HHS gives active shooter guidance for healthcare facilities, says there is 'no perfect response'

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Double homicide at Houston nursing home; victims' roommate arrested
Double homicide at Houston nursing home; victims' roommate arrested

Federal agencies recently issued guidance for how long-term care facilities and other healthcare providers should prepare for an active shooter emergency. The 33-page document covers threat assessment, actions to take during and after an emergency, and other best practices.

The “ideal situation” would be preventing a shooting incident entirely, the planning guide emphasizes. Facilities should consider creating a threat assessment team with “diverse representation,” including administrators, human resources workers and law enforcement personnel. The team would be trained to identify warning signs of a potential shooter, whether the troubled individual is a staff member, resident or visitor. These teams are “not common” in healthcare settings but have been mandated by some institutions after high-profile incidents, such as the shooter at Virginia Tech in 2007, the document notes.

If an incident does occur, facilities should train people to run to safety. If this is not possible, hiding in the most secure available place should be the next course of action. Fighting the shooter might be a last resort. While the “run, hide, fight” protocol is recommended, the guidance acknowledges that active shooter situations unfold quickly and people's responses are hard to predict. There may be additional challenges in a healthcare facility, such as the presence of residents who cannot easily flee. Therefore, people should be prepared to use “more than one option” in the “run, hide, fight continuum,” and emergency planners should consider the complicated reality of these emergencies.

“It would be difficult or impossible for [healthcare facilities] to inform visitors and patients of every eventuality,” the document states. “HCFs should help employees understand there is no perfect response.”

One aspect of post-incident response that facilities may consider is psychological first aid. PFA training is available in person and online, and covers such topics as approaching traumatized people to calm and orient them, the guidance explains.

The document offers a variety of other suggestions, including how best to communicate during an active shooter emergency. Some facilities fear sparking a panic if they openly announce the presence of a gunman, and so they develop codes to be used over paging systems. Research has shown that people in fact do not panic and respond more effectively if clear details are provided, the document states.

A Colorado nursing home allegedly used a code as part of a controversial active shooter drill, which led to a lawsuit against the facility.

Click here to access the complete planning guide, prepared by staff at the Department of Health and Human Services, the Federal Emergency Management Agency and other agencies.