SCPS Public Safety Webinar 03 | Mandala Collections

Hello everyone and welcome to UVA's Masters of Public Safety Program webinar

series on active shooter incidents in the healthcare setting. This program is

brought to you by the School of Continuing and Professional Studies. The

title of this webinar is Active Shooter Incidents in the Healthcare Setting:

Operational Considerations for Healthcare Facility Responders. I'm Meghan

Stepanek and I'll be your presenter today. There are three webinars in this series.

On the first webinar we discussed collaborative planning for active

shooter incidents and healthcare facilities, including crisis

communications and training. In the second webinar we discuss operational

considerations for first responders, including what they need to know about

the healthcare context. In this webinar we'll discuss the operational

considerations for healthcare facility responders. At the conclusion of this

session learners will be able to 1. discuss what healthcare entities need to

know for their interactions with Public Safety in response to active shooter

incidents. 2 identify messaging and staff coordination needs, and 3.

discuss continuity of operations or COOP issues for active shooter incidents. Our

first segment is what healthcare entities need to know for interactions

with Public Safety in response to active shooter incidents. When an active shooter

incident occurs the immediate response from law enforcement will be to identify

and subdue the perpetrator to prevent further harm to victims. Active shooter

situations are typically distinguished from other longer responses, such as a

hostage incident, in that they only last minutes The Police Executive Research

Forum characterizes active shooters as aiming to inflict mass casualties as

quickly as possible. Shooters don't necessarily target

particular individuals but, rather try to kill as many people as possible. In an

FBI study of 63 active shooter incidents in the United States between 2000 and

2013 where the duration the incident could be ascertained, well over half of

the incidents ended in five minutes or less, and over a third ended in two

minutes or less. Even though the active shooter incident is typically short in

duration it is nevertheless important for health care entities to activate their

healthcare incident command structure or HICS for their internal response to

begin coordination. the HICS brings together planning, operations, logistics,

and administration to inform leadership and enable

entities to properly deal with the many challenges in the aftermath of the

shooting. Additionally use of a HICS means that law enforcement and other

responders involved will be able to more easily interface with healthcare

entities when the common framework is used. Management of the incident, from

initial response to recovery, may also necessitate coordination through a

unified command. In a unified command the HICS is integrated into the external

response agencies ICS structures to facilitate decision-making and

communications. After perpetrators initiate shooting, calls coming from

multiple sources to 9-1-1 centers are likely to relay at least some

conflicting information about the incident.

This may include varying descriptions of the shooter or shooters. In the chaos of

the first few minutes of response, law enforcement officers need to make quick

decisions to identify the shooter amidst employees, visitors, and patients - some of

whom may be wounded and seeking assistance. Depending on the incident the

available resources ,and the protocol for the response agency, law enforcement may

not wait for specialized units to arrive. In this instance, a single patrol level

law enforcement officer may make entry into the facility to subdue the shooter

while other units are still responding.P atrol level officers typically wear

bulletproof vests, while law enforcement responders who are part of a specialized

team may also have ballistic gear, shields, and helmets. In either case the

gear will not protect them from all threats. In addition to protective

equipment officers may also carry different weapon types and may even use

pepper spray or teargas to control the situation.

Law enforcement officers may also be wearing body worn cameras, or BWCs,

while responding to an active shooter incident. BWCs record video footage of

the response that can serve as evidence in criminal investigations and

prosecutions. Law enforcement agency policies concerning body worn cameras

will vary by jurisdiction, and based on applicable laws.

While law enforcement officers will typically turn off the BWCs when

entering into patient care areas under normal circumstances, they're likely to

have the cameras on when confronting a violent or assaultive of suspect, and when

anticipating the use of force. The area where the threat is not under control is

known as the hot zone. When making entry law enforcement may need to shout

commands to direct building occupants, and to distinguish them from the

perpetrator. Healthcare facility employees may need to assist patients

and visitors and following these commands, and directing them to evacuate,

hide, or shelter in place. First-in law enforcement officers will initially

bypass victims who've been shot in order to subdue the shooter before going back

to help the wounded. The cold zone is the area that has been completely cleared

and has deemed safe. The warm zone is the area between the hot and cold zones. For

incidents involving casualties, emergency medical services or EMS responders may

not be allowed to enter an area where victims are located if it is in a hot or

a warm zone, until the shooter is controlled, they are able to be escorted

with protection, or until the area is cleared and deemed safe. Some law

enforcement groups have EMS responders embedded in their team. These responders

can take immediate action to control bleeding, such as applying tourniquets,

before moving the victim to an area of safety to receive additional emergency

care. Responders from law enforcement, fire, and EMS will need to be advised by

healthcare facility representatives who are knowledgeable of the facility, and

the patient population. Health care facilities should have a go kit prepared

with floor maps, keys, and access cards to quickly provide to first responders. This

should include information on the location of dangers as discussed in

webinar 2 such as biohazard agents, medical gases, and MRI machines. In some

incidents fire service responders may need to breach walls or ceilings and

will need to know about the location of gas lines and air handling units. They

will also need information from health care facility reps about health care

operations, including where surgeries are being

performed, and units with patients who rely on medical equipment. Hospital

police departments and security personnel will also need to control the

perimeter around the incident to keep people from unsafely entering dangerous

areas or to identify where the perpetrator has fled. Once an active

shooter incident occurs, the health care facility, particularly the parts of it

where the shooter traveled through and inflicted harm to others, will be

considered a crime scene. Evidence preservation will be important for law

enforcement officers who will need to collect information about what occurred

in order to complete their investigation. Access control to the areas of these

facilities is essential to ensure that the crime scene is not disturbed.

Health care entity representatives may also need to coordinate with law

enforcement to identify witnesses. Our second segment is about identifying

messaging and staff coordination needs. Notification to health care employees is

critical at all phases of Incident Response. Timely messages are necessary

to inform employees action steps, including decisions that they'll make

that impact the safety of patients and visitors in their care. For health care

facilities, notification to regulatory entities such as the Joint Commission,

the state health care licensure agency, and the state occupational safety and

health agency, is advisable to keep these stakeholders informed. and it may even be

required. Notification ensures that response by the regulatory entity is

planned and that the healthcare entity can connect them to the appropriate

points of contact. In addition, information also needs to be collected

for use in response recovery and investigation. For example, staff at ID

check points such as visitors desks, in-patient registration, and in-patient

census can supply information to ensure that all personnel and occupants are

accounted for, including those who may have fled the scene. As an incident

unfolds and external response resources arrive on scene, updated information

will need to be conveyed. Coordination through public information

representatives from the healthcare entity and the responding

agencies should be done through a joint information center or JIC as discussed

in webinar one. This helps not only with the information directed to the public,

but also to health care employees, visitors, and patients. Some building

occupants may be sheltering in place, and will need to receive word, and even

through face-to-face communications in order to know that a shooter is subdued

and the scene is safe. Message coordination through the JIC helps

ensure that information concerning suspects and victims is appropriately

shared.

Our final segment is on healthcare continuity of operations or COOP issues,

during and after an active shooter incident. COOP planning ensures that

essential functions can be maintained in an active shooter incident. The response

and aftermath will cause disruption to clinical and other healthcare facility

activities. Planning ahead for this disruption helps reduce the impact of an

active shooter emergency. COOP plans in the healthcare setting can include

procedures such as those for patient tracking, surgery cancellations, and

patient transfer. Planning resources and templates exist that provide healthcare

specific guidance using an All Hazards approach that can be adapted for use in

active shooter incidents. One such publication is the Department of Health

and Human Services Assistant Secretary for Preparedness and Responses "Health

care COOP and Recovery Planning: concepts, principles, templates, and resources"

Demands on health care services considered essential such as emergency

care may surge during the active shooter response before an incident even occurs.

Some facilities may already be at or near capacity. A sudden influx of

patients from casualties could necessitate movement and transport of

victims to other nearby facilities or trauma centers. Incoming patients for

emergency treatment or scheduled treatments may also need to be diverted

to other facilities that can absorb the extra patient volume. If the incident is

expected to rise to the level of an emergency declaration and have a

prolonged impact on operations, health care entities can request a waiver of

Medicare, Medicaid, and Children's Health Insurance Program, or CHIP requirements.

This allows for modifications of conditions of participation or other

certification requirements. These waivers, under Section 1135 of the Social

Security Act, help to ensure that services provided can be reimbursed. They can also

allow exemptions under the Emergency Medical Treatment and Labor Act ,or

EMTALA, to alleviate surge and facilitate patient transfer. In the immediate

aftermath, as well as the days, weeks, and months that follow, the active shooter

incident may trigger stress in healthcare

workers and other employees of the affected facility. For larger facilities,

in-house resources such as employee assistance programs, and/or Social Work

departments may be leveraged for stress support after an incident. For others,

external resources specializing in psychological first aid or critical

incident stress management may need to be identified for mental health support.

All Hazards COOP planning is a necessary aspect of healthcare facility

preparedness for an active shooter incident because of the disruptions to

operations that can be anticipated. The references shown on these slides were

utilized in developing the content for this webinar. These sources include those

from government, healthcare, academia, nongovernmental organizations, industry

publications, and news media. We hope this session will spark your interest in

UVA's Master's of Public Safety program. We encourage you to take a look at the

website to find out more about the learning opportunities and resources

available through the program and the UVA School of Continuing and

Professional Studies

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