ACTIVE SHOOTER: NEW GUIDANCE FOR HEALTHCARE WORKPLACE INCIDENTS
Workplace violence, and specifically active shooter incidents, are a real threat for hospitals and healthcare facilities. Emergency preparedness managers need to consider planning, response and recovery efforts as well as ethical and legal considerations.
These five takeaways were presented in a webinar on Nov 16. The entire webinar can be accessed at ModernHealthcare.com/ActiveShooter.
Conduct work area evaluations
Shootings in healthcare environments are atypical from others because there’s a variety of different locations and people that can be affected—for example, special patient areas like forensic rooms, biohazard rooms, radiation rooms, etc. Also, certain patients may be unable to move due to handicaps, unconsciousness, or open operations. This brings up an ethically tricky discussion on whether staff should stay to protect the patient, or evacuate with the idea to survive so they can return to their care later. One size doesn't fit al, so each hospital must evaluate these issues for their own specific policies.
Develop an emergency communication plan
Communication strategies by the hospital are another important element. “The very best way to reduce the number of victims, or even prevent any, is through good communication that can deprive the shooter of their targets,” says Crimando. “This is done by letting people know where the shooter is, where they can go to for safety, and what they can do next.” He suggests communicating plain, concise language, rather than coded text, through multiple channels like texting, emergency emails, or other messaging systems. Giving people good, clear instruction is calming and helps them stay focused in executing plans appropriately.
Learn signs of a potentially volatile situation
Healthcare workers are 4 to 5 times more likely to be assaulted on the job than any other kind of employee. Therefore, they must be able to identify individuals who may be on a trajectory to commit violent acts. According to Steve Crimando, principal at Behavioral Science Applications, shooters in healthcare environments typically have specific motives for specific targets, whether based on a personal grudge, an angry reaction to news, or even a desire to end the life of an ill relative. It’s important for staff to learn the signs of a potentially volatile situation so they can help prevent an incident from occurring.
Pre-develop a response and evacuation plan
One thing to consider is a person’s “response gap”, or immediate reaction in the case of an emergency. It’s suggested to run if you can, hide if you can’t, and fight only if you must. Crimando asks healthcare workers to go beyond this "run, hide, fight" approach to a more expansive one of “stop the killing, stop the dying, stop the crying.” This model suggests confronting a shooter if the opportunity permits. “Granted, it depends on the circumstance and the person’s judgment in that moment. But I’m inviting you to share this with your leadership, because this may mean an adjustment in thinking and training,” he says.
Crimando also advocates for bystander interventions, both in tending to wounded victims and in dealing with emotional reactions that may increase fear and arousal.
Train on how to deal with the immediate aftermath
After a shooting event is handled and an “all clear” is given, a few steps should be taken in the aftermath. It’s important to make sure communications are extended on issues like family unification, business continuity, and crime victim services. It’s also important to offer special resources such as mental health support.