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suspicious person, hostage situation, a bra wl, a
murder, suicide or knife attack. The distinction
is important, because the response to each is
unique. For example, during an event with a
knife, barricading may be more feasible than
during a firearm attack. For a hostage event,
cordoning the area and evacuating nearby people may be a plan of action. During a murder or
murder-suicide, there may be no further threat.
During an active shooter event, everyone is at
risk while the shooter or shooters are engaged.
A MULTIDISCIPLINARY TEAM
In early 2013, the Healthcare and Public
Health Sector Coordinating Council, a part of
the Critical Infrastructure Partnership Advisory Council, formed a multidisciplinary team
to look at active shooter response in healthcare.
The team was comprised of federal, state
and private sector partners including clinicians,
law enforcement, civil rights attorneys, emergency planners, responders, fire and EMS and
leaders from law enforcement active shooter
The team discovered that not only was there
confusion about how to prevent, respond to
and recover from an event in a healthcare set-
ting, there was also a lack of knowledge by law
enforcement about the hazards in a healthcare
facility, such as MRI machines, medical gases
and hazardous materials.
The team published their consensus recommendation guide, “Active Shooter Planning
and Response in a Healthcare Setting, 2” in the
summer of 2013 and later that fall the federal
government released “Incorporating Active
Shooter Incident Planning into Health Care
Facility Emergency Operations.” 3
In 2015, the team released an updated version of the planning and response guide, which
is available on the FBI active shooter website. The updated guide includes a section for
law enforcement responders, including tactics,
crime scene operations and interoperability, as
well as a section on behavioral health support.
The team has committed to reviewing and
updating the guidance annually and is currently meeting, with an anticipated update
being released this fall. The new guide will
include staff and administrative tools, unified
command issues and answers, recovery and
behavioral health assessment teams.
RESPONDING TO THE EVENT
How do you respond to an active shooter event
inside a healthcare facility, and how do you
address ethical issues such as abandonment?
There’s one fundamental point in an active
shooter incident: The fewer people there are
in the hot zone, the fewer targets and poten-
tial victims. Getting people out of the imme-
diate areas of the shooter is the first priority.
Hiding may not be adequate. “Run, hide and
fight” is the recommendation for the immedi-
ate areas where the shooter is located. This may
mean leaving patients behind, some of whom
may not be able to evacuate themselves. It’s
a life and death decision, and that’s why it’s
important to discuss these options with staff
before an incident occurs. It’s also important
to remember that while “run, hide and fight”
are three separate options, you may use more
than one of them in the course of the event.
For the rest of the healthcare facility (
outside of the shooter’s location), locking down
the unit is imperative—and not an easy thing
to do. Knowing how to barricade doors without locks takes practice and planning. Those
units should also monitor the situation and
prepare to run if the shooter enters their immediate area.
What about ambulatory patients, visitors,
and contractors? The guidelines recommend
using plain language (and, when appropriate,
multilingual messaging) to announce what’s
happening and what to do. Although some
would argue that could cause panic, decades