As active shooters increasingly target healthcare settings amid a nationwide spate of attacks, safety experts emphasize nursing homes must confront distinct disadvantages to ensure patient and staff safety.
“The whole point of conducting an analysis is no longer arbitrary. It’s not just about geocentric events anymore,” said Stan Szpytek, president of the national consulting firm Fire and Life Safety Inc., noting that past emergency preparedness efforts focused largely on possible natural disasters. “With the Uvalde shooting, how much more vulnerable can you get than an elementary school, maybe a preschool? I would think all faith-based organizations, churches, synagogues, all healthcare organizations, have to realize the vulnerability is there.”
The increased possibility of an active shooter event is increasingly placing providers in the position of preparing for the worst. Late last month, LeadingAge sponsored a national webinar on the topic, presented by Steve Wilder, president and CEO of Sorensen, Wilder & Associates.
In an interview with McKnight’s Long-Term Care News, Wilder noted that nursing homes have historically been affected by a type of shooting he refers to as a PHASE attack, short for personal hostile agenda singular event. In that situation, a gunman has a personal reason, often domestic- or employment-related, for an attack and it is targeted in nature.
But today’s nursing home operators also have to be prepared for what Wilder calls a CAVE attack, short for continuous active violent event. In those cases, the shooter is looking to cause harm until he or she runs out of victims or is stopped by someone else.
“It can happen anywhere,” said Wilder, adding that onboarding education and routine training and drills are critical factors in an effective plan. “Your employees know the risk is there, your staff, your families, your visitors, even your cognitively aware residents. You’ve got to accept it. Not having a plan is negligent, not training your staff is negligent, and you’ve got to do the exercises.”
Assess, then act
Since at least 2014, the FBI has designated healthcare as one of the 11 settings where the public is most at risk during an active shooter attack.In 2019, two of 28 US active shooter incidents took place in healthcare facilities. Last year, there were 61 active shooting scenarios, as defined by the FBI. This year is on pace to surpass that, and there have been four shootings at hospitals alone since June.
That reality informs a Hazard Vulnerability Assessment developed by the American Health Care Association/National Center for Assisted Living, which uses an algorithm to help providers calculate which threats they could encounter.
Szpytek said most nursing homes would likely score high for active-shooting risk.
Firms like Wilder’s visit healthcare sites, increasingly including nursing homes. They also conduct on-site assessments and look for weaknesses and strategies to address them. They begin at the perimeter and work their way in, considering along the way how accessible the facility is from the outside and the inside.
While designers have “hardened” school buildings in recent years, skilled nursing facilities often haven’t been similarly upgraded. There’s also the issue of keeping a home-like environment that feels welcoming to both residents and their families.
The lack of locks is a major concern in nursing homes, as it leaves few areas for staff to barricade themselves or residents from an attacker. A key part of training is educating anyone regularly in the building as to where locking doors are — medication and janitorial closets, offices, etc. — and how to get people behind them. It has to be taught routinely because even basic information may not be remembered in a crisis.
Wilder said operators should make sure any plan they use is customized for their facility and take into account factors such as number floors, room layout, staff on duty and much more. A good plan, he noted, also gives choices on how to respond.
Wilder recommends a strategy he calls the 4 Outs: Get out, Hide out, Keep out and Take out. He also trains staff in a protocol to determine when they might be able to help a resident and when they need to protect themselves.
“In skilled nursing, we know we’ve got residents who can’t take care of themselves,” he acknowledges. “They rely on us to keep them safe.”
Technology complements planning
Technology also can play a role in well-developed plans.
Alarms and cameras won’t stop armed intruders alone, but notification systems can help alert staff, residents and visitors to a shooter. Szpytek has worked with two mass communication companies that, when triggered, can send out notifications to all building computers, cell phones and other devices so anyone on site can begin their appropriate active shooter response.
He also worked with a Catholic nursing home in Chicago that developed a mobile alert system that triggered blue strobe lights when activated. It was a quiet, less confusing way than pulling a fire alarm to alert people to an emergency.
More recently, Challo, a cloud-based platform, launched an active-shooter tool that allows staff to access plans online that might be kept in a binder in an out-of-reach location. It also allows team members to assign tasks and monitor actions during a threat situation.
Of course, it’s the human factor that will matter when an incident occurs and in the immediate aftermath. If the worst should happen, Szpytek said providers will also need a comprehensive recovery plan, which should be part of the preparedness phase.
“Overlooking this is a mistake I’ve seen happen in countless care centers,” he said.
Some included recovery elements should be hiring a restoration team to handle any crime scene clean up, so as not to further traumatize staff; lining up emergency staffing resources and counseling in the days (or longer) after the event; and having legal and crisis management.
For providers whose plans are outdated or too broad to be effective, both Szpytek and Wilder said it’s time to modernize.
“Security in long-term care has been too lax for too long,” Wilder said. “Accept that it can happen in your community. Then write a good plan, and train to that plan.”
