Practice Management Alert

The recent mass shooting in a Tulsa, Oklahoma, hospital underscores the need to be prepared.

Gun violence is a fact of life in the United States, and, unfortunately, healthcare personnel may find themselves in a situation where they are dealing with an active shooter, and not just the medical management of the results. Many healthcare facilities (HCFs) include inclement weather or disasters in their emergency preparedness, but is your practice or organization also considering how to deal with active shooters?

“Most HCFs practice evacuation drills for fires and take protective measures for tornadoes, but far fewer HCFs practice for active shooter incidents. To be prepared for an active shooter incident, training and exercises should include what to expect and how to react,” says the resource guide “Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans.” The resource guide was compiled by several federal government agencies, including the U.S. Department of Health and Human Services (HSS), U.S. Department of Homeland Security (DHS), U.S. Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and the Federal Emergency Management Agency (FEMA).

Plan Now

Experts say that active shooter scenarios escalate rapidly, so knowing exactly what to do is crucial, rather than trying to make major decisions in the moment. 

“Health care professionals may be faced with the decision about the safety of patients and visitors in their care who may not be able to evacuate due to age, injury, illness, disability or because of an ongoing medical procedure. Understandably, this is a sensitive topic. As appropriate for the HCF, it may be valuable to schedule times for open conversations with employees to explore this topic,” the federal agencies say.

The agencies recommend that your plans include:

• proactive steps, including training for employees;
• a way to communicate during the incident, including with people who may be entering the HCF;
• evacuation policy and procedure;
• emergency escape routes and safe areas;
• lockdown procedures for rooms, halls, floors, etc.;
• integrated communication between facility and external incident commanders; and
• contact information, including internal contacts, for local area response agencies.

Basically, you want to be as proactive as possible in preventing situations from occurring in the first place by securing entrances and taking other defensive precautions, but also have the practiced ability to communicate to staff and patients what they should do in such a situation and when and where they should do those things.

Prioritize Training

The federal government resource guide advises focusing on training staff to act quickly. People experiencing an active shooter situation may not be able to think clearly, so being able to rely on the “muscle memory” of training can be very helpful.

Important: With high staff turnover rates throughout the healthcare industry, getting all employees up to speed may feel like a Herculean task. Work with local law enforcement and human resources to figure out how best to incorporate such training into onboarding, as well as continuing education programs.

“Train staff to overcome denial and to respond immediately. For example, train staff to recognize the sounds of danger, act, and forcefully communicate the danger and necessary action (e.g., “Gun! Get out!”). In addition, those closest to the public address or other communications system, or who are otherwise able to alert others, should communicate the danger and necessary action. Repetition in training and preparedness shortens the time it takes to orient, observe, and act. Upon recognizing the danger, staff or others must alert responders as soon as it is safe to do so by contacting 911 with information that is as clear and accurate as possible,” the federal government agencies say.

A major aspect of preparing for an active shooter scenario is delegating which employees are in charge of which responses. At the very least, administrators should select an internal incident commander and that person should know their responsibilities and obligations during a situation.

Obviously, anyone present during an active shooter situation will need to make decisions on some level, but designating specific people to plan and execute various tasks will make planning smoother and increase preparedness.

However, recent research suggests that active shooter drills can in fact be dramatic, depending on the population involved. “While there is limited proof of the effectiveness of these drills, anecdotal evidence, including many online conversations, increasingly suggests that active shooter drills may be harmful to mental health,” notes a research report, “The Impact of Active Shooter Drills in Schools,” released by Everytown for Gun Safety and the Georgia Institute of Technology’s Social Dynamics and Wellbeing Lab. While the study focused on active shooter drills in elementary, middle, and high schools, people working in healthcare facilities or patients seeking treatment may be sensitive to the high emotions and fear a drill could impart.

Take Reality Into Account When Planning

Although the common mantra for active shooter scenarios is to “run, hide, fight,” patients, especially if actively undergoing a medical procedure, obviously may not be able to run or hide without assistance.

“While personal safety is the primary consideration in any emergency, helping others to safety increases the survivability for all potential victims. Rendering aid can be as simple as rallying likely victims to ‘Follow me!’ or aiding nonambulatory persons and performing immediate first aid in safer areas. Consideration should be given to children and others who may have difficulty evacuating without assistance,” the federal government says.

In these instances, it’s important, when and where possible, to help patients shelter in place. Draw the blinds, shut the lights, silence cell phones, turn off any music speakers or televisions.

Find out more about how to plan for various scenarios surrounding the aftermath of an active shooter situation in the next issue of Practice Management Alert.

Resource: www.phe.gov/preparedness/planning/Documents/active-shooter-planning-eop2014.pdf.