Active Shooter

Code: Silver

Defined: An active shooter is an individual actively engaged in killing, or
attempting to kill people, in a confined and populated area, typically through the
use of firearms.

Immediate Action: “Run, Hide, Fight.”

General Staff Assignments:

  1. While personal safety is the primary consideration in any emergency, helping others to safety increases the survivability for all potential victims. Rendering aid can be as simple as rallying likely victims to “Follow me!” or
    aiding non-ambulatory persons and performing immediate first aid in safer areas. Consideration should be given to residents who have difficulty evacuating without assistance.
  2. Active shooter incidents are unpredictable and evolve quickly. Because of this, individuals must be prepared to deal with an active shooter incident before law enforcement personnel arrive on the scene. Shooters generally arrive with more ammunition than they could ever use, increasing the urgency for everyone to have a plan and act on it as quickly as possible.
  3. When an incident occurs, follow the emergency plans and any instructions given, taking into consideration their particular circumstances. The safety of residents, other staff, visitors, and vendors is the most important factor
    to consider when making decisions.
  4. Staff closest to the public address or other communications system should communicate the danger and necessary action.
  5. As the situation develops, it is possible that those present will need to use more than one option. While they should follow the “Run, Hide, Fight” plan and any instructions given by appropriate facility representatives during an
    incident, they will often have to rely on their own judgment to decide which option will best protect lives.

Run – Best option

  1. Run out of the facility or away from the area under attack and move as far away as possible until in a safe location. Simply exiting the building and going to an evacuation site via practiced fire drill routes may put individuals at risk.
  2. Recent research shows the best method to reduce loss of life in an active shooter incident is for people to immediately evacuate or be evacuated from the area where an active shooter may be located or attempting to enter.
  3. Leave personal items behind.
  4. Visualize possible escape routes, including physically accessible routes for residents, visitors, or staff with disabilities and others with access and functional needs.
  5. Avoid escalators and elevators.
  6. Take others if possible, but do not stay behind because others will not go.
  7. Call 911 when safe to do so.

Call 911 to Report:

  1. Location and description of attackers.
  2. Types of weapons, methods and direction of attack, and flight of attackers.
  3. Don’t assume that someone else has called.

Hide – if Exits are Inaccessible

  1. If running is not a safe option, hide in a safe space with thick walls and few windows. For residents who cannot “run” because of mobility issues (e.g., they are unable to leave their bed) hiding may be their only option.
  2. Lock the doors.
  3. Barricade doors with heavy furniture or wedge items under the door.
  4. Secure the unit entrance(s) by locking the doors and/or securing the doors by any means available (e.g., furniture, cabinets, bed, and equipment).
  5. Close and lock windows and close blinds or cover windows.
  6. Turn off lights.
  7. Silence all electronic devices.
  8. Remain silent.
  9. Look for other avenues of escape.
  10. Identify items (fire extinguishers, chairs, lamps) that could be used as weapons.

Communicate Nonverbally with First Responders

In rooms with exterior windows, make signs to silently signal law enforcement and emergency responders to indicate the status of the room’s occupants).

  1. Hide along the wall closest to the exit but out of view from the hallway (which would allow the best option for ambushing the shooter and for possible escape if the shooter enters or passes by the room).
  2. Remain in place until given an all clear by identifiable law enforcement.

Fight – If Running and Hiding Aren’t Options

  1. A. Disrupt or incapacitate the shooter by using aggressive force and items in their environment, such as fire extinguishers, chairs, etc.
  2. Research shows the strength in numbers; potential victims themselves disrupted 17 of 51 active shooter incidents before law enforcement arrived.

Interacting with First Responders

Police officers, firefighters, and EMS personnel (i.e., first responders) who come to the facility because of a 911 call involving gunfire face a daunting task. Though the objective remains the same—protect residents, visitors, vendors and staff—the threat of an active shooter incident is different than responding to a natural disaster or many other emergencies. Information coming in can be inaccurate and conflicting. This violence might be directed not only in or at facilities, staff, residents, visitors and vendors, but also at nearby buildings off site.

Law enforcement’s first priority is to locate and stop the person or persons believed to be the shooter(s); all other actions are secondary.

  1. Do not interfere with the law enforcement response.
  2. Follow directions and display empty hands with open palms.
  3. Law enforcement may instruct everyone to get on the ground, place their hands on their heads
  4. Individuals may be searched. Don’t resist.

Specific Staff Assignments/following the active shooter situation:

After the active shooter has been incapacitated, management should engage in post-event assessments and activities:

  1. Account for all individuals at one or more designated assembly points to determine who, if anyone, is missing or potentially injured.
  2. Coordinate with first responders to account for any residents, visitors, vendors and staff who were not evacuated.
  3. Determine the best methods for notifying families of individuals affected by the active shooter, including notification of any casualties; this must be done in coordination with law enforcement.
  4. Assess the behavioral health of individuals at the scene. Provide information to victims, victim families, staff and others about distress helplines, Office for Victims of Crimes counselors or employee assistance personnel (EAP). Substantial resources and processes are in place to aid victims and their families, most notably through state agencies, the Department of Justice, and the FBI’s Office for Victim Assistance.
  5. Ensure equal access to all such resources and programs for people who are deaf, hard of hearing, blind, have low vision, low literacy and other communication disabilities and individuals with limited English proficiency.
  6. Activate a staff family unification plan, communicating this to staff and providing a safe place, away from press for families to gather.
  7. Identify and fill any critical personnel or operational gaps left in the organization as a result of the active shooter.
  8. Determine when to resume full services.
  9. Nothing should be touched unless it involves tending to the wounded. The situation and the location are an active crime scene.
  10. Plan for an extended, evolving situation and the mass casualty or internal disaster plan to be activated to manage the continuing situation. This may include altering daily activities in order for law enforcement and first responders to adequately investigate and clear the scene.

Preparing Ahead/Training:

  1. Train staff, appropriate residents, and volunteers the “Run, Hide, Fight” response.
  2. Train staff to overcome denial and to respond immediately. For example, train staff to recognize the sounds of danger, act, and forcefully communicate the danger and necessary action (e.g., “Gun! Get out!”). M.Repetition in training and preparedness shortens the time it takes to orient, observe, and act.
  3. Training provides the means to regain composure, recall at least some of what has been learned, and commit to action. Training to “Run, Hide, or Fight” prevents inaction.
  4. In many instances, an individual might first need to hide and then run to safety when able.
  5. It is not uncommon for people confronted with a threat to first deny the possible danger rather than respond, hearing firecrackers when, in fact, they are hearing gunfire.
  6. Speaking with staff about confronting a shooter may be daunting and upsetting for some people, but great comfort can come from the knowledge that their actions could save lives. To be clear, confronting an active shooter should never be a requirement of any health care provider’s job; how each individual chooses to respond if directly confronted by an active shooter is up to him or her.

See Also: Kentucky Community Crisis Response Board (KCCRB), Mental Health Resources, Psychological First Aid, Workplace Violence

Resources:

Information taken from “Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans”, U.S. Department of Health and Human Services, U.S. Department of Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation Federal Emergency Management Agency, 2014. Access at http://www.phe.gov/HCF-Plans/Pages/default.aspx.

Other Active Shooter resources include:

http://www.activeshooter.lasd.org/
The Los Angeles County Sheriff’s Department created this video to help people answer the question “What would you do?” in the event of a sudden attack by a gunman while at work, at school, or in public. The video contains graphic content of a violent nature. Viewer discretion is advised.

Access a free webinar, “The Active Shooter in Long Term Care and Assisted Living Communities.” (1 hour, 29 minutes) at https://www.youtube.com/watch?v=HgDeTFLZMPU This webinar was produced by the Stanford Geriatric Education Center.

The MESH Coalition (Managed Emergency Surge for Healthcare), based in Indianapolis, IN has a training video: http://vimeo.com/meshcoalition/review/108575641/dd69fdb233