July 2015
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Did You Know?

Violence and Active Shooter Events

Top 10 List
Now Trending

Nearly two million American workers report having been victims of workplace violence each year.

Recommended Readings

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  • #63716 / #91016 Gun Violence and Public Health
  • #43116 Surviving an Active Shooter Event
  • #80916 Active Shooter for First Responders

* course numbers may vary by facility

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Did You Know?

Violence and Active Shooter Events

People around the world are deeply saddened and troubled by deadly attacks occurring over the past several months and years. Perpetrators of these events choose multiple different methods to carry out their attacks, but firearms are the most prevalent. Although the likelihood of being directly involved in an active shooter event is extremely low, the numerous occurrences of these stories in news reports, social media and daily conversations, can lead to an exaggerated sense of their frequency – and that leads to feelings of greater vulnerability and fear. Preparedness and training significantly reduces stress and anxiety levels and organizations should take active steps to plan for all types of emergencies – including active shooter events.

The United States Department of Homeland Security defines an Active Shooter as an individual actively engaged in killing or attempting to kill people in a confined and populated area.

According to the workplace violence prevention coordinator at the National Institute for Occupational Safety and Health (NIOSH), hospital-based shootings are a relatively rare event, but have sharply increased over the past ten years. Of the incidents that occurred 2000 to 2011 (Annals of Emergency Medicine, 2012):

  • 30% happened in Emergency Departments, 23% in parking lots and 19% in patient rooms
  • Motives were: 27% grudge, 21% suicide, 14% “euthanizing” an ill relative and 11% prisoner escape
  • Hospital employees composed 20% of victims - 3% physicians, 5% nurses
  • 23% of Emergency Department shootings were committed by a weapon that was taken from a security officer

Because active shooter events are unpredictable and evolve quickly, the natural human reaction is disbelief, anxiety and fear. Noise from alarms, gunfire and people shouting and screaming can increase confusion and chaos. Preparedness training on what to do in these events can help staff quickly gain composure and take the best actions to protect themselves and others. The Department of Health and Human Services (HHS) recommends healthcare workers be taught the easy-to-remember mantra: Run, Hide, Fight.

Run – If safe to do so, the first course of action should be to run out of the building and far away to a safe location.

  • Leave personal belongings behind
  • Visualize possible escape routes, including routes for patients, visitors or staff with access and functional needs
  • Avoid escalators and elevators
  • Take others with you, but do NOT stay behind if others refuse to go
  • Call 911 when safe to do so

Hide – If running is not a safe option, hide in a safe place.

  • Find a location where walls might be thicker and have fewer windows
  • If available and possible, lock the door
  • Barricade the door with heavy furniture
  • Secure the unit entrances by locking the doors or barricading them
  • Close, lock and cover windows
  • Turn off the lights
  • Silence all electronic devices
  • Remain silent
  • Use silent communication with first responders if possible. For example, put signs in windows to signal law enforcement and emergency responders to indicate the status of people in the room. Be careful not to expose yourself to a shooter if they are located outside the facility.
  • Hide along the wall closest to the exit but out of view from the hallway, allowing for an ambush of the shooter and for possible escape if the shooter enters the room
  • Remain in place until given an all clear by identifiable law enforcement

Fight – If running or hiding are not safe options, adults in immediate danger should consider trying to disrupt or incapacitate the shooter using aggressive force and items such as fire extinguishers, chairs, etc.

Other actions to consider:

  • Barricade areas where patients are located
  • Transport patients in wheelchairs, on stretchers, or by carrying them to a safe location
  • Identify safe locations in your work area before an event where staff or patients may safely barricade themselves during an event
  • If the shooter is not located in your area, know how to lock down and barricade your unit in case of an attempt to enter at a later time

According to HHS report notes, healthcare workers may have challenges unique to their field and feel conflicted about, for example, abandoning patients by running away. They may be faced with difficult decisions about the safety of patients and visitors who may not be able to evacuate due to age, injury, illness, disability or because of an ongoing medical procedure. Although there is no single best method for responding, planning allows staff to choose the best options during an event, with the goal of maximizing lives saved.


Top 10 List

Often times, violent situations happen with little or no warning. However, when early signs of disruptive behavior are noticed, non-violent de-escalation techniques may be helpful in avoiding a potential crisis. The Crisis Prevention Institute (CPI) lists their Top 10 De-Escalation Tips for responding to difficult behavior in the safest, most effective way possible.

Tip 1 – Be empathetic and nonjudgmental.
When someone says or does something you perceive as weird or irrational, try not to judge or discount their feelings. Whether or not you think those feelings are justified, they’re real to the other person. Pay attention to them.

Tip 2 – Respect personal space.
If possible, stand 1.5 to three feet away from a person who’s escalating. Allowing personal space tends to decrease a person’s anxiety and can help you prevent acting-out behavior.

Tip 3 – Use nonthreatening nonverbal.
The more a person loses control, the less they hear your words – and the more they react to your nonverbal communication. Be mindful of your gestures, facial expressions, movements and tone of voice.

Tip 4 – Avoid overreacting.
Remain calm, rational and professional. While you can’t control the person’s behavior, how you respond will have a direct effect on whether the situation escalates or defuses.

Tip 5 – Focus on feelings.
Facts are important, but how a person feels is the heart of the matter, yet some people have trouble identifying how they feel about what’s happening to them. Watch and listen carefully for the person’s real message.

Tip 6 – Ignore challenging questions.
Answering challenging questions often results in a power struggle. When a person challenges your authority, redirect their attention to the issue at hand.

Tip 7 – Set limits.
If a person’s behavior is belligerent, defensive or disruptive, give them clear, simple and enforceable limits. Offer concise and respectful choices and consequences.

Tip 8 – Choose wisely what you insist upon.
It’s important to be thoughtful in deciding which rules are negotiable and which are not. For example, if a person doesn’t want to shower in the morning, can you allow them to choose the time of day that feels best for them?

Tip 9 – Allow silence for reflection.
We’ve all experienced awkward silences. While it may seem counterintuitive to let moments of silence occur, sometimes it’s the best choice. It can give a person a chance to reflect on what’s happening and how he or she needs to proceed.

Tip 10 – Allow time for decisions.
When a person is upset, they may not be able to think clearly. Give them a few moments to think through what you’ve said.


Recommended Readings


Now Trending

Nearly two million American workers report having been victims of workplace violence each year. According to the U.S. Department Health and Human Services, warning signs that typically occur before a crisis can usually be identified at three levels:

At which level are the following warning signs categorized:


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Answer

Sabotages equipment or steals property for revenge.
Level 2

×

Answer

Argues with co-workers frequently.
Level 1

×

Answer

Spreads rumors and gossips to harm others.
Level 1

×

Answer

Shows a weapon or refers to having them close at hand.
Level 3

×

Answer

Refuses to obey basic company policies and rules.
Level 2

×

Answer

Talks openly about wanting to hurt co-workers or management.
Level 3

×

Answer

Shows difficulty coping with major life changes such as: being passed over for a promotion, financial difficulties, failed romance or marriage or death in the family.
Level 1

×

Answer

Sees themselves as a victim of management (me against them) and blames them for all problems.
Level 2

×

Answer

Repeated threats of suicide.
Level 3

×

Answer

Raises his or her voice or yells on the phone.
Level 1

×

Answer

Vague threats or references to "end all of the problems."
Level 2

×

Answer

Repeated fist fights, shoving, destruction of property
Level 3

×

Answer

Increasing arguments with customers, vendors, co-workers or management.
Level 2

×