone affected (missing, injured, killed), but that this should be done in coordination with law enforcement. Communication should be a top priority in both preparedness planning and execution.

There should be a safe space available for employees and affected patients to reunite or unite with their families (or where families can wait for information), which should be communicated to those affected without the pressure or presence of the press.

“Within an ongoing and/or evolving emergency, where the immediate reunification of loved ones is not possible, providing family members with timely, accurate, accessible, and relevant information is paramount. The local or regional mass fatality plan may call for the establishment of a family assistance center to help family members locate their loved ones and determine whether or not they are among the casualties. This center should be placed away from media view or exposure,” the federal agencies say.

If your medical organization sees minors, make sure you include a child release process to ensure that any children involved are released only to authorized people, the agencies note.

Provide Immediate and Long-Term Resources

Once the initial accounting has been performed, a designated staff member should have information available for victims to access resources like distress helplines, counselors, and employee assistance, as well as platforms for recovery support. Facilities should plan in advance to make sure all of these resources are accessible to those who are blind, have low vision, deaf, hard of hearing, low literacy, or other communication disabilities, as well as individuals who may not speak or read English proficiently.

Make sure there are backups for all of these responsibilities or other organizational gaps in case any of the people designated to fulfill these duties are hurt or killed by the active shooter. Organizations should also know who will be responsible for determining if, how, and when full services will resume.

Besides the immediate actions of tending to the wounded and not touching anything that would affect the facility as a crime scene, it’s important to have a plan in place that emphasizes that an affected facility will be subject to an extended and evolving investigation. This is part of the continuity and succession planning that should already be part of your general and specific emergency preparedness plan and response.

The federal agencies note that part of your planning should include training personnel to provide assistance to victims, witnesses, and their families, including an incident response team (which includes first responders). These are the folks who should be able to assess and triage victims immediately and help throughout the recovery, eventually integrating with local or state or federal resources and response teams.