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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 ModernHealth­­tiveShooter.

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.

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