Active Threat in the Healthcare Setting 1 1

Presented by Charlie BunnRN CEN CCRN Jim Zerylnick RN CEN 2

Definitions 3 3

Definitions – Active Shooter  According to the Department of Homeland Security: A person actively engaged in killing or attempting to kill people in a confined and populated area In most cases, active shooters use firearms and there is no pattern or method to their selection of victims 4

Definitions –Armed Intruder  Person armed with weapon capable of causing death, or great bodily harm  Person has physically demonstrated, or otherwise indicated, an intent to cause such injury and has the immediate ability to do so  An attempt to stop, or restrain the person would likely result in serious injury or death 5

Threat Landscape 6 6

Acknowledgement… Statistical data/assistance courtesy of FBI Atlanta 7

GOOD NEWS… Active Shooter events in Georgia healthcare facilities are EXTREMELY RARE !!!

In fact…….. The only 2 we found were…..  An event at Doctors Hospital in Tucker, GA in 1983  An event at Doctors Hospital in Columbus, GA on March 27,

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One Measure…  Campus incidents from – (n=281)  Killings PER CAPITA remained stable -from Drysdale, Modzeleski, and Simons, 2010 (courtesy FBI Atlanta) 15

Threat Landscape Internal threat landscape – very relevant Internal threat landscape – may be very different than the actual threats

New Data / Study – F.B.I. “Active shooter incidents are becoming more frequent—the first seven years of the study show an average of 6.4 incidents annually, while the last seven years show 16.4 incidents annually.” from: 14/september/fbi-releases-study-on- active-shooter-incidents/pdfs/a-study-of- active-shooter-incidents-in-the-u.s.- between-2000-and-2013http:// 14/september/fbi-releases-study-on- active-shooter-incidents/pdfs/a-study-of- active-shooter-incidents-in-the-u.s.- between-2000-and-2013

Additional FBI Data ( ) More than half of the incidents—90 shootings—ended on the shooter’s initiative (i.e., suicide, fleeing), while 21 incidents ended after unarmed citizens successfully restrained the shooter In 21 of the 45 incidents where law enforcement had to engage the shooter to end the threat, nine officers were killed and 28 were wounded

Perception vs. Reality  More media today  More formats of media today  24-hour news cycle  Repetition of broadcasts (across formats too)  SCARY topic  Attention-grabbing topic  Media goals – get attention 23

Perception vs. Reality Event provides attention to political agendas (prolongs coverage…) Risk perception – often inaccurate FEARS – useful to many groups/agendas

BIG FEAR…. Interpersonal human violence Virtually phobic-scale response Natural disaster vs. Violent event Activates sympathetic nervous system Changes behaviors / can warp perception

Locations of Active Shooter Events…  Workplace  School / campus  Healthcare facilities(?) / hybrid  Multi-location events 26

Active Shooter Data (from 35 events)  Workplace – 51% of attacks  School – 17%  Public place – 17%  Religious establishment – 6%  At residence of victim or offender – 9% -per John Nicoletti, Ph.D. (Nicoletti-Flater Associates) as provided to PERF 4/22/13 (data courtesy of FBI Atlanta) 27

Active Shooter Data (from 35 events) 57% of attackers were insiders (known) 63% of attackers broadcasted a perceived injustice 71% of the victims initially targeted were the focus of the perceived injustice (per John Nicoletti, Ph.D. [Nicoletti-Flater Associates] as provided to PERF 4/22/13 [data courtesy of FBI Atlanta])

Active Shooter Data (from 35 events) 63% of attacks were over in under 15 minutes 37% of attacks were over in under 5 minutes 74% of attackers entered thru main entrance (per John Nicoletti, Ph.D. [Nicoletti-Flater Associates] as provided to PERF 4/22/13 [data courtesy of FBI Atlanta])

Foreign Events Southern Russia – mass hostage-takings in hospital Mumbai – coordinated terrorist attacks (hospital as one target) Iraq/Afghanistan – medical facilities targeted Mexico – (multiple) mass-shootings at drug rehab facilities

Most Lethal Active Shooter Event… Norway (2011) - Anders Breivik Right-wing militant ideology VBIED attack (govt. buildings - Oslo) –8 killed Followed immediately by active shooter attack (Utoya Island) –69 killed (mostly teens) Wore POLICE uniform

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Other Shooting / Violent Events…  May be increasing…  Don’t confuse with “ACTIVE SHOOTER” events 33

"Health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide," according to a 2010 report from the Joint Commission's Sentinel Event Database. - CNN 9/17/10 34

The Joint Commission, which accredits and certifies more than 18,000 health care organizations and programs, compiled the numbers based on voluntary reports. Its database indicated the greatest number of reported assaults, rapes, homicides in the last three years: 36 incidents in in in 2009 The actual number of cases is believed to be higher. – CNN 9/17/10 35

“Expectation landscape…” Public expects to be safe at medical facilities “Save my kids/spouse…” – (go in) Active-shooter events prominent in media for YEARS (shouldn’t be new to responders) Tendency to assign blame / litigation Not impressed with excuses / bureaucratic explanations

Before or After? BEFORE – Prevention/Detection/Deterrence/Interdicti on (ie –Threat Assessment Team) AFTER – Active Shooter Response Why not both?

Responder / Planner Role  Plan/equip/train for WHEN the event happens at your facility (not IF)  “It’s not if, it’s WHEN it happens….” (not for public statements)  MINDSET – critical to preparedness AND response  Totally different than public communications 38

“The will to win is not nearly as important as the will to PREPARE to win.”

For a lame prize……. Who said that?