10/10/2017. Dan Wilder. Armed Intruder and Active Shooter in the Long Term Care Facility. On The Loose Terror in the Streets.

Transcription

1 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 ( ) Vice President of Operations, SWA ( ) HSEEP & CFATS Certified through USDHS CPTED Certified, National Institute of Crime Prevention Firefighter / EMT, Bradley, IL (2001 ) On The Loose Terror in the Streets 1

2 Active Shooter Incidents They re Getting To Common Seminar Objectives Understand A State of Preparedness Review Terminology and Concepts Case Study Learn 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. 2

3 Amish School Shooting Nickel 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 3

4 Golden West Towers Senior Community November 20, 2012 Torrance, CA Double Murder Suicide: 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. Pablo Davis Elder Living Center October 20, 2013 Detroit, MI Double Murder: 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. Abington Manor November 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. 4

5 Mercy Fitzgerald Hospital July 24, 2014 Darby, PA Murder and Gunfight: 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. Think About Your Emergency Operations Plan It probably addresses a lot of possibilities Amberwood Gardens Skilled Nursing and Rehab Center June 25, 2011 San Jose, CA One killed and six injured 5

6 Hurricane Sandy Jersey City Town Hall October 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 Center May 22, 2011 Joplin, MO EF-5 tornado: 159 people killed, including 16 at Greenbriar West Fertilizer Company April 17, 2013 West, Texas 6

7 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. 7

8 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 8

9 9 EMERGENCY RESPONSE BASIC INCIDENT COMMAND STRUCTURE I N C I D E N T C O M M A N D E R O P E R A T I O N S S E C T I O N P L A N N I N G S E C T I O N L O G I S T I C S S E C T I O N F I N A N C E / A D M I N. S E C T I O N L I A I S O N O F F I C E R S A F E T Y O F F I C E R P U B L I C I N F O R M A T I O N O F F I C E R Nursing Home Incident Command System Situational Awareness: Part of Emergency Operations Plan Development!

10 What If Your Facility Is Across The Street? How Vulnerable Are They? Terminology and Concepts Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable 10

11 Terminology and Concepts Definitions Offender Armed Caregiver Clear Crime scene Domestic dispute Evidence Facility Firearm Lockdown Mercy killing Security SWAT Threat Unified Command Violent crime Weapon Witness Terminology and Concepts 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 Terminology and Concepts 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 11

12 Terminology and Concepts Definitions Violent Crime: Defined by the Department of Justice as pursesnatching/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 personality Feelings of persecution Feelings of injustices Sensitive to rejection Self-perception (outsider) Sees no other options 12

13 Terminology and Concepts Concepts PHASE Incident CAVE Incident Rapid Response Self Aid / Buddy Aid PHASE Incident PHASE Incident P: Personal H: Hostile A: Agenda S: Singular E: Event 13

14 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 14

15 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 15

16 Evolution of PHASE into CAVE Evolution of PHASE into CAVE Incident Can it evolve? Mindset Factors Evolution of PHASE into CAVE Incident Mindset PHASE characterizations review Personal Emotions are HIGH!!! Agenda Thorough pre-plan event Determined Resolute 16

17 Evolution of PHASE into CAVE Incident 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 17

18 Rapid Response Response to Law Enforcement Arrival 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 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 18

19 Individual SABA Trauma Kits Case Study Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable Pinelake Health & Rehab Carthage, NC 19

20 Case Study: Pinelake Health & Rehab Carthage, NC Facility Overview Skilled nursing, Alzheimer s care, rehabilitation therapy, and hospice care 110 beds on campus 90 resident beds 20 special care (Alzheimer s/dementia) Aerial View of Pinelake Health & Rehab Carthage, NC Case Study: 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. 20

21 Case Study: Pinelake Health & Rehab Carthage, NC Incident Overview 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 Case Study: Pinelake Health & Rehab Carthage, NC 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 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 welltrained officer, who performed his job the way he was supposed to and prevented this from getting even worse than it is now. 21

22 Case Study: Pinelake Health & Rehab Carthage, NC Incident Discoveries and Aftermaths 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 Case Study: Pinelake Health & Rehab Carthage, NC John W. Goldston, 78 Margaret Johnson, 89 Jessie V. Musser, 88 Jerry Avant Jr., 39, nurse Lillian Dunn, 89 Tessie Garner, 75 Louise Vocht De Kler, 98 Bessie Hedrick, 78 22

23 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. Defense Argument Attorney Jonathan Mergerian (defense attorney for Robert Stewart) Case Study: Pinelake Health & Rehab Carthage, NC 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. 23

24 Case Study: Pinelake Health & Rehab Carthage, NC 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 Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable 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. 24

25 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. 25

26 Boyd s OODA Loop Cycle of Decision-Making Decide Act Orient Observe 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 OODA Loop Cycle of Decision-Making 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 26

27 OODA Loop Cycle of Decision-Making 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 OODA Loop Cycle of Decision-Making 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 Protocol Why do we need to practice and train? Stress responses Heart rate Breathing Stress inoculation What is it? How does it help? 27

28 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 Stress and Anxiety Reduction Stress Inoculation 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? 28

29 Stress and Anxiety Reduction Stress Inoculation 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? Awareness is good, but without skills and ability tied to that awareness, all you have is anxiety. ~ Tony Blauer extreme close combat trainer Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable 29

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31 Get Out 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 911 Things to remember regarding 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 Ifusing a cell phone, the 911 operator may not be able to identify your location unless you give them the address! 31

32 911 Information to give the 911 Operator 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 Firearm Tutorial Firearm Styles 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) Handgun Weapon Types Long gun 32

33 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! 33

34 Desk Door to Safety Copier 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! 34

35 Hide Out 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 An Awareness Test 35

36 Hide Out: It s easy to miss something you re not looking for! 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 Two volunteers, please!!! Hide Out Hallway Hide in plain sight: deep corner Bad Guy s Line of Sight 1 Resident Room 36

37 COVER CONCEALMENT VS. Hides you STOPS Bullets Hides you DOES NOT STOP Bullets Keep Out 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

38 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 38

39 Todd M. Beamer United Airlines Flight 93 10:03 a.m. September 11, 2001 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! 39

40 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? 40

41 Exercise 2 We need a new bad guy. Who feels like shooting up a bunch of colleagues? Safety Transition Adjustment Formula Protocol STAF-P Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable The Dilemma What about my residents?!?! 41

42 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 What is the Safety Transition Adjustment Formula Protocol (STAF-P)? 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 SAFETY RESIDENTS S T A F - P EMPLOYEES Safety Transition Adjustment Formula Protocol (STAF-P)...balancing the safety of residents and employees 42

43 Safety Transition Adjustment Formula Protocol (STAF-P) Active Threat Distant Immediate Resident Safety Personal Safety Response Active Shooter Safety Action Plan Safety Transition Adjustment Formula Protocol (STAF-P) 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 Safety Transition Adjustment Formula Protocol (STAF-P) Protocol 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! 43

44 Safety Transition Adjustment Formula Protocol (STAF-P) Protocol 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 Safety Transition Adjustment Formula Protocol (STAF-P) Active Shooter Rule of Thumb: In the midst of a CAVE incident, the active shooter will be looking for targets of convenience and opportunity. The shooter is looking for mass casualties. As (s)he moves from area to area in your facility, (s)he is not likely to take time to breech a door or do a room-by-room search looking for victims. The shooter knows (s)he must move quickly before police intervene. Washington, DC Navy Yard Shooting Surveillance Footage (September 16, 2013) Source: FBI 44

45 Safety Transition Adjustment Formula Protocol (STAF-P) Protocol: Hide Out/Keep Out 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 Policy Development and Training Armed Intruder and Active Shooter in the Long Term Care Environment: Plan Respond and Survive the Unthinkable Policy Development and Training Policy 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! 45

46 Policy Development and Training Five Steps to Protect Our Stakeholders 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 Even if this is a good depiction of your maintenance director, this does NOT represent a good site security plan... Policy Development and Training Step 1: Conduct a Security Vulnerability Assessment (SVA) 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? 46

47 Policy Development and Training Step 2: Develop An Active Shooter Emergency Response Plan 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 Policy Development and Training Step 2: Develop An Active Shooter Emergency Response Plan Develop plan with employees and residents in mind 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 Policy Development and Training Step 3: Active Shooter Training 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 47

48 Policy Development and Training Step 3: Active Shooter Training 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 departmentspecific orientation as on-the-job training Policy Development and Training Drills 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 Policy Development and Training Step 4: Active Shooter Response The first response to an active event is the same for TRAINED and UNTRAINED (and UNPREPARED) people 48

49 Policy Development and Training Step 4: Active Shooter Response Trained and Prepared: Anxiety Recall what they have learned Ready to act as they have been trained Untrained and Unprepared: Panic Frozen with fear; disbelief and denial Stay frozen in shock and denial Policy Development and Training Step 5: Post-incident Recovery Policy Development and Training 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 49

50 Review PHASE Incident/CAVE Incident Decision making/stress Control 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 dwilder@swa4safety.com Armed Intruder and Active Shooter in the Long Term Care Environment: Plan... Respond and Survive the Unthinkable 50