RANDY G. FISCHER · Two of the deadliest tragedies on record ... mitigate the loss of life. The 4...

RANDY G. FISCHER

Discusses potential characteristics of an

active shooter

Potential warning signs for an active

shooter

Strategies for surviving an incident

Law Enforcements response to an active

shooter incident

Incidents of Active Shooters

2000-2013

160 incidents

Combined 1,043 killed and

wounded, not including

shooter(s)

486 killed

557 wounded

Incidents of Active Shooters

2014 and 2015

40 incidents

Combined 231 killed and wounded,

not including shooter(s)

92 killed

139 wounded

Shooter events occurring with

greater frequency and loss

Three active shooter events, over the course of

less than 17 months, produced more than 50%

of the casualties reported from 2000 to 2013.

Pulse Nightclub in Orlando, Florida (June 12,

2016): 49 dead, 58 wounded

Las Vegas, Nevada (October 1, 2017): 59 dead,

441 wounded

Sutherland Springs, Texas (November 5, 2017):

27 dead, 20 wounded

Two of the deadliest tragedies on record

happened within five weeks of each other.

*

*Shooter Statistics from 35 active shooter events in

2012:

*- 57% were known to the others in their target area

*- 71% just walked into the location

*- 63% had somehow shared a perceived injustice

*- 74% entered through the main entrance

*- 37% of the attacks were over in under 5 min.

*- 63% of the attacks: over in under 15 min.

*No profile exists for an active shooter

*De-escalation of volatile situations is the most

important preventive measure

*Know the signs of a potential volatile situation

for prevention and detection

*Report concerning behaviors to

Director/Manager, or Law Enforcement

a) Development of a personal grievance

b) Recent acquisitions of multiple weapons

c) Escalation in target practice and weapons training

d) Recent interest in explosives

e) Fascination with previous shootings or mass attacks

f) Experience with a significant real or perceived personal loss such as death, breakup, divorce or loss of a job

g) Few offenders had previous arrests for violent crimes.

Potential pre-attack behavior that could be

indicators of concern per FBI

“Active Shooter” is defined as an individual or others who are “actively

engaged in killing or attempting to kill people in a confined and populated

area.

Active shooter situations are unpredictable and evolve quickly.

Because of this, individuals must be prepared to deal with an active shooter

situation before law enforcement personnel arrive on the scene.

In many cases the shooting is over before Law Enforcement arrives

The primary purpose of a response plan is to:

Prevent,

Reduce,

Limit access to potential victims and

mitigate the loss of life

The 4 A’s is a 4 step process to prevent or reduce loss of life in an active shooter event

1.Accept that an emergency is occurring

2.Assess what to do next so that you can save as

many lives as possible

3.Act: lockdown (lock and barricade the doors, turn off the lights, have patients get on the floor and hide)or evacuate

4.Alert law enforcement

*Startled

*Feel fear and anxiety

*Experience initial disbelief and denial

Expect to hear noise from alarms, gunfire, and

explosions and people shouting and screaming

People might be deceased or badly wounded

*Run, Hide, Fight is a three step process to prevent or reduce loss of life in an active shooter event.

1.Run- is to immediately evacuate the area

2.Hide-seek a secure place where you can hide and/or deny the shooter access

3.Fight-where your life or the lives of others are at risk, you may make the personal decision to try to attack and incapacitate the shooter to survive. This is

NOT a requirement but is an option.

*Dial 9-911 when safe to do so: if able dial 9-911 and

leave phone off the hook and evacuate or hide.

* If safely evacuated call Dispatch and provide

information on the shooter

* If able provide the location of the Shooter

*Number of shooter(s)

*Physical description of shooter

*Number and type of weapons held by the shooter

ie, hand guns, shot guns, Rifle etc.

*Page over head if safe to do so. Any staff can

make this announcement

*Page “Active shooter _________. Shelter in

Place or evacuate building

*Use cell phone to notify 911

*LE main objective is to locate and neutralize

the shooter

*Remain calm and follow officer's instructions

*LE will NOT stop to assist injured until the

shooter is contained.

*Immediately raise hands & keep hands visible

*Avoid making quick movements toward officer

*Avoid pointing, screaming and or yelling

*DO NOT stop to ask for officers help precede in

directions that officer is entering

*Follow directions of LE officer

*Staff not on duty to report to staging area

*Site of Active Shooter immediately becomes a

crime scene

*Director/Manager will develop information to

disperse to staff/families/children and news

media

*Behavioral Health services should be made

available to all staff

*Debriefing

*Offer Behavioral Health Services

*After action report

*Update plans as needed

*Exercise/drill

*

*One of the biggest misconceptions involves the denial

that this can happen to one’s self.

*One of the first hurdles to overcome is denial. This idea

that it is not going to happen where we live. It’s

Nebraska. It’s not going to happen here. That is one of

the most difficult things to make people realize and

face. It can happen anywhere.

*The best thing to do is prepare for the worst, and to

just be alert in case the unfortunate scenario of an

active shooter happens.

**It is lunchtime at your facility and the staff are assisting

residents with their meals. You glance up and observe a

noticeably agitated adult male entering the building. He

is wearing a jacket and carrying a duffle bag.

*As he enters through the front door, you recognize him as

“John Smith”, a disgruntled employee who had recently

been terminated as a result of several altercations with

the administrator.

**John enters the administrators office and is overheard

angrily addressing him/her. His voice begins to

escalates in volume as he becomes more agitated. You

hear him yell, “You can’t do this to me!”

*Suddenly, you hear loud screams and “popping noises”.

You stand frozen in place by shock and disbelief. Other

personnel in the immediate vicinity rush into the

hallway to see what is going on.

**As John turns to leave the administrators office, he

spots the people in the hallway, raises his weapon and

begins firing rapidly. People begin screaming and trying

to run away. The scene unfolds in what seems to be

slow motion. It is utter chaos.

*Thirty seconds later, John has fired an entire magazine

of ammunition and 5 people lay dead or injured.

*He reaches into his bag, pulls out another clip, and

begins to reload……..

*

*In the time you have worked at your

organization, has there been at least

one incidence where you thought as

co-worker, patient/resident or visitor

was contemplating attacking another

person?

Apply firm, steady pressure to stop bleeding.

* Understand when to use a tourniquet.

* Apply a tourniquet.

*

*Stop the Clock!

*Every minute with uncontrolled bleeding decreases the chance of survival!

*35% of pre‐hospital traumadeaths are due to blood loss

*

*When your body loses approximately half its

blood volume, it cannot survive –

regardless of the quality of medical care

you eventually receive.

* You can lose that amount in just minutes!

*This is the averageamount of blood inthe body.

5 liters

2.5 liters

*

*

Find the source(s) of bleeding.

If you have something to put in between the blood and your

hands, use it. Examples include gloves, a cloth, or a plastic

bag.

Apply firm, steady pressure directly on the source of the

bleeding. Push hard to stop or slow bleeding – even if it is

painful to the injured!

Keep applying pressure until EMS arrives.

*

Think of a tourniquet as another

way to apply firm, steady pressure

when:

The injury is to an arm or leg.

The bleeding is so severe it

cannot be controlled otherwise.

*

Place as high up as possible on the injured

limb – closer to the torso. It can be placed

over clothing. Pull the strap through the

buckle.

Twist the rod tightly until bleeding

stops/slows significantly. This may be

painful!

Secure the rod.

If bleeding doesn’t stop, place a second

tourniquet.

Leave in place until EMS takes over care.

*

If you don’t have a commercially available tourniquet, you

can attempt to improvise one using material that is:

Broad

Flexible

Strong

Able to be twisted, tightened, and secured.

* Apply firm, steady pressure on the source of bleeding.

If you cannot control the bleeding with manual pressure,

then consider applying a tourniquet.

Continue applying pressure and do not remove a

tourniquet until professional first responders arrive.

DEVELOP A PLANRUN

HIDE

FIGHT

HELP IS ON THE WAY

*

45

* Active Shooter Planning and Response in a Healthcare Setting. April 2015

* Department of Home Land Security (DHS) Active Shooter Response Booklet

* U.S. Department of Homeland Security. Washington, DC 20528

* cfsteam@hq.dhs.gov www.dhs.gov

* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans, Washington, DC, 2014.

* Violence in Hospitals: Assessing your risk and developing a response. Live process aha October 2011. October 3, 2011.

*

*What if…

Randy Fischer

2731 Austin Drive

Lincoln, Nebraska 68506

402-840-5915

rfische@yahoo.com

*