EXECUTIVE SUMMARY
ASCs and other healthcare organizations are vulnerable to active shooter scenarios, so they should prepare for these by learning prevention strategies.
- To minimize risk, any inmate who arrives at an ASC for surgery should be treated according to VIP processes, entering through a back door.
- ASCs should create an open communication environment, encouraging staff to speak up if they have domestic issues that could spill over into the workplace.
- ASCs should take all threatening emails, calls, or letters seriously and monitor the person’s social media behavior.
In mid-May, a prisoner in a hospital ED in Geneva, IL, overpowered a guard, grabbed his gun, and held two nurses hostage. He was shot and killed after negotiations failed and a SWAT team moved in.
The nurses were unharmed physically, but emotionally distraught, according to a report.1
The wrong thing for an ASC team to think after reading about this type of incident is “it can’t happen here,” active shooter training specialists say.
When security and risk consultant Lee Eaves of Nashville, TN, recently spoke to a group of ASC directors and staff about how to prevent active shooting incidents, he was shocked at how many people said their ASCs had treated people in criminal custody.
“What can you do to minimize the risk?” Eaves says. “You probably should have a VIP program and use that program to have prisoners go through the back entrance or a secluded elevator, keeping them out of the main lobby and out of sight of other patients within the center.”
If law enforcement brings an inmate to an ASC for surgery, another strategy is to be alert for the number of security officers escorting that person. If only one security officer arrives with the inmate, then an ASC director should ask that the surgery be rescheduled until a second officer is available as well, says Eaves, who worked for the Secret Service for 10 years, corporate security for five years, and also has worked as a flight paramedic.
“If someone in custody presents themselves for glaucoma or cataract surgery and they’re six-foot-seven and 300 pounds, and you don’t feel security is adequate, make a phone call and request more security,” he says. “If you don’t feel comfortable with the situation, then make sure law enforcement has provided adequate support staff to ensure the ASC is safe and security is maintained.”
Active shooting incidents happen, on average, once a day in the United States. Healthcare settings, schools, churches, and other public places are vulnerable targets. Most active shooters are men with a history of mental instability.2
Several things make ASCs a potential target for gunmen, such as stashes of pain medication someone might desire to steal, says Ken Alexandrow, founder of Agape Tactical, an organization that educates and trains individuals, families, churches, and businesses in self-protection.
Another issue, which is a possibility for any employer, is that a member of the staff is involved in a romantic relationship with someone who is violent. A third possibility is that a disgruntled patient or former employee would seek revenge for perceived wrongs.
Eaves and Alexandrow offer the following suggestions for how ASCs might prepare for and prevent an active shooter event:
• Prevention is the answer. In cases like the incident of a prisoner kidnapping nurses, the only good solution is prevention, Eaves says.
“Mitigating the threat on the front end is the only thing you can do,” he explains. “And the way to do that is by having adequate guards and limiting movements.”
There are times when surgery centers are asked to treat inmates. When this occurs, they should keep in mind that some prisoners will see this as an opportunity to escape. So in planning for this event, ASCs should create a special plan or enact their VIP plan, Eaves says.
For instance, a VIP plan might require certain patients enter through a back or side door so they do not have to be seen in the lobby. The inmate also should enter that way. Surgery centers also should make certain the inmate’s facility does not tell the patient in advance where the surgery will take place. This could prevent the inmate collaborating with an outside contact to escape.
The foundation of active shooter prevention rests on three pillars: deter, detect, deny.
“Deterrent is largely psychological,” Alexandrow says. “If someone wants to attack a building, but there are security controls like a buzzer to get in and cameras, you deter them before they even try.”
Detection involves putting in place early warning systems, including cameras or security guards, that detect an active shooter before the person enters the building, Alexandrow explains.
A threatening email or letter also can be detected and red flagged.
Denial is up to the individual industry or business, but it can involve hiring armed guards or equipping certain staff with weapons.
“Some doctors are arming themselves, and they are well-trained, taking training multiple times a year,” Alexandrow says. “Their weapon is always accessible within a few steps.”
Also, professionals can teach staff how to fight back by throwing chairs, books, clipboards, bottles of water, or anything they can reach, Alexandrow says.
“Throw and distract the shooter until you can neutralize the threat,” he suggests.
• Develop an open communication culture. Domestic violence accounts for a sizeable number of active shooter situations. An angry, estranged husband or boyfriend seeks out the woman and kills other people in the process.
Employers must know when an employee is going through a difficult divorce or has experienced domestic violence. The best way to be aware is to create an open communication culture in which employees feel safe sharing this kind of information, Alexandrow says.
An ASC’s policies and procedures should state that reporting information like this will not cause workers to lose their jobs, he says.
“One of the most important things you can do is eliminate the gossip and have an open, inviting environment to say, ‘I want to talk to you about this,’” Eaves says.
ASC directors or human resource departments should tell staff that if they experience domestic violence, stalking, or threats of violence, they need to speak with a designated ASC person about it. “If they keep that information to themselves, then the business can’t prepare for it,” Alexandrow says.
A supervisor or HR director could meet with the employee and ask, “I don’t want to pry into your life, but are you OK? Is there anything you want to talk with someone about?” Eaves suggests. “It’s OK to pull someone aside and say, ‘Are you OK? Is there anything I can do for you?’ That can be the discussion and open the door to their talking.”
• Monitor pre-attack behavior. If an ASC receives an ominous or threatening email or letter from an unhappy patient or angry ex-employee, the organization should take it seriously and monitor the person’s social media behavior, Eaves says.
“So many times there is pre-attack behavior, stalking or threatening behavior on social media,” Eaves says. “So many times, we see the news and see underlying mental health issues, or there is someone with a high emotional load.”
Emotional load is like a bridge that has a certain weight limit. If someone puts on more weight than the bridge can hold, it will crumble, he says.
“I don’t believe you one day wake up and by lunch, you’re an active shooter,” Eaves says. “What does happen is a person goes through a divorce and then tremendous financial strain; they’ve lost their support system, lost a loved one, and feel like a failure.”
The ASC’s outstanding surgery bill could be the final emotional load that breaks a person.
Employers might feel it is “big brother” behavior to monitor social media, but it’s acceptable to do so when there’s a potential threat.
“We might look at Facebook or social media that is open to the public. A simple Google search for someone’s name can [turn up] quite a bit of information,” Eaves says.
Small organizations that cannot afford to hire staff to monitor social media accounts can hire outside professionals to do so. That’s what large corporations do on a regular basis, he says.
Security experts can monitor behavior of threatening individuals and suggest a course of action. For instance, if the threat came from an unhappy client, the answer might be to forgive the person’s medical bill, making the threat disappear, he suggests.
• Teach staff to recognize precursors to an attack. After a major shooting tragedy, police and media usually find that there were warning signs that no one caught. For example, a jealous romantic partner might say something like this verbally or by text: “If I can’t have you, then no one else can,” Alexandrow says.
“That’s one of the most common phrases, but we can’t overlook it anymore,” he adds.
Other precursors include stalking or excessive texting. The partner or spouse might show up at the workplace uninvited.
“The thought is, ‘I’m going to catch you cheating on me with the doctor or someone,’” Alexandrow says.
“In my 26 years of law enforcement, the most violent cases were domestics because it’s passionate,” he notes. “When a woman is stabbed 16 times, we don’t look for a stranger; we look for the husband or boyfriend.”
Staff could explain to employees that common phrases can take on a different meaning depending on how they’re said.
“Someone says, ‘I love you, and I can’t live without you,’” Alexandrow explains. “That’s a common phrase, but if you hear in their voice that creepy factor, you might hear the person’s meaning: ‘I can’t live, and I might take you with me.’”
REFERENCES
- Associated Press. Armed Inmate Killed, Hostages Rescued. May 14, 2017. Available at: http://bit.ly/2qPpWUW. Accessed May 22, 2017.
- Invictus Consulting. Active Shooter Statistics: Understand the Issue, March 2016. Available at: http://bit.ly/2qPLb9e. Accessed May 22, 2017.
The wrong thing for an ambulatory surgery center team to think after reading about an active shooter incident is “it can’t happen here,” training specialists say.
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