1. Active Threat in the Healthcare Setting

2. Active Threat in the Healthcare Setting
Presented by Charlie BunnRN CEN CCRN Jim Zerylnick RN CEN

3. Definitions

4. 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

5. 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

6. Threat Landscape

7. Acknowledgement…
Statistical data/assistance
courtesy of FBI Atlanta

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

9. 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, 2008

15. One Measure… Campus incidents from 1909-2009 – (n=281)
Killings PER CAPITA remained stable
from Drysdale, Modzeleski, and Simons, 2010
(courtesy FBI Atlanta)

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

21. 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:

22. Additional FBI Data (2000-2013)
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

23. 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

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

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

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

27. 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)

28. 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])

29. 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])

30. 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

31. 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

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

34. "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

35. in the last three years: 36 incidents in 2007 41 in 2008 33 in 2009
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 2007
41 in 2008
33 in 2009
The actual number of cases is
believed to be higher.
– CNN 9/17/10

36. “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

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

38. 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

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

40. For a lame prize……. Who said that?