Planning important when facing unthinkable violence


Since the beginning of 2019, there have been hundreds of mass shootings across the nation. According to data from the nonprofit Gun Violence Archive (GVA), which tracks every mass shooting in the country, there have been 301 mass shootings as of September 17. The GVA defines a mass shooting as any incident in which at least four people were shot, excluding the shooter. Acts of violence that once may have been thought impossible have become regular headlines, leaving many organizations to wonder if they are prepared to face such an emergency. Healthcare facilities, like nursing homes, have not been immune to acts of gun violence in recent years. There were mass shootings in 2009, 2017 and 2018 at long-term care facilities. This year, there have also been at least two murder-suicides at facilities. To keep their residents and staff safe from gun violence, providers should seriously consider active shooter response as part of their emergency preparedness plan.
Probability of the unpredictable
The final rule for the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers requires that facilities prove they have adequate planning for both natural and man-made disasters. The first step in developing a plan for a facility is performing a risk assessment to determine the likelihood of emergencies common to its geographic location as well as the risk of emergencies that occur within its unique resident population. However, assessing the probability of an active shooter emergency may prove difficult and could require considering many other factors, such as crime rates in the local area, gun ownership statistics and stringency of state gun laws. For example a study published in the BMJ, a medical journal, found that in states where gun ownership is higher or where gun laws were weaker, there were more mass shooting incidents.
Facilities should also look at their vulnerabilities as a possible site for an act of violence. The security of the building and grounds should be evaluated to determine weaknesses. Considerations may include building access, existing security systems and possible locations where residents and staff can shelter in place from an attack. Facilities should also determine if it has internal issues that could increase the likelihood of violence in the workplace. In 2015, the Occupational Safety and Health Administration (OSHA) released guidelines for preventing workplace violence for healthcare and social service workers. OSHA identified several risk factors linked to the potential for violence including: residents or their relatives that have a history of violence, abuse of drugs and alcohol or gang activity; prevalence of firearms or other weapons among residents’ family or friends, high employee turnover, inadequate security and lack of policies and staff training for recognizing and managing hostile behavior.
Saving lives
Recognition of hostile behavior in an employee, visitor or even a resident, in some cases, is key in possible prevention of a shooting or other act of violence. Some common signs of hostile behavior include: aggressive statements, intimidation, prolonged or intense glaring, irritability, pacing and yelling. Most acts of violence are some form of verbal or non-verbal threat, bullying, harassment or physical assault. However, research done by federal agencies on common behavior for active shooters has identified warning signs for potential deadly acts. Such behaviors include: anger, fixation on a person or cause, confrontations, identification with previous attackers, communication of intent to harm someone and experiencing multiple life stressors. Although threats and warning signs may not lead to a violent act in the majority of cases, facilities must take all of them seriously and staff should and leadership should know how to respond appropriately to deescalate a potentially violent situation.
In the event that deadly violence can’t be prevented, knowing what to do can save lives. Active shooter emergencies are unpredictable and can evolve quickly. According to a 2013 study released by the Federal Bureau of Investigations, 60 percent of these incidents ended before law enforcement arrived. Therefore, an active shooter response plan is vital for keeping staff and residents safe until help can intervene. The plan needs to include basics such as a method for communication of active shooting incidents, response strategies, a detailed evacuation procedure for each area of the facility, lock down procedures and guidance on communication and coordination with law enforcement. After the plan is established, it needs to be communicated to staff and training provided. The plan can be as simple or as detailed as needed. But, ultimately, everyone should know the signs of a potentially violent situation and prevention methods, how to maximize the chances of surviving an active shooter attack and how to best work with responding law enforcement.
The Compliance Store has resources to help you formulate an effective active shooter response plan, including policies and procedures. To learn more, go to