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Hernand o ES F -8 Working Grou p / COAD Healthcar e Active & Directe d Shooter

Hernand o ES F -8 Working Grou p / COAD Healthcar e Active & Directe d Shooter. Tabletop Exercis e Template. H EALTHCAR E A CTIVE S HOOTE R C ONSULTIN G S ERV I CES P AUL L. F OR D , P H D , MBA, CHPA. Hernando Count y ES F - 8 W orking G r oup

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Hernand o ES F -8 Working Grou p / COAD Healthcar e Active & Directe d Shooter

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  1. HernandoESF-8WorkingGroup / COAD HealthcareActive&DirectedShooter TabletopExercise Template HEALTHCAREACTIVESHOOTERCONSULTINGSERVICES PAULL.FORD,PHD,MBA,CHPA

  2. HernandoCounty ESF-8WorkingGroup To enhancehealthandmedicalpreparednessand responseinHernandoCounty SpecialthanksgotoNinaMatteiwho conceivedofthis projectand provided guidance inthedevelopment.Itwouldnot havehappenedwithouther leadership. PresentationIncludes

  3. Youmaycopythewebsitebelowand watchhowonehospitaldid anactiveshooterand masscasualtyEXERCISEtogether. https://www.youtube.com/watch?v=XuTJdNk2c9o Reference:“ActiveShooter:HowtoRespond.”U.S.DepartmentofHomeland Security.2013.http://www.dhs.gov/publication/active-shooter-how-respond

  4. Background • JohnHopkinsHealthcarespecificresearch • ”thelikelihoodofbeingshotin ahospital islessthan thechanceofgettingstruck • bylighting” • “Mostoftheeventsinvolvedadeterminedshooterwithaspecifictarget”— • DirectedShooter • “Zeroriskisnotachievable” • Tabletopexercisesareanexcellentmethodtorefineand improve currentpoliciesand procedures.

  5. ReasonstoDevelopanActive/DirectedshooterPlan • ActiveShootersarerare,butcatastrophic • LossofLife • LossofReputation • LossofJobs • OSHAStandards • canbeutilizedtowinnegligencelawsuitsifthereisnoplan/education • Youcare

  6. 2000to2011HealthcareShootings • FBIStatistics: • Shootingsoccurred in40States—Florida,California,Texas,OhioandNorth Carolinaaccountformorethanonethird of allshootings. 44% occurred in southernstates. • 91% of perpetratorsweremen(allages) • 29%intheEmergencyDepartment(only19%fatality) • Mostcommonvictim wasperpetrator(45%) • 32% current orestrangedintimaterelations • 25% formerpatients • 5% formeremployees(this is whereworkplaceviolenceprogramsfail) • Active/DirectedshooterEvents areIncreasing

  7. FBI-LawEnforcementBulletin,January2014 J.PeteBlair,Ph.D.,M.HunterMartaindale,M.S.,andTerryNichols,M.S. The abovechartdemonstratestheincreasesinactive shooterevents. The abovechartdemonstratesthatfrequenciesofpeople bothshot and killed areincreasing.

  8. HealthcareRisks • AnActiveShooterisanindividualactivelyengagedinkillingorattemptingtokillpeopleinaconfinedandpopulatedarea;inmostcases,activeshootersusefirearm(s) andthereisnopatternormethodtotheirselectionofvictims(almostimpossibletopreventlessthan1%ofevents) • ADirectedShooterisanindividualwhofeelstheyhavebeenwrongedandhasa grudgeorreasonfortheiractionandisfocusedonaspecificperson.Thisis99%of healthcareshooters • DirectedShootermotivations • DomesticViolenceoverflowfromhome • Euthanasiaoflovedonesinpain • Grudgeorgrievanceagainsthealthcareprovider • EmployeeAngersituations • OverflowfromStreetevents

  9. HernandoCountyESF-8WorkingGroup To enhancehealth andmedicalpreparednessandresponsein Hernando County HealthcareActive/Directed ShooterExercise This ActiveShooterTabletopExerciseTemplatewas developed specificallyfortheHernandoCountyESF-8WorkingGroup.Itis developed asalearningtool.Itistangibleevidence ofthefacilities’commitmentto promotesafety throughpreparednessforanactive/directedshooterevent.

  10. Purpose TheActiveShooterTabletopExerciseTemplateprovideshealthcarefacilitiesausefulexerciseplanningandoperationaltemplatetoaddressactiveanddirectedshooter workplaceviolencethreats,issues,andconcerns.TheexerciseencouragesparticipantstoaddresskeyissuesThistabletopexerciseisaninteractive,discussion-basedactivityfocusedonadomestic-basedActiveShooterincident.Thescenario consistsofthreemodulesinchronologicalorderandportraysapre-incidentphase,anincidentandresponsephase,andanassessmentphase. TargetCapabilities Thesecapabilitiesprovidethefoundationfordevelopmentoftheexerciseobjectivesandscenario,asthepurposeofthisexerciseistomeasureandvalidateperformance ofthesecapabilitiesandtheirassociatedcriticalthinkingandtasknecessities. Planning Communications

  11. ExerciseObjectives ToopencommunicationsamongparticipantsconcerningActive/Directedshooterevents. AssessthemethodsandeffectivenessofinternalandexternalcommunicationsduringanActive/DirectedShootereventinaccordancewithexistingplans. Identifyandevaluatepreparedness,mitigation,response,andrecoveryactions associatedwithanActive/DirectedShootereventatyourfacility. Identifygaps,redundancies,deficienciesforimprovementinthecurrentpolicy. ProvidediscussiononpossiblebestpracticesandrevisionofActive/DirectedShooter policy/procedures. Prepareyourfacilityforactiveshooterfull-functionactiveshooterexercises.

  12. ExerciseGuidelines • This isanopen,low-stress,no-faultenvironment.Varyingviewpoints,even • disagreements,areexpected. • Respondbasedonyourknowledgeofcurrentplansandcapabilities(i.e.,youmayuse onlyexistingassets)andinsightsderivedfromtraining. • Decisionsarenotprecedentsettingandmaynotreflectyourorganization’sfinalpositiononagivenissue.Thisisanopportunitytodiscussandpresentmultipleoptionsandpossiblesolutions. • Issueidentificationisnotasvaluableassuggestionsandrecommendedactionsthat couldimproveresponseandpreparednessefforts.Problem-solvingeffortsshouldbethefocus. • Healthcarefacilitiesshouldbringtheexerciseday'sactualpatient/residentcensusto thetabletopexerciseforuseduringdiscussions.

  13. AssumptionsandArtificialities • Inanyexerciseanumberofassumptions and artificialitiesmay benecessarytocompleteplayinthetimeallotted.Duringthisexercise,thefollowingapply: • Healthcarefacilitiesshouldassumethatinitialpatient/residentcensusisactual patient/residentcensus. • Thescenarioisplausible,andeventsoccurastheyarepresented. • Thereisno“hiddenagenda”noranytrickquestions. • Allparticipantsreceiveinformationatthesametime. • Thiseventcouldapplyto anyhealthcareorganization. • Somedetails ofthepresentation and picturesofyourfacilityshouldbe added.

  14. It is a pleasant,summerday atlunchtimewithtemperaturesapproaching95F. Yourmaintenancedirectorisintheparkinglotassessingtreedamagefromlastevening’sthunderstormwhenheobservesa noticeablyagitatedunknownadult maleexitinghispickup truck. Theindividualis dressedin alongblacktrenchcoatand is wearingablackskihat.Uponexitingthetruck, hereachesintothebedofthepickupand pullsouta longcamouflageddufflebagandissoon observedenteringthecenterthroughthefrontdoor.

  15. Themaintenancedirectorcallsto theadministrator’sofficeto informthemof whathehasjust observed.(“JohnSmith”isa disgruntledemployee,whohad aprevioushistoryofcombativeargumentswiththeadministratorbeforehewasterminatedlastyear.) ShortlyafterJohnSmithentersthebuilding,themaintenancedirectorhearsloudscreamsand “poppingnoises”similarto gunshotscomingfrominsidethefrontfoyerofthecenter. Severalstaffmembersarethenseenfleeingthebuilding andsomeofthemare obviouslycoveredin blood andlookliketheyarein shock.Thegunmanthenleavesthefrontfoyerandproceedsto walkdownthe hallwaytowardsthedayroom andresident/clientdiningarea. Thesoundofpoppingnoisesand screamingcontinuessporadically.

  16. Questions?—Pleasetakenotes In yourcurrentposition,whatareyourinitialactionsandthe actionsof the staff? Whowouldcall 911and what informationshould beprovided? Whoisin charge? Howis whathashappenedcommunicated,internallyand externally? Do youlock down, andif sohow? Where doeslaw enforcementarrive? (Do theyknowthe facility orplan?) Do youhaveplannedescaperoutes or saferooms?What is a saferoom? Do youhaveaplanto facilitate communicationsand decisionmakingbymeetingwithlawenforcementat a leadershiprallyingpoint? (Where,who,how)

  17. INJECT1: ARRIVALOFLAWENFORCEMENT

  18. LawEnforcementArrives Locallawenforcementofficialsarriveonscenewithinfiveminutesofthefirst 911 callfromanemployeecellphoneinsidethebuilding.Policequicklyenterthebuildingthroughthefrontdoorstoact on“Active Shooter”information.Theentryteamconfirmsthatthepoppingnoiseswereindeedgunshotsand theyhave encounteredseveralwoundedordead residents/clientsandstaffmembers. Theybegina systematicsearchofthebuildingfortheintruderandcallforthe countybombsquadto respondonlocationastheyhavefounda largedufflebagthat appearssuspiciousandcould containanimprovised explosivedevice. Themaintenancedirectorremainsoutsideat theLeadershiprallyingpointtogive thepoliceofficersmoreinformationabouttheintruder. Additionalgunshotscanbeheardinsidethebuilding.

  19. Questions? Howdoesthearrivalof law enforcementchangetheresponselandscape?(How haveyouremployees beentrainedtoact)? HowwouldyouestablishaLeadershipRallypointtoassistlawenforcementwiththeirresponse?(Who,where) Whatareyourpriorityaction items forconsiderationat thispointintheincident? Whatdocumentationis beingdoneby yourstaff? Whatwouldbe theexpectationsthatyourstaff mightassistinthe coordinationoftriageandpre-hospitaltreatmentwithon-scene? Whatspecificinformationabouttheincidentwouldyoureleasetothemediaat anewsconferenceorinanewsrelease?Whattopics wouldyouaddress?Whatinformationwillneedtoremaincloselyheld?Do you haveaCrisis CommunicationPlan?

  20. INJECT2: INCIDENTRESOLUTION

  21. IncidentResolution Localnewsagenciespick upthechatterfromlawenforcementagenciesonpolicescannersandbeginto broadcastnewsoftheincident“LIVE”.Initialreportsindicatethatthe AdministratorandDirectorofNursinghavebeenshot andkilled.EmergencyMedicalServiceambulanceshavebeendispatchedand beginto arrive onlocationat the incident. Severalstaffmembersrunfromtherearofthebuildingshoutingthatthe manhas grabbedafellowassociateand hasshotandkilledseveral patients/residents/clients.Theygivedirectionsoftheapproximatelocationofthe gunmanto lawenforcementpersonnel.TheSWAT teamfindsthegunmaninthediningroomonthewestsideofthecenterholdinganassociatehostage.

  22. Casualties • Meanwhile,firstresponderteamsenterthecenter,securetheeastwingand beginevacuationofthebuilding.Negotiationwiththegunman continuesfor abriefperiodoftimeastheSWATteamentersthebarricadedroom,butnotbeforethegunmanshootshimselfand commitssuicide. • Summaryof • Casualties • TotalCasualties23 • Fatalities17

  23. Questions Howdoyoukeepstaff membersfromthemedia? Whatareyourpriority action itemsat thispoint? Whatis themediastrategyat this time?Willinterviewsand access tothesitebe allowedat thispoint?How willthisbe decided?Howwillitbe coordinated? Howwouldinquiriesfromprivate citizensseekinginformationon missinglovedonesbe handled?Howwillthefamilies ofvictims be notified? What typeof decisionsand actionswould havebeendecidedatyourleadershiprallyingpointduringthisevent? Willyourorganizationbeacasualtyor emergestrongerandmoreresilient? Whatwillbe theimmediateeffectsonstaff, residentsand families? What typeofemotionalsupportisinplaceforyourstaff members? Whatsystemis inplace todealwithfamiliesofthedeceased? Doyou have theresourcestoprovide immediateand longterm stressmanagementand/ormentalhealthservicestoyour personnel?If not,howcouldthoseservicesbe delivered? Howwillyour businessrecoverand cleanupfromcarnage?Howdoyoubringthecenterbackto a senseof “normal”afteranincidentofthis magnitude? Whowillnotifynext ofkin of thedead or wounded?

  24. ExerciseEvaluation PleaseprovidefeedbackontheActiveShooterTabletopExercise: 1.Howcouldthiseventhaveactuallyhappened? • What gapsdid youidentify inyour plan? • Whatrecommendationsdoyouhavetoimprovethecurrentplan? • Wereyouengagedenoughtostimulateactivethinking? • Whatthings didyoudiscoverthathadnotbeendiscussedbeforetheexercise? • Wouldyourecommendthisexercisetootherfacilities? • Whyorwhy not? • HernandoCountyESF-8WorkingGroup • Toenhancehealthand medicalpreparednessand responseinHernandoCounty

  25. BasicEmployeeActiveShooterTraining • Run,Hide,Fight • OptionsforEscape Routes and MeetingPlaces • Equipped Safe Rooms • PlainLanguageInternaland ExternalCommunications • Hot Wash(AfterActionReports) • Employee AssistanceProgram Available • Anexcellenthospitaltrainingvideo is https://vimeo.com/111156310

  26. PersonalPlanning RUN HIDE FIGHT

  27. RUN Ifyouhearshotsor“Gun,getout”RUNawayfromtheshooterandgunshots--fastin azigzagpattern usingcoverif possible,lookingfor exitsigns Trytogeteveryonetogowithyoubutleavepersonalbelongings Call911assoonasitissafe

  28. HIDE Gotosafestroompossible(medroom,patientroom,bathroom);if inapatientroom,reassurepatientandexplainyouwilllockand barricadethedoorswithheavyfurnitureandwedgethebottom Turnofflights Silenceallelectronicdevices Signallawenforcementifpossible(papersigninwindow) RemainsilentbutpreparetoFight Remainuntillawenforcementstaysitisallclear

  29. FIGHT • Findaweapon • Fire extinguishers,chairs,IV poles, flowers,phone, keys,etc. • TexasStateStudy2013 • Of 41 ActiveShootereventsfrom2000to2010thatendedbeforelaw enforcementarrived • Potentialvictimsstoppedtheattacker16times • Theattackerwas subdued13times

  30. MovingForward Forhelpwithafacilityspecificplan,trainingandexercises: PaulL. Ford,Ph.D.pford51@gmail.com(813) 610-8148 NinaMattei,APR,FPEMNina.Mattei@FLHealth.Gov(352)540-6822

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