Planning an Active Shooter Full Scale Exercise

1. Planning an Active Shooter Full Scale Exercise Ken Bishop

2. For Today’s Discussion: • Active Shooter: • An individual actively engaged in indiscriminately killing or attempting to kill people in a populated area. FBI • Targeted Shooter: • An individual searching for a specific person he/she wishes to kill. Targeted shooting incidents can easily develop into Active Shooters. • Mass Shooting: • An active shooter event that results in three or more fatalities (excluding the shooter). FBI

3. Quick Review of The Numbers • In the U.S. between 2000 and 2015: • 241 shootings occurred in 148 hospitals in 40 states. • 235 victims (injured or dead) • Five states (Florida, California, Texas, Ohio, and North Carolina) accounted for more than one third of the events. • Between 2006 and 2011 active shooters in healthcare environments rose to 16.7 per year. • Shootings ranged from 6 in 2000 to 22 in 2015. WAKE FOREST BAPTIST HEALTH

4. Specific LTC Shootings • Canyon County, California; husband shoots and kills wife with dementia; 2016 • Canton Township, Ohio; nurse gunned downed by estranged husband 2015 • Chesterfield, Missouri; nurse gunned downed by estranged boyfriend 2015 • Barnesville, GA; 1 killed by estranged husband 2009 • McDonough, GA SNF 1 resident killed and family member shot himself. 2008 WAKE FOREST BAPTIST HEALTH

5. Let Us Never Forget the Carthage Nursing Home Shootingof 2009 (domestic violence) • March 29, 2009, in North Carolina • Suspect Robert Stewart, 45, kills seven elderly patients and one nurse. • His estranged wife worked at the nursing home. • Shooting stopped after Stewart was wounded by the police.

6. Unique Challenges Presented in Healthcare Environments • SOFT TARGET!! • No such thing as a single response plan. • Vulnerable patient population • Difficult choices often need to be made • State and federal life safety rules • High community and media visibility • Sometimes dangerous physical environment • Hazmat & infectious disease • Locked BH units • Maybe not locked, but isolated units; e.g.: Surgical Services WAKE FOREST BAPTIST HEALTH

7. Planning The Exercise • First, there must be a response plan • Otherwise, what are you testing in the exercise? • Recommend plan be built around Run, Hide, Fight. • Concerns around Secure, Preserve, Fight NEJ 2018 • Second, staff must be educated to the plan. • Otherwise, why would you exercise? • Third, tabletop the exercise VERY HIGHLY RECOMMENDED • Lastly, plan the full scale. WAKE FOREST BAPTIST HEALTH

8. Basics of Run, Hide, Fight • Run- If there is an accessible escape path, evacuate the premises. • Hide- If evacuation is not possible, find a place to hide where the shooter is less likely to find you. • Fight- As a last resort, and only when your life is in imminent danger, attempt to disrupt and/or incapacitate the active shooter. WAKE FOREST BAPTIST HEALTH

9. Rapidly Disseminated, Well Structured Communications • The single best way to protect the workforce and save lives during a shooting event is to deny the shooter of potential targets. • Rapid disseminated, pre-constructed messages delivered to multiple points upon immediate awareness of the threat can redirect staff, visitors and guests away from harm and toward safety. WAKE FOREST BAPTIST HEALTH

10. Planning Process Under No Circumstance Should A full Scale Active Shooter Exercise Be Conducted as a No-Notice or Unannounced Exercise WAKE FOREST BAPTIST HEALTH

11. Under No Circumstance Should A full Scale Active Shooter Exercise Be Conducted as a No-Notice or Unannounced Exercise WAKE FOREST BAPTIST HEALTH

12. Planning Process • HSEEP • Start a year to 18 months out. • Minimum of 4 planning sessions • Concepts and Objectives Meeting • Initial Planning Meeting • Mid-Term Planning Meeting • MSEL (Master Sequence of Events List) Planning Meeting • Final Planning Meeting • Use the HSEEP Toolkit and Templates WAKE FOREST BAPTIST HEALTH

13. Who’s at The Table? • Administration • Someone who can speak on behalf of executive leadership and will be responsible for keeping other administrators informed. • Trusted Agents from the areas to be exercised • Internal Emergency Management • Internal Security • City/County First Responders (Fire, LE, EMS, and possibly 911) • City County EM • Representation from every internal department that will be involved in the full scale • Do you have some type of family council? • CISM • Media Relations • If you intend to transport “patients” to an outside facility, include representation from that facility • Coalition WAKE FOREST BAPTIST HEALTH

14. Building the Planning Team WAKE FOREST BAPTIST HEALTH

15. Up Front • Be very clear about what is expected to happen during the exercise • Will the exercise be conducted in a working patient care unit? • Will there be live fire? • If you are located within a city or town, do you need a waiver to discharge a firearm? • Will there be moulage? • Will there be an “entrance” by first responder teams? • Will there be first responder staging outside of the facility? WAKE FOREST BAPTIST HEALTH

16. The Table Top • Conducted far enough in advance to identify holes in the exercise plan and finalize FSX Exercise Objectives. • Open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected. • Responses based on participants knowledge of current plans, capabilities and insights derived from training. • Decisions are not precedent setting and should not reflect organization’s final position on a given issue. • The exercise is an opportunity to discuss and present multiple options and possible solutions. • Issue identification is not as valuable as suggestions and recommended actions that could improve response and recovery efforts. Problem-solving efforts should be the focus. WAKE FOREST BAPTIST HEALTH

17. FSX SMART Objectives • Specific, Measurable, Achievable, Relevant, Time Bound • No more than 4 to 6 objectives • Suggested areas from which to design objectives: • Identification and evaluation of plans • Effectiveness of coordination between agencies • Effectiveness of communications (both internal and external) • Identify and evaluate response, mitigation, and recovery actions • Identify gaps and redundancies • Evaluate media management initiatives WAKE FOREST BAPTIST HEALTH

18. Safety Plan • NO LOADED WEAPONS INSIDE OF EXERCISE VENUE • Minimum of 3 weapons checks by someone very familiar with firearms safety • Weapons must be clearly marked to indicate safety status • No Ammunition Inside of Exercise Venue • Participating LEO’s should submit to search for ammunition • If the mock shooter will discharge blanks it must be a person very skilled in use of blanks • The mock shooter must have at least one escort who is dressed to clearly identify participation in an active shooter exercise (vest) • There must be a safety perimeter established for participating officers who have been stripped of live weapons and ammunition. WAKE FOREST BAPTIST HEALTH

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20. Officer Safety Zone CLEARLY IDENTIFIED Armed Officers in uniform whose sole responsibility is to cover the officers responding to exercise play. Officer Check-in Area Exercise Venue Officer Stand Down Area NO LIVE WEAPONS WAKE FOREST BAPTIST HEALTH

21. Safety Plan • Simunitions • If simunitions are to be used, be absolutely certain that all players who could possibly be “shot” receive a simunitions briefing and are given the opportunity of opt out of that portion of the exercise. • DO NOT, under any circumstance shoot a person with a simunition who has not previously agreed to it. Written waivers are suggested. • Be certain that anyone who will be “shot” is dressed appropriately, to include soft body armor, eye protection and helmet. • Signage to clearly indicate the location of the exercise, the nature of the exercise, time of the exercise, and whether or not there will be live fire. WAKE FOREST BAPTIST HEALTH

22. Safety Plan • If exercising Run, Hide, Fight, will FIGHT be an option for players? • Generally not a good idea • Requires one on one monitoring • “Bad guy” must be red suited • Red man weapons must be provided for exercise participants WAKE FOREST BAPTIST HEALTH

23. Outside Review of ExPLAN & Safety Plan • Have someone who is VERY KNOWLEDGABLE of Full Scale Active Shooter Exercise planning review the ExPlan and Safety Plan. • Preferably someone who was not on the original exercise planning team. WAKE FOREST BAPTIST HEALTH

24. Real World Patient Management • Real World Patients MUST be apprised of what will happen during the exercise • Families MUST be apprised of what will happen during the exercise • Will anything happen within their “sight picture”? • Will anything happen on working patient floors? • Live fire? • Moulaged patients? • Law enforcement entry teams? • Rescue teams? • After Action Follow-up with real world patients • Be prepared for CISM WAKE FOREST BAPTIST HEALTH

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26. Real World Patient Management WAKE FOREST BAPTIST HEALTH

27. Media Management • Media should be brought in well in advance of exercise day, preferably as part of the exercise planning team • Early press releases • Request for interviews and coverage a day or two prior to the exercise, ideally during exercise set up • Invite media to be onsite the day of the exercise • Requires one on one media escorts who are very well versed on the exercise operation • Turn the exercise into a positive media event WAKE FOREST BAPTIST HEALTH

28. After Action • A no-fault, no finger pointing process intended to truly identify strengths and opportunities for improvement • Typical findings include: • COMMUNICATIONS, COMMUNICATIONS, COMMUNICATIONS • Identification of omissions in plans and procedures • Identification of actual structural issues in the facility • Identification of additional equipment needs • Identification of additional training needs • Identification of overall lessons learned • BE HONEST. LEARN FROM THE EXERCISE! WAKE FOREST BAPTIST HEALTH

29. Thanks for Having Me! Ken Bishop kbishop@Wakehealth.edu