6 steps for creating an active shooter plan

Active shooter.

No matter where you are, that two-word phrase inspires fear in almost everyone. And it should. An active shooter is an individual or individuals actively engaged in killing or attempting to kill people in a confined and populated area.

Now, imagine that active shooter is within the walls of your hospital.

An active shooter event in the environment of a healthcare facility presents new and unique challenges. Healthcare professionals may be faced with decisions about leaving patients, visitors will likely be present, and patients may be unable to evacuate due to age, injury, illnesses or a medical procedure in process. From 2000-2011, there were 164 hospital related shootings. While that number means you are more likely to be struck by lightning than to be shot in a hospital, shootings in and around healthcare grounds do happen and it is up to hospital administrators to make sure a plan is in place.

Because of the unpredictable and quickly evolving nature of an active shooter situation, individuals must be prepared to manage it before law enforcement personnel arrive on the scene. These six steps will help hospital staff in creating a plan to effectively respond to an active shooter situation in a healthcare facility.

Step One: Establish a preferred method for reporting active shooter incidents to staff and hospital guests.

Research shows that warnings do not induce panic. People need accurate information and clear instructions. The quick delivery and notification of an incident can keep people out of harm’s way. And that means saving lives. In creating the notification plan, hospital staff need to consider multiple factors to make sure the notification plan is as clear as possible.

Protocols should be available and clearly understood by those responsible for issuing the alert. Make sure communication barriers such as multi-lingual, hearing impaired and learning disabled messaging, are all considered in the reporting method. Electronic communications, such as text messages or email, are effective provided the language uses familiar terms and considers the issues mentioned above. Other methods include the use of sounds or lights as notification.

When choosing notifications, stakeholders should also consider hospital workers in locations outside of main buildings or in more remote areas of the hospital grounds. Another critical aspect if the ability to alert other local hospitals and emergency responders - as well as letting patients, visitors and staff know when the hospital grounds are safe once again.

Step 2: Create emergency escape procedures and route assignments for healthcare staff.

The golden rule is less people in the hot zone means less victims. In fact, according to the Healthcare and Public Health Sector Coordinating Council, an evacuation policy and procedure, as well as emergency escape procedures and route assignments, are among the items that must be included in an effective plan.

Because of that, active shooter plans should identify safe areas and provide floor plans of the entire healthcare network. Another consideration is how will evacuation take place when the primary evacuation routes are unusable. Have a route, have secondary route, and if possible, have a tertiary route.

Step 3: Establish lockdown procedures for individual units, locations and other buildings.

Hospital grounds normally include multiple buildings and wings. In fact, in research conducted by John Hopkins University of Medicine in Baltimore, 40 percent of all the hospital-based shootings occurred outside of hospital buildings.

In creating an active shooter plan, teams should consider how to effectively lockdown patients, visitors and staff to keep them safe, making sure to take into account access to functional safety needs when advising on shelter sites.

In terms of shelter sites, effective shelter-in-place locations should be carefully selected. Optimal location characteristics include thick walls, solid doors with locks, minimal interior window, first-aid emergency kits, communication devices and telephones or duress alarms.

Step 4: Integrate the plan with facility Emergency Operations Plan (EOP) and Incident Command System (ICS).

An active shooter plan should be integrated with both the hospital’s EOP and ICS. Hospitals are required to have an EOP which describes how a facility will respond to and recover from all hazards. It is inclusive of the following six critical elements within The Joint Commission’s Emergency Management Standards:
● Communications
● Resources and assets
● Safety and security
● Staff responsibilities
● Utilities and clinical
● Support activitie

An ICS is a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure.

Step 5: Establish pertinent information for local emergency response agencies and hospitals.

Pertinent information for other local hospitals and emergency response agencies may include items such as telephone numbers, names and distance from the active shooter location. Having this information collected and easily accessible during an emergency has the potential to help teams act quickly when time is at a premium.

Step 6: Maintain your plan with ongoing training.

Ongoing training is an important part of ensuring everyone involved shares the most up-to-date resources. Training shouldn’t be limited to one approach, consider using methods such as annual competencies, monthly newsletter, orientation and training videos as vehicles for ongoing training.

Patient safety demands safe facilities. Part of that includes the creation and implementation of a smart, effective active shooter plan. While there may never be a need to enact it, planning for the unexpected will keep hospital staff, patients, and visitors safe. Hospitals and healthcare facilities save lives every day. Why should this be any different?

About the Author
Scott Cormier is the Vice President of Emergency Management, Environment of Care (EOC) and Safety at Medxcel Facilities Management, specializing in facilities management, safety, environment of care and emergency management and provides healthcare service support products and drives in-house capabilities, saving and efficiencies for healthcare organizations that, in turn, improve the overall healing environment for patients and staff. Cormier leads the development and implementation of emergency management, general safety, security, fire protection, life safety and accident-prevention programs for a national network of hospitals that Medxcel Facilities Management serves.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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