armed intruder- active shooter - nebraska healthcare association · 2019-02-08 · phase® incident...

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Armed Intruder and Active Shooter in the Long Term Care Facility

Plan…Respond…and Survive the Unthinkable

© 2015 Sorensen, Wilder & Associates

Presenter

•Dan Wilder

� Professional Security Consultant, SWA (2006 – )

� Director of Professional Services, SWA (2015 - 2017)

� Vice President of Operations, SWA (2015 – 2017)

� HSEEP & CFATS Certified through USDHS

� CPTED Certified, National Institute of Crime Prevention

� Firefighter / EMT, Bradley, IL (2001 – )

On The Loose…Terror in the Streets

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Active Shooter Incidents…They’re Getting To Common

Seminar Objectives

Understand

• A State of Preparedness

Review

• Terminology and Concepts

• Case Study

Learn

• Active Shooter Safety Action Plan

• Stress Control and Decision-Making

• Safety Transition Adjustment Formula (STAF) Protocol

Remain

• Safe and alive during an active-shooter incident

The prevailing attitude: “It won’t happen here.”

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Amish School ShootingNickel Mines, Pennsylvania

On October 2, 2006, Charles Roberts stormed a one-room schoolhouse in Nickel Mines, Pennsylvania. He took hostages and shot 10 Amish girls (ages 6 to 13) before committing suicide. Five of the children died.

Even Hollywood is in on it…

Creating a State of Preparedness

Armed Intruder and Active Shooter in the Long Term Care Environment:Plan…Respond…and Survive the Unthinkable

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Golden West Towers Senior CommunityNovember 20, 2012 • Torrance, CA

A male resident in

his 80s shot and killed two females

(a 54-year-old

facility manager

and 54-year-old

caregiver) in the lobby before

turning the gun on

himself.

Double Murder–Suicide:

Pablo Davis Elder Living CenterOctober 20, 2013 • Detroit, MI

A 65-year-old male resident

shot and killed two female residents at the center after

retrieving a rifle from his

room. The shooting

stemmed from a breakup

with his girlfriend that he blamed on the two women.

Double Murder:

Abington ManorNovember 4, 2013 • South Abington, PA

Murder-Suicide:A 42-year-old staff nurse shot a resident to death at a nursing home where she worked and then turned the gun on herself.

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Mercy Fitzgerald HospitalJuly 24, 2014 • Darby, PA

A psychiatric patient

pulled out a revolver from his waistband and

executed his

caseworker before

turning the gun to his

doctor. Dr. Silverman, shot also, pulled his

own gun and wounded

the assailant.

Murder and Gunfight:

Think About Your Emergency Operations Plan…

It probably addresses a lot of possibilities…

Amberwood Gardens Skilled Nursing and Rehab CenterJune 25, 2011 • San Jose, CA

One killed and six injured

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Hurricane SandyJersey City Town HallOctober 29, 2012 • Jersey City, NJ

‘Superstorm Sandy’

caused an estimated 68 billion dollars in

damages and killed

148 people. The

hurricane affected

24 states including the entire eastern

seaboard of the US.

Greenbriar Nursing Care CenterMay 22, 2011 • Joplin, MO

EF-5 tornado:159 people killed, including 16 at Greenbriar

West Fertilizer CompanyApril 17, 2013 • West, Texas

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West Rest Haven Nursing Home

The Active Shooter Plan is Another Tab in Your EOP

Reaction to Disaster or Crisis

It’s not what you think.

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Failure to Respond

• Subconscious need for normalcy

• Overwhelming sense of denial

• Unable to comprehend scope of event

• Optimistic bias

• Lack of safety culture

• No planning or preparedness

• Poor training

• No practice or rehearsal

While an Armed Intruder or Active Shooter in YOUR facility may be

“UNTHINKABLE”

It can be managed with…

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EMERGENCY RESPONSE

BASIC INCIDENT COMMAND STRUCTUREINCIDENT

COMMANDER

OPERATIONSSECTION

PLANNINGSECTION

LOGISTICSSECTION

FINANCE/ADMIN.SECTION

LIAISONOFFICER

SAFETYOFFICER

PUBLIC

INFORMATIONOFFICER

Nursing Home Incident Command System

http://www.cahfdisasterprep.com/NHICS/GuidebookTools.aspx

Situational Awareness:

Part of Emergency Operations Plan Development!

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What If Your Facility Is Across The Street?

How Vulnerable Are They?

Terminology and Concepts


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Definitions

• Offender

• Armed

• Caregiver

• Clear

• Crime scene

• Domestic dispute

• Evidence

• Facility

• Firearm

• Lockdown

• Mercy killing

• Security

• SWAT

• Threat

• Unified Command

• Violent crime

• Weapon

• Witness


Definitions

Offender: The offender or perpetrator of an incident/event

Armed: The Offender carrying, displaying, and utilizing a weapon (primarily a firearm, but not always)

Caregiver: A healthcare worker (doctor, nurse, med tech, aide, social worker, etc.)

Clear: The methodical search of a facility by law enforcement for additional Offenders and threats

Crime scene: The exclusionary zone law enforcement cordons off. Encapsulates the location of the crime and evidence to be collected

Domestic dispute: An emotionally charged dispute between two or more persons engaged in a sexual, domicile, or family relationship; incident may have started off facility grounds

Evidence: Items that result from the planning, execution, and commission of a criminal act. May be material, electronic, statements, fluids, etc.

Facility: The structural location of employment or physical location where an incident occurred


Definitions

Firearm: A gun; may be a handgun or long gun (shotgun or rifle)

Lockdown: An emergency safety procedure utilized by a facility to announce a threat within the facility, combined with a safety action plan to secure occupants until the threat has concluded

Mercy killing: A homicide committed to alleviate the suffering of the victim (usually from a medical condition)

Security: Persons tasked by the facility to ensure the safety of employees, patients, and visitors. Security may be a facility employee or contracted staff (armed or unarmed)

SWAT: Special Weapons and Tactics. A highly trained and equipped team of law enforcement officers tasked to deal with high-risk threats

Threat: (v) Verbal, non-verbal, and other actions expressing an intention to inflict fear, injury, or death; (n) the actual person committing the above

Unified Command: A shared incident management system in which two or more officers from different responding agencies and functionality share management responsibilities from an established command post

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Definitions

Violent Crime: Defined by the Department of Justice as purse-snatching/pick-pocketing, assault (simple or aggravated), robbery, rape, and homicide

Weapon: Any item used to inflict fear in or cause injury to another individual; may be defensive or offensive (e.g., impact weapon, cutting weapon, weapon of opportunity)

Witness: Any person having material information about the planning or commission of a crime. Statements gathered from a witness during an investigation become evidence for prosecution or clearance of the crime

Characteristics of an Active Shooter

As with all aspects of human behavior, there is no 100 percent “tried and true” characteristic of a shooter. But we still need to focus on behaviors, not profiles

Common characteristics include:A “brittle” personalityFeelings of persecutionFeelings of injusticesSensitive to rejectionSelf-perception (outsider)Sees no other options

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Concepts

PHASE® Incident

CAVE® Incident

Rapid Response

Self Aid / Buddy Aid

PHASE® Incident

PHASE Incident

P: PersonalH: HostileA: AgendaS: SingularE: Event

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PHASE Incident

Personal: This incident is not random and occurs between known

persons. The incident is driven by an emotional cause (passion, rage, love, revenge, etc.)

Hostile: The offender’s action toward the victim is driven by emotion

and will be brutally violent

Agenda: The offender has a premeditated plan and has come to the

facility prepared to carry it out

Singular: The incident will be over once the agenda has been

completed; not a continuous act

Event: The quantified incident

PHASE Incident Examples

PHASE® Incident

• Mercy killing

• ‘Wrongful death’—targeting caregiver

• Resident mistreatment/abuse

• Domestic dispute

• Child custody

• Employee harassment

• Employee termination

CAVE® Incident

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CAVE Incident

C: Continuous

A: Active

V: Violent

E: Event

CAVE Incident

Continuous: The offender will continue the incident until (s)he is stopped by some outside force

Active: The offender’s agenda has no clear end point. (S)he may have an objective, but it is very broad and not clearly defined

Violent: Because the objective is broad, the offender needs a grandiose method to carry it out (e.g., large quantities of weapons, munitions, and possibly explosives). The method of violence delivery is usually well thought out

Event: The quantified incident

CAVE Incident Examples

• Mental illness

• ‘Wrongful death’ (departmental-wide)

• Resident mistreatment/abuse

• Employee termination

• Political agenda

• Personal agenda

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Evolution of PHASE® into CAVE®

Evolution of PHASE® into CAVE® Incident

Can it evolve?

• Mindset

• Factors


Mindset• PHASE® characterizations review

• Personal

• Emotions are HIGH!!!

• Agenda

• Thorough pre-plan event

• Determined

• Resolute

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Factors prompting the evolution• Change of Heart

• Offender cannot kill himself – decides to run

• Planned victim not there

• Offender deep in building, might shoot his way out

• Murphy and his ruthless law

Rapid Response

Rapid Response

• A trained, coordinated law enforcement technique

to respond to and mitigate the potentially high casualty count from an active-shooter incident

• Developed after and due to the Columbine High

School mass shooting in 1999

• Primary objective: Enter the facility, proceed to

the sound of gunfire, stop the threat• The initial entry team will bypass the wounded

and those in need of help

• The second entry team is tasked with assisting

the wounded and directing evacuation

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Rapid Response

• Officers will be in different uniforms but will be

clearly identifiable as police• Follow law enforcement directions

• Do not have any items in your hands

• Keep your hands up. Try and remain calm

• Do not run or make sudden movements toward

officers• Do not yell, scream, or speak with officers

• Expect to be detained, searched, and questioned

Response to Law Enforcement Arrival

Self Aid / Buddy Aid (SABA)

Where will you be if it happens?

Self Aid / Buddy Aid (SABA)

A military and law enforcement technique now being

expanded into the private sector that teaches care and

treatment basics for self survival and buddy survival. Topics

include:

• Controlling Bleeding

• Direct Pressure or Pressure Bandage

• Tourniquet Application and Use• Penetrating Chest Wound

• Airway Management

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Individual SABA Trauma Kits

Case Study


Pinelake Health & RehabCarthage, NC

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Case Study:Pinelake Health & Rehab • Carthage, NC

• Skilled nursing, Alzheimer’s care, rehabilitation therapy,

and hospice care

• 110 beds on campus

• 90 resident beds

• 20 special care (Alzheimer’s/dementia)

Facility Overview

Aerial View of Pinelake Health & Rehab Carthage, NC


On Sunday, March 29, 2009, at approximately 10:00 a.m., an act of violence at Pinelake Health & Rehab in Carthage, North Carolina ended several lives and wounded residents, staff, and a visitor—both physically and emotionally.

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• The gunman, Robert Stewart, arrives on location and

parks in the front of the building• Stewart fires multiple rounds into the PT Cruiser of his

estranged wife, who is an employee of the facility

• Before entering the building, Stewart shoots a visitor,

Michael Cotton, in the shoulder

• Stewart enters the building to search for his estranged wife, Wanda Stewart

• Unable to find her because she is in a locked dementia

unit, Stewart begins to shoot at residents and staff

Incident Overview


• Nurse Jerry Avant Jr. identifies the incident and

makes a facility-wide “lockdown” announcement• Avant begins to move and secure residents but is

shot by Stewart and later dies from the injuries

• A police officer arrives on scene and challenges

Stewart, who turns his gun at the officer

• The officer is shot, but returns fire, hitting and injuring Stewart and stopping his attack

• The officer takes Stewart into custody

Incident Overview

Case Study:Pinelake Health & Rehab-Carthage, NC

Police Response: Cpl. Justin Garner

"He acted in nothing short of a heroic way today, and but for his actions, we certainly could have had a worse tragedy," said Moore

County District Attorney Maureen Krueger. "We had an officer, a well-trained officer, who performed his job the way he was supposed to

and prevented this from getting even worse than it is now.“

www.wral.com/news/local/story/4837676/

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• 7 residents and 1 staff member killed

• 3 injured, including the gunman• Stewart brought multiple firearms to

the facility and a bag of ammunition

• 12-gauge shotgun

• .22 caliber rifle

• .22 Magnum semi-automatic pistol• .357 Magnum revolver

• The 12-gauge shotgun was Stewart’s

primary weapon of choice

Incident Discoveries and Aftermaths


Lillian Dunn, 89

Jerry Avant Jr., 39, nurse

Louise Vocht De Kler, 98

Jessie V. Musser, 88

John W. Goldston, 78

Tessie Garner, 75

Bessie Hedrick, 78

Margaret Johnson, 89

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“

”

Robert Stewart entered Pinelake that day with a specific reason—to chase down Wanda Stewart. He brought four guns and a bag of ammunition with the intent of creating mass casualties.

Opening statement to jurors by Tiffany Bartholomew, Assistant District Attorney for Moore County, North Carolina, at the homicide trial of Robert Stewart on August 1, 2011

Motive

“

”

Stewart doesn't recall what happened the day of the shooting and can't be held legally responsible for his actions. Stewart overdosed on the sleep-aid Ambien the night before the shootings and also was taking antidepressants at the time.

Attorney Jonathan Mergerian (defense attorney for Robert Stewart)

Defense Argument


On Saturday, September 3, 2011, Robert Stewart, 45, was found guilty of second-degree murder for killing eight individuals while the influence of antidepressants and six (6) Ambien pills.

He was sentenced to 142 years in prison.

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Summary and Conclusions

• A quick announcement of “Lockdown” by nurse Jerry Avant Jr. alerted

staff and residents, saving countless persons

• Nurses and CNAs were able to secure and save many patients in locked areas that were unable to be accessed by the gunman

• A quick, composed response by a well-trained Carthage police officer

stopped the shooting rampage, preventing further casualties

• Robert Stewart will spend the rest of his life in jail

• Several families filed wrongful death civil suits against the parent company of Pinelake Health & Rehab for lack of safety procedures and related issues

Decision Making and Stress Control


Active Shooter Safety Action Plan

Making the Decisions

“Making the ‘right’ decision quickly and devoid of hesitation, under a great amount of stress, takes an understanding of how the decision-making process functions. This procedure must be understood and practiced. Furthermore, there also needs to be an understanding of safety policy and protocols revolving around an active shooter threat in your facility. If you can master both of these concepts, it will save lives.”

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Making the Decisions


Boyd’s Cycle of Decision-Making

(OODA Loop)

USAF Colonel John Boyd


Boyd’s OODA Loop Cycle of Decision-Making

United States Air Force (USAF) Colonel John Boyd was a jet pilot and

military strategist in the 1960s . During the Korean War, he founded

and developed the OODA Loop cycle of decision-making, which

helped Air Force pilots make decisions during air-to-air combat. The

US pilots, flying the F-86 Sabre against the superior Russian MiG-15,

were dominant because of the OODA Loop. It helped the pilots make

rapid decisions and win the dog fights.

The US pilot who went through the OODA Loop cycle in the shortest

time prevailed because the MiG-15 pilot was caught responding to

situations that had already changed.

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Boyd’s OODA Loop Cycle of Decision-Making

Observe

Orient

Decide

Act


OODA Loop Cycle of Decision-Making

Observe

• The ‘Observe’ segment of the OODA Loop is extremely important

• Know that ‘Observe’ is not limited to sight and includes other senses

• ‘Observe’ is the initial recognition of a PHASE® /CAVE® Incident

• The faster ‘Observe’ is applied in a PHASE® /CAVE® Incident, the more lives will be potentially saved

Observe


Orient

• The ‘Orient’ segment of the OODA Loop follows ‘Observe’

• ‘Orient’ will place you in perspective to the Offender’s position in the facility and your position within the facility

• ‘Orient’ will determine which leg of the STAF protocol you employ: Resident Safety or Personal Safety (the STAF protocol will be examined in subsequent slides)

Orient


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Decide

• The ‘Decide’ segment of the OODA Loop follows ‘Orient’

• Once the ‘Observe’ and ‘Orient’ segments of the cycle are complete, ‘Decide’ must be quickly chosen—Make a Decision!

• Once designated, the ‘Decide’ segment must not vary—DO NOT BE WISHY-WASHY!

• Any decision is better then NO decision. The decision you make quickly will save lives

Decide



Act

• The ‘Act’ segment of the OODA Loop follows ‘Decide’

• Once the ‘Observe,’ ‘Orient,’ and ‘Decide’ segments of the cycle are complete, ‘Act’ must be quickly executed without hesitation and with total conviction

• ‘Act’ functions need to be trained and rehearsed to ensure the highest survivability of residents, visitors, employees, and YOU

Act

Stress and Anxiety Reduction

Why do we need to practice and train?

• Stress responses• Heart rate

• Breathing

• Stress inoculation• What is it?

• How does it help?

Protocol

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Anxiety and Heart Rate

Siddle and Grossman 1997

Tactical Breathing

The 5-by-5 Rule

• Inhale slowly while counting for five seconds

• Hold that breath while counting for five seconds• Slowly exhale while counting for five seconds

• Hold the ‘empty lungs’ while counting for five

seconds

• Repeat

• This will decrease your heart rate

• This will help you regain focus


• How to inoculate: TRAINING, PRACTICE and DRILLS• How would you react to an active shooter in your facility if you

were unprepared, not trained, and have never experienced the stresses of such an event? How would your anxiety, stress and fear be…could you think and function?

• Would your reaction be different to the event after training, practice and drills? Think about how you react to a life threatening medical emergency? Are you full of stress, anxiety and fear or do you function well because of training and life experience during those events?

Stress Inoculation

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• Mental Imagery: Mental imagery helps you personally train without the formality of organized drills.

• During your shift, stop and ask yourself, what would I do right now if an “Armed Intruder/Active Shooter” announcement were made over the overhead PA system?

• Imagine the bad guy in different locations throughout the facility

• Look at where staff members and residents are right at the time of your mental imagery training…what would you do to increase the survivability chances for them?

Stress Inoculation

“Awareness is good, but without skills and ability tied to that awareness, all

you have is anxiety.”~ Tony Blauer

extreme close combat trainer



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• Exit the facility as quickly as possible

• Leave personal belongings behind

• Encourage people to go with you

• Use the “bounding overwatch” technique to move groups of people and yourself from point of cover to cover if you are not aware of the offender’s location

• Stay calm and quiet

• When in a safe location, call 911

• Follow police directions

Get Out

911

• Who should call 911?• Anyone and everyone!

• When should you call 911?• When it’s safe to do so!

• How should you call?• If possible, use a facility phone. This will allow the 911

operator to positively identify the address you are calling from without you having to give it

• If using a cell phone, the 911 operator may not be able to identify your location unless you give them the address!

Things to remember regarding 911

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911

• Facility name and location

• Your name

• Nature of the event

• Description of the subject or shooter (if known)

• Type of weapon(s)

• Persons injured—number and extent

Information to give the 911 Operator

Firearm Tutorial

• It is not important that you are a ‘firearm expert’ when giving information to the 911 operator

• You do not need to know make, model, or caliber

• If possible, give the 911 operator the style of firearm

• Handgun: A firearm that can be held in one’s hand (e.g., a pistol or revolver)

• Long gun: A firearm that is designed to be fired by mounting on one’s shoulder (e.g., a rifle or shotgun)

Firearm Styles

HandgunLong gun

Weapon Types

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Get Out: The Bounding Overwatch


The Bounding Overwatch

• The Bounding Overwatch is a technique used by military and law enforcement to safely move groups of soldiers or officers from one point of cover and concealment to another

• This technique, modified for you, uses the same practice—moving from one point of safety to another point of safety in small groups or by yourself. You move to safely evacuate the facility

• When moving a group of people, do not move the entire group at once. Break it up into smaller groups and coordinate movements


The Bounding Overwatch

Plan….Look….Move….Look….Move….GOAL!

• Have a PLAN• LOOK from a point of cover/concealment for an opportunity to move safely

to another point of cover/concealment…the OPPORTUNITY is to move without the bad guy seeing you!

• MOVE quickly and with conviction to the next point of cover and

concealment...stay low• LOOK again from the new point of cover/concealment for an opportunity

to move safely to another point of cover/concealment…the GOAL is to Get Out safely!

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Copie

r

Desk

Door to

Safety


Get Out: The faster and smarter you move to “Get Out,” the lower the

probability you will be shot by the bad guy. Moving targets are hard targets to hit.


Statistically, trained and prepared law enforcement officers involved in a gunfight only hit 18 to 27% of targets.

The likelihood of being hit by a bullet fired by the offender during an Active Shooter Event is low if you move quickly!

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• Inconspicuous place

• Cover yourself

• Call 911 if able and safe to do so

• Be QUIET

• Silence cell phones, pagers, etc.

• Be still

• Elevator or stairwell?

• Hide in ‘plain sight’

• Play dead

Hide Out

An Awareness

Test

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• Hiding in Plain Sight

• The bad guy is looking for targets of convenience and opportunity

• If you can hide out of the bad guy’s Line of Sight, chances are low (s)he will not see you

• Can be utilized to hide residents

• Because of the police Rapid Response, the bad guy will be moving quickly and not take time to search for victims

Hide Out: It’s easy to miss something you’re not looking for!

Two volunteers, please!!!


Hide OutHide in plain sight: deep corner

Bad

Guy’s

Line ofSight

Hallway

Resident

Room

1

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COVER

• Hides you

• STOPS Bullets

CONCEALMENT

• Hides you

• DOES NOT STOP Bullets

VS.



• Lock/deadbolt

• Big, heavy things• Furniture (desks, bookshelves, etc.)

• Medical equipment

• Resident room beds

• Lots of smaller things

• Body fluids: fecal matter???

• Once secure, call 911

Keep Out

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Take Out

• The FIGHT of—and for—your LIFE

• Commit to the act…• …and do not stop until the threat has ended

• Misery LOVES company—strength in numbers

• Weapons of opportunity in the workplace

• Position of Tactical Advantage

• Diversion and confusion prior to the fight• Speed, aggression, surprise


Take Out

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United Airlines Flight 93 10:03 a.m. September 11, 2001

Todd M. Beamer

Bay County School Board Meeting • Panama City, FL

Tuesday, December 14, 2010 (approximately 2:00 p.m.)


Take Out: Weapons of Opportunity• What is a ‘Weapon of Opportunity’?

• A Weapon of Opportunity is any item in your immediate area that can be crafted into a tool to defeat the bad guy

• What can be used as a ‘Weapon of Opportunity’?• Anything!! Look around now…what could you use to strike,

throw, stab, etc…at a bad guy if you had to?• Look for ‘opportunity’ to use a Weapon of Opportunity

Look for the Opportunity to use a Weapon of Opportunity to create Opportunity for yourself and your

residents during Take Out!

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Weapons of Opportunity


You need to combine a and a

with a to successfully defeat the Offender.


Take Out: Diversion

• Key component in a coordinated ‘Take-Out’ action plan

• What is ‘diversion’?• What can be used for a ‘diversion’?

• How can you use your tools of ‘diversion’?

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Exercise 2

We need a new bad guy.

Who feels like shooting up a bunch of colleagues?

Safety Transition Adjustment Formula Protocol STAF-P


The Dilemma—What about my residents?!?!

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Resident Safety and Personal Safety During a PHASE® or CAVE® Incident

• Questions you will have to answer with little or no prep time:

• How do I protect myself?

• How can I protect my residents?

• When should I act?

• How should I react?

Introducing the

(STAF-P)

Resident Safety and Personal Safety During a PHASE® or CAVE® Incident

• A formula, driven by policy and training, that plans employee actions during a fluid PHASE® or CAVE® incident, ensuring the maximum survivability chances for both residents and personnel

• Designed to save as many residents and personnel during a PHASE® or CAVE® incident as possible

What is the Safety Transition Adjustment Formula Protocol (STAF-P)?

SAFETYSAFETYSAFETYSAFETY

EMPLOYEES

S

T

A

F

-

P

RESIDENTS

Safety Transition Adjustment Formula Protocol (STAF-P)

“...balancing the safety of residents and employees”

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Response

Active Threat

Resident Safety Personal Safety

Distant Immediate

Active

Shooter

Safety Action

Plan


Time of Recognition

• Employee awareness and recognition of a PHASE® or CAVE® incident needs to be immediate

• Employees need to identify and announce to the facility the Offender’s location and intention

• Employees need to move residents and visiting family members to and secure them in areas of safety per the STAF protocol

• When the offender breaches your area/wing/floor, transition from resident safety to personal safety utilizing the Active Shooter Safety Action Plan


• Which residents do I attend to first?

• How do I attend to them?

• Know that you may not be able to secure all residents before the Offender enters your area

• The end goal of the STAF protocol is to save as many lives, including yours, as possible during an incident in which the offender is trying to take them!

Protocol

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• You are making decisions for the residents

• Are you able to lockdown the entire unit/wing/floor and barricade it?

• If not, whom do I attend to first?

• Residents who are able to act without assistance following caregiver directive

• Ambulatory/mobile residents

• ‘High-maintenance’ residents

Protocol


Active Shooter Rule of Thumb:

In the midst of a CAVE® incident, the active shooter will belooking for targets of convenience and opportunity. The shooteris looking for mass casualties. As (s)he moves from area to areain your facility, (s)he is not likely to take time to breech a dooror do a room-by-room search looking for victims. The shooterknows (s)he must move quickly before police intervene.

Washington, DC Navy Yard Shooting Surveillance Footage (September 16, 2013)

Source: FBI

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• Know your facility• Are you able to lock your wing or floor and keep the

Offender from gaining access?

• Can you secure residents in their rooms?

• Is there a room where you can ‘stash’ numerous residents and lock the door?

• Supply/janitor’s closet• Medication room• Records room• Bathrooms

• Hide ‘in plain sight’

Protocol: Hide Out/Keep Out

Policy Development and Training



• Why do we need a policy on Active Shooter Response?• Statement of purpose

• Clearly defined protocol

• Staff understand their roles

• Minimizes confusion

• Reduces liability

• Saves lives!

Policy

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1. Conduct Security Vulnerability Assessment

2. Develop An Active Shooter Emergency Response Plan

3. Develop an Active Shooter Training Program

4. Train Staff on How to Respond to an Active Shooter Event

5. Plan for Recovery

Five Steps to Protect Our Stakeholders

Even if this is a good depiction of your maintenance director, this does NOT represent a good site security plan…...


Answers several key questions:

1. From what and from whom should the healthcare facility be protecting itself? (What are the THREATS)

2. Where are the “chinks in the armor” that could allow the event to occur (What are the VULNERABILITIES)

3. What are the likely consequences in the event the vulnerabilities are recognized and compromised? (What are the RISKS)

4. What can we do to minimize the vulnerability?

Step 1: Conduct a Security Vulnerability Assessment (SVA)

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Make it realistic to the threat:• PHASE® Event: Shooter has a specific target

• CAVE® Event: Shooter looks for high body/casualty counts; shoots as many as possible

• There will be no “Code Team” responding

• Chaos will reign

• It may be only you and a colleague to get through this…alive

Step 2: Develop An Active Shooter Emergency Response Plan


• Develop plan with employees and residents in mind• Active Shooter Safety Action Plan• STAF-P

• Denial has no survival value� It won’t happen here…

• Develop a plan with a survival mindset• Lines of survival: exits, hiding places, barriers, weapons of opportunities

Step 2: Develop An Active Shooter Emergency Response Plan


• Your training strategy:• Provide a range of options and choices for occupants to make decisions

• Survival is not a random outcome— survival is the result of training and preparedness!!!

• The four-step approach to training� Awareness

• Preparedness

• Drills and exercises

• Evaluations and improvements

Step 3: Active Shooter Training

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Training should be multilevel. At new employee orientation, all

new employees should go through the facility-wide program. Once they get to the particular unit in which they will be working, they should go through department-

specific orientation as on-the-job training

Step 3: Active Shooter Training


• How do we practice and train?• Seminars

• Tabletop exercises

• Practical exercises

• How often do we need to practice and train?• Frequency should be clearly defined in policy

• Biannual seminars/tabletop exercises

• Annual practical exercises

Drills


• The first response to an active event is the same for TRAINED and UNTRAINED (and UNPREPARED) people …

Step 4: Active Shooter Response

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Trained and Prepared:

• Anxiety

• Recall what they have learned

• Ready to act as they have been trained

Step 4: Active Shooter Response

Untrained and Unprepared:

• Panic

• Frozen with fear; disbelief and denial

• Stay frozen in shock and denial


Step 5: Post-incident Recovery


Step 5: Post-incident Recovery

Recovery

• Initiate the facility Crisis Management Plan

• Takes place after the event is over

• Return to normal or safer state of affairs as

quickly as possible

• May take days, months, or years

• Key is evaluation of event and a recovery plan

in place BEFORE the event occurs

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Review

• PHASE® Incident/CAVE® Incident

• Decision making/Stress Control

• Active Shooter Safety Action Plan• The 4 ‘Outs’: Get, Hide, Keep and Take

• Safety Transition Adjustment Formula (S.T.A.F.) Protocol

• Balancing Patient and Personal Safety

• Decision making

• Policy Development and Training

Dan Wilder

[email protected]

@SorensenWilder800-568-2931

Armed Intruder and Active Shooter in the

Long Term Care Environment:

Plan... Respond… and Survive the Unthinkable

armed intruder- active shooter - nebraska healthcare association · 2019-02-08 · phase® incident...

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