8/15/2016 THREAT ASSESSMENT: THE ACTIVE SHOOTER RISK OBJECTIVES RECENT NEWS K DON EDWARDS DO. Understand what the past has shown us

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1 K DON EDWARDS DO THREAT ASSESSMENT: THE ACTIVE SHOOTER RISK OBJECTIVES Understand what the past has shown us Develop a better awareness of the risks Prepare staff in what to do Develop a simple, practical plan RECENT NEWS almost 75% of all workplace assaults between 2011 and 2013 happened in healthcare settings; 80% of emergency medical workers will experience violence during their careers; 78% of emergency department physicians nationwide report being the target of workplace violence in the past year; 100% of emergency department nurses report verbal assault and 82.1% report physical assault during the last year;. N Engl J Med. 2016;374:

2 CONTINUED 40% of psychiatrists report physical assault; the rate of workplace violence among psychiatric aides is 69 times higher than the national rate of workplace violence; 61% of home healthcare workers report violence annually; and family physicians are also at high risk, although limited data exist in the outpatient setting. HISTORICAL BACKGROUND Active Shooter: an individual is actively engaged in killing or attempting to kill people in a confined and populated area. US Department of Homeland Security- DHHS December 2014 Planning Guide for Active Shooter Planning Healthcare facilities vulnerable targets : preparatory drills must be routinely pursued BACKGROUND: ANNALS OF EMERGENCY MEDICINE (DECEMBER 2012 VOLUME 60, ISSUE 6, P ) Review 154 hospital related shootings Large hospitals higher incidence Nearly 60% inside building (34% ED / 32 % rooms) 91% shooters male Most shooters neither current nor former employees or patients Most shooters has a specific target Estimated 30% incidents could have been prevented by use of a metal detector 2

3 BACKGROUND INFORMATION CONTINUED 23% weapon was a security officer s in the ED Most incidents involved a determined shooter with strong motive defined by: a grudge (29%) Suicide (21%) Euthanizing (14%) Perpetrator most common victim (45%) Hospital employees (20% victims) 235 injured or dead FBI REPORT KEY FINDINGS 1. 60% incidents end before police arrived 1. 69% < 5 minutes (36% ended in less than 2 minutes) % incidents ended after unarmed citizens restrained shooter. 3. Citizens should be trained in their options to respond. 4. Active Shooter Incidents are increasing. 3

4 TOOLS TO HELP OSHA REQUIREMENTS TYPE OF VIOLENCE 85 % workplace homicides (Type 1) : perception there is something of value to take (cash, meds) Health Care and Social Service (Type 2) : offender known to organization as client, patient, customer and violence occurs during when service provided (4x risk of or types of workers) New type blurs lines between workplace violence and terrorism 4

5 PLANNING TOOLS ew CHALLENGES FOR HEALTH CARE Vulnerable population Hazards: chemical /radiological/ medications Service oriented Security Ethical Decisions LEARNING PEARLS No Single method to respond Planning allows staff to select best option Best way to save lives is to remove potential targets from shooters vicinity Active shooter are unpredictable and evolve quickly Staff must be prepared to deal with incident before law enforcement arrive 5

6 PLANNING IDEAS Maximize protection of Life Evacuate if possible Individuals will have to make decisions based on situation May have a duty of care for patients Involve your staff Simulation and practice.. Make it fun PREVENTING AN ACTIVE SHOOTER SITUATION No profile exists for active shooter: There may be signs or indicators that can be recognized FBI BEHAVIORAL INDICATORS Development of a personal grievance Contextually inappropriate and recent acquisitions of multiple weapons, explosives interest, fascination in mass shootings Personal loss due to death, breakup, divorce, job loss Few offenders had previous arrests for violent crimes 6

7 CONSIDERATIONS IN PLANNING How to evacuate or lock down (secondary routes) Identify effective shelter-in Place locations How to communicate (inside and out) Discuss Response Plans Exercise /Drill your plan WHAT HAVE WE DONE HERE? Training/ Exercising/ Infrastructure Secure Access (doors, card access)/ Drives/ Cameras Workshops Subject Matter Experts and Real Lessons Learned Active Shooter Preparedness Training Coordination with Local Law Enforcement/ Emergency Management Drills/ Exercises (full range) Refresher training Behavioral Health Adding partners (Long Term Care) EXAMPLES, MODELS, IDEAS Hospitals are on the off-limits list even for those with legal permit/license (includes open carry and conceal carry) One policy for all on campus and off campus practices/ buildings Some have included any type of weapon in policy Some on person/ even in vehicle of employees Staff review each year 7

8 WHO IS EXEMPT On duty Law Enforcement Prison or Corrections Officers FOR INSTANCE Procedure/ Policy Should define offensive or threatening acts What to report, When and to Who The follow up of the incident or concern PUBLIC/ STAFF AWARENESS Signs Overhead Pages(announcements) Security alert 8

9 FEMA TRAINING IS 907- ACTIVE SHOOTER: WHAT YOU CAN DO IS 907 internet self paced course THE FUTURE Changing threats Run, Hide, Fight Distract (focus), Disrupt (rhythm), Disarm (access) Behavioral Health Starts early and can last long term REVIEW Understand what the past has shown us Develop a better awareness of the risks Prepare staff in what to do Develop a simple, practical plan 9

10 THANK YOU QUESTIONS??? K Don Edwards DO D1meddir@sbcglobal.net 10