Administrators should take measures, including regular training sessions and internal and environmental assessments, to ensure staff members and patients are equipped to handle an active shooter situation, as Solveig Dittmann, senior risk specialist at Coverys explains.
The number of active shooter incidents in U.S. hospitals has steadily increased over the past 10 years, now reaching more than one per month. No matter where violent events may occur within the healthcare setting, it is vital that all staff are trained on how to respond in an active shooter situation to protect their patients and themselves.
In order for staff members to protect everyone’s safety, administrators should take proactive measures, including regular training sessions as well as internal and environmental assessments, to ensure staff members and patients are equipped to handle an active shooter situation.
There are various forms of preparedness training and education, so it can be difficult for hospital administrators to determine the most effective way to train staff members. The Department of Homeland Security’s (DHS) Run, Hide, Fight strategy is a good place to start. This method, which is fairly self-explanatory, is easily remembered by staff and teaches them the best course of action to take in the event of an active shooter or another violent episode.
"Communication between hospital staff and law enforcement will help to ensure that staff take actions that will ultimately work for, not against, efforts by police."
In addition, administrators must give employees hands-on instruction, guidance, and practice to effectively carry out these methods. To do so, training preparedness in the form of active shooter drills or tabletop sessions is essential.
The most effective training method for active shooter preparedness is an active drill. This type of training provides hospital staff the opportunity to practice proper responses through a simulated scenario of an active shooter and should be done on an annual basis.
Whenever possible, it is recommended to work closely with local law enforcement on active drills. Communication between hospital staff and law enforcement will help to ensure that staff take actions that will ultimately work for, not against, efforts by police who arrive to manage the situation.
To conduct an active drill, if you’re following the DHS’s guidelines, run through possible scenarios with staff so they know how to respond. Then physically walk through the process of identifying all accessible exits. If exiting isn’t an option, assist staff members in identifying “shelter in place” areas which can be closed off and secured with heavy furniture or equipment such as file cabinets or copiers.
Last, if there isn’t an easy exit or hiding place, fighting may be the only option. DHS recommends teaching staff members to take note of objects in their work environment that could be used to disable an assailant such as heavier items that could be picked up and thrown at an intruder. In these circumstances, DHS suggests that taking physical action may be the only way to save lives. Walking through an active drill of what it means to fight back can help staff feel prepared should the time come.
If running active drills isn’t feasible, DHS suggests conducting tabletop exercises. Tabletop exercises are roundtable discussions that give management and staff the opportunity to verbally walk through various simulated emergency situations and the different responses. While these may not be as impactful as active drills, tabletop discussions bring awareness about potential threats and give staff some strategies to use in the event of an active shooter situation.
If opting for tabletop exercises, do not forget to include representatives from local law enforcement. Staff members need to understand certain aspects of the law enforcement response in these situations. It is essential for hospital staff and visitors to exit quickly and with their hands visible to not be mistaken for potential shooters and to understand why police in an active shooter situation will not stop to help the injured until the threat has been neutralized.
Plain language codes
During a time when violence in healthcare settings is on the rise and as healthcare organizations embrace enterprise risk management, implementation of plain language codes is another way to promote safety and reduce harm. While color codes are still used by many hospitals, using plain language codes in some situations will provide greater clarity and enable more appropriate response times.
The risk associated with using a color code, for example “code gray”, to describe an active shooter situation is that it may mean something different to staff with previous work experience and may not be understood at all by visitors or vendors who might be present. It also lacks vital details on the situation.
By using a clear description such as: Active Shooter + Location + Action Required (eg, shelter in place or evacuate), staff can immediately act based on the details provided without having to recall what a specific color code means during times of urgency. Hospital administrators have the responsibility of determining which plain language words and directions will best meet their facility’s needs. The goal is for staff, visitors, and patients to understand the communication the first time they hear it and to immediately know what actions are required.
Awareness of internal risks
It is vital that HR and department managers assess the stability of their workforce to prevent the likelihood of workplace shootings in a healthcare setting.
Managers should be properly trained to identify stress in employees, report on-the-job performance issues, and conduct regular check-ins to assess mental, physical, and emotional well-being. Working with department managers, HR should identify potentially unstable or disgruntled employees who may become violent. It is also important to encourage staff to come forward with any concerns of colleagues who exhibit aggressive or potentially violent behavior.
Monitoring internal stress levels of employees includes identification of situations where employees’ personal lives are affecting their work lives. While this is not always easy, managers should try to make staff comfortable enough to share personal situations such as domestic violence, particularly if they feel as though their partner or member of their household could bring violence to the workplace.
When discussing the matter at department meetings or during training sessions, having real-life cases to share as examples can help staff feel more comfortable coming forward. It is important to provide a safe and confidential method for employees to report any domestic issues to HR. If a problem is identified, retain counsel to provide guidance on the best way to proceed. Solutions may include allowing an employee to take a leave of absence to allow time and attention to resolve the issue or obtaining a restraining order.
A Threat Assessment Team comprising the same individuals in leadership, HR, safety/security, and care providers should convene regularly to review all threats and provide input into active shooter preparedness. If internal risks are flagged, security should be notified of the potential threat. This proactive communication effort helps identify problems early on, opens the discussion to find a solution, and helps to prevent a potentially violent act.
In addition to staff training, environmental assessments and panic alarms can be used in order to increase safety in the workplace.
The first step is to assess your hospital’s design in each department. It is vital for staff members to know their surroundings. Identify the safest and quickest routes to exit in all areas and make sure these are covered with staff during training sessions. In addition to being aware of all escape routes, DHS recommends that hospital staff should familiarize themselves with nearby objects that can double as defense weapons. Newer buildings should include multiple, clearly marked exits in each room in order to provide an escape route in the event that the shooter is blocking one exit.
Should an exit not be accessible, ensure staff know where they can safely hide from the threat and go over these areas in training sessions. If there are designated safe areas within the hospital, they should not be located in restricted access areas as all staff members must be able to gain access in case of an emergency. By going over safe area locations in training, employees can save seconds and even minutes in a crisis situation by knowing how to respond.
In addition to hospital design and familiarizing oneself with the surroundings, there are tools available to hospital staff that provide immediate notification of law enforcement in case of an emergency. For instance, some computers can be equipped with emergency alert buttons that immediately trigger nearby security and direct them to the scene.
There are also personal panic alarms available that hospital staff can wear to alert security or law enforcement. These panic buttons trigger a silent alarm to summon help. These are often used in emergency departments or behavioral health units, but can be more widely applied to encourage all hospital staff members to be prepared in the event of an active, violent situation.
Preparedness is key to staff and patient safety
Active shooter situations are unpredictable and tragic events. Preparation is key to minimizing impact and maximizing safety. To do so, organization leaders can follow the core elements in helping staff prepare for these situations: conducting regularly scheduled preparedness training sessions in the form of active drills and tabletop sessions; identifying and monitoring potential internal threats or stressors; and ensuring staff are keenly aware of the workplace environment and that the proper communication tools and equipment are available in crisis situations.
By ensuring staff are adequately trained, HR professionals better position their hospital to handle the crisis of an active shooter situation and increase safety for both staff and patients.
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Coverys, US, Solveig Dittmann, Healthcare, Risk management, Department of Homeland Security, Threat Assessment Team, Crisis management