Preparation. Are We Ready? Preparing for the Unpredictable

Transcription

1 Are We Ready? Preparing for the Unpredictable Eric Goralnick, MD, MS Medical Director, Emergency Preparedness Brigham and Women s Healthcare Preparation 2012 Prioritized Active Shooter in Hazard Vulnerability Analysis Tabletop and 1 Functional Exercise Plain Language Video 2014 Active Shooter Incidents in Hospitals and Healthcare Settings Symposium Brigham and Women s Hospital National Preparedness Leadership Initiative Johns Hopkins CEPAR 1

2 Response Response 1102 Panic button alarm from Watkins Clinic Base dispatches officers to respond First officer on scene observes employees fleeing. She hears them say someone is shooting. Officer announces Shots Fired, Watkins Clinic over radio. BPD detail officer hears our radio call and in turn broadcasts it over the BPD radios Second Security officer on scene hears gunshot from exam room. Suspect is found dead of self inflicted gunshot wound BPD detail officers arrive at Shapiro. Within 5 minutes, dozens of BPD Officers were on scene Stat line Operator announces Life Threatening situation 1107 Dr. Davidson transported to Emergency Department 1108 Emergency Notification System notice sent out 2

3 Response 1110 Shapiro is locked down by Security Code Amber called 1125 Emergency Operations Center (EOC) holds first briefing ED on Code Black BPD announces scene is secure and we can resume normal operations except for 2 nd floor, which is a crime scene. A short time later, the crime scene is reduced to just the Watkins Clinic Code Amber cleared 1155 ED off Code Black 1230 EOC has second briefing 1315 Press briefing 1430 Leadership Huddle Recovery: Debriefing Tactical Watkins Cardiovascular Clinic Public Affairs Emergency Management Senior Leadership Associate Chief Nursing Officers Vice Presidents Support Service Operations Nursing Administration Medical Staff Employee Assistance Program Operating Rooms and PACU Staff Emergency Department Staff Social Work Psychiatry Engineering Emergency Management Committee Human Resources Ambulatory Patient Family Relations Psychological First Aid Employee Assistance Program Social Work Psychiatry Psychiatric Nursing Peer Support Chaplaincy 3

4 Training Helped Training and Videos Helped Limited group participated in exercises Limited follow up from Exercises Voluntary Training #1: Have a Plan, Practice the Plan Familiarize yourself with your environment Design a Plan Drill the Plan Modify the Plan Educate Repeat 4

5 Debriefings Psychological Multidisciplinary Psychiatry Psychiatric RNS Employee Assistance Peer Support Social Work Chaplaincy Coordination of various efforts Tactical Timeliness Prioritization #2: The Event begins, the minute it ends What is your organization s psychological first aid plan? What services are available? Who would facilitate debriefings to capture lessons learned? 5

6 Transparent, Timely Communications Internal Our Plain Language was Not Plain Enough No speakers in some areas Voluntary Employee Alert System Text your loved ones External Social Media and Privacy Timely Press Conference #3: Communications is actually #1,2 and 3 What is your personal, family and organizational plan in an emergency? How do you and your staff communicate with one another? Transparent, timely and accurate 6

7 #4: CPR and Tourniquet Training Nearly 50% of combat deaths since World War II can be attributed to blood loss In 2002, the war in Afghanistan prompted the invention of the one-handed tourniquet Death Rates: Pre: 23.3 deaths per year, During: 17.5 deaths per year Post: 3.5 deaths per year, 85% decrease in mortality At Home Boston Marathon Bombings Stop the Bleed Campaign References Jansheski, John W. Mass Shootings in the United States: Common Characteristics and Predictive Behaviors. ARMY COMMAND AND GENERAL STAFF COLLEGE FORT LEVENWORTH KS, Active Shooter Educational Booklet, Department of Homeland Security, Kelen, Gabor D., et al. "Hospital-based shootings in the United States: 2000 to 2011." Annals of emergency medicine 60.6 (2012): US Department of Justice; Federal Bureau of Investigation. A study of active shooter incidents in the United States between 2000 and /fbi-releases-study-on-active-shooterincidents /pdfs/a-study-of-active-shooter-incidents-in-the -u.s.-between-2000-and Accessed March 10, The Medical Surge Capacity and Capability Handbook. September February Jacobs, Lenworth M., et al. "Improving survival from active shooter events: the Hartford Consensus." Journal of Trauma and Acute Care Surgery 74.6 (2013): Merchant, Raina M., Stacy Elmer, and Nicole Lurie. "Integrating social media into emergency-preparedness efforts." New England Journal of Medicine (2011): Cassa, Christopher A., et al. "Twitter as a sentinel in emergency situations: lessons from the Boston marathon explosions." PLoS currents 5 (2013). Johns Hopkins to Host First National Symposium on Hospital Shootings hopkinsmed.org. 04 March February Hodge, James G., and Kellie Nelson. "Active Shooters in Health Care Settings: Prevention and Response through Law and Policy." The Journal of Law, Medicine & Ethics 42.2 (2014):