Violence and Active Shooter Events
Nearly two million American workers report having been victims of workplace violence each year.
* course numbers may vary by facility
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):
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.
Hide – If running is not a safe option, hide in a safe place.
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:
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.
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.
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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Sabotages equipment or steals property for revenge.
Argues with co-workers frequently.
Spreads rumors and gossips to harm others.
Shows a weapon or refers to having them close at hand.
Refuses to obey basic company policies and rules.
Talks openly about wanting to hurt co-workers or management.
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.
Sees themselves as a victim of management (me against them) and blames them for all problems.
Repeated threats of suicide.
Raises his or her voice or yells on the phone.
Vague threats or references to "end all of the problems."
Repeated fist fights, shoving, destruction of property
Increasing arguments with customers, vendors, co-workers or management.