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Active Shooter:Healthcare Facility

Brian J. HeavrenAssistant Police Chief

Hartford Police Departmentheavb001@hartford.gov

Donald CyrVP Facilities and Hospitality Services

Hospital for Special Caredcyr@hfsc.org

AGENDA

• Hospital for Special Care Event – Feb. 22, 2012 HSC – Background and Leading up to the shooting Events of the evening

Interactions between hospitals and police department

• Recovery • Short Term – Getting staff back in building• Getting operations up and running

• Preplanning from Police Department (PD)• Key components for exercising an active shooter

plan

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275,000 sq ft 205 Long Term Acute Care beds on this campus

100 – 110 ventilator patients

1,100 staff 400 – 450 on 1st shift 100 – 150 on 2nd shift

29 access points No Emergency Department Security Staffing – 2 security (all shifts)

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On February 22, 2012 at approximately

5:50 PM, the Hospital for Special Care experienced an act of violence that significantly disrupted hospital operations.

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EVENT

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An employee entered the hospital with a weapon and shot two supervisors in their office

Local PD responded utilizing active shooter protocols.

Initial PD and subsequent SWAT response was under the command of the New Britain PD and then State PD

Mutual aid from Hartford, Newington and other surrounding agencies.

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EVENT

2 supervisors in office

Shooter entered the hallway

Nurse waiting for elevator sees shooter heading toward supervisors’ office

Office is not visible from elevator lobby

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Nurse hears 4 shots; someone says:

“Oh My God”

Nurse calls operator.

Security responds. Sees no sign of a shooter.

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Security ResponseCode Activation

• Security identifies the two victims• Calls for a Dr. Quick (Clinical Response Team)• Switchboard operator follows up with a call to

911 after activating the Dr. Quick Team• Realizing that it was an active shooter the

operator follows up by calling a Dr. Safe (Security Event: Defend in Place / Lockdown)

• Dr. Safe actions implemented throughout

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First Responders

• Remarkable response saved the lives of the two victims

• 2 more 911 calls placed by the clinical responders• Reportedly, there were approximately seven calls

made from the hospital to 911• Location of shooter unknown• Switchboard activates Emergency Operations

Command (EOC)• Dr. Safe actions implemented throughout

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NBPD Arrives

New Britain Police Department secures basement LL• Asks the switchboard operator to evacuate; she refuses• Second security officer explains why she cannot leave• Security officer brings the police to the supervisors office• NBPD provided cover for the responders• NBPD assists evacuation of victims • Secures crime scene• Continued their search of LL

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SWAT / ERT

• SWAT / ERT arrive from surrounding towns and state Secure entire building, Lock Out Secure city block Respond to Hospital’s Research & Education building,

located two blocks away

• EMR prepares for the possibility of a full hospital evacuation

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At the Scene

• Police requested building blueprints and keys• Also requested a picture of the shooter Would not allow access to obtain these items Reports indicated there may have been two shooters

• Communication was challenged Phone lines were jammed Media had already broadcasted the incident; citizens

and media were tweeting and active on Facebook Families and staff were calling in

• EOC was fragmented• Media was on the scene

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The Unexpected

• Goals of the Police Department and Hospital Facilities Team did not align Facilities wanted to get staff back into the building,

get operations up and running again, and assure that all patients remained safe

PD wanted to assure EVERYONE’s safety and continued with the hospital lockdown until they were confident another person with a weapon was not still in the hospital

• Did not anticipate that police would order evacuation of the hospital including patients and staff

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The Unexpected

• During the lockdown, the code team of approximately 22 staff members were escorted out of the building and not allowed to return.• 2nd shift – massive impact to continuity of care

• Other staff were contained in the cafeteria and other parts of the hospital and not allowed to return to their units.

• Leadership returning to the hospital were not allowed access.

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The Unexpected

• Do not expect that you will be able to assist in the police response

Leadership was identified as a possible target of the shooter, isolated and not allowed to leave police protection

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The Unexpected

• Police response was enormous and reportedly included a SWAT armored vehicle and helicopter

• Building access was so congested with police cars and ambulances that the ambulances transporting the victims had difficulty leaving the campus

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Planning for Vehicle Staging

The Unexpected• Police did not anticipate that Hospital staff

and patients would not evacuate the building• Police did not anticipate their radios would

not work in some areas of the hospital• Interior / Exterior Communication Failures

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Immediate Steps Taken

• VP of Nursing, VP of Facilities, and VP of Quality established cell phone communications with the head nurses on patient units

• Established a plan with Police on scene to escort a response team should there be a medical emergency

• Public Information Officer (PIO) established communication at R&E Center, 2 blocks away

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Shooter Apprehended

• Hospital President, Physicians and Response Team all wanted to get onto the patient units

• Our lobby was occupied with Police and SWAT

• The commander worked with us to get back into normal operations. The shooter was in custody but they feared that there may have been a second shooter. They were also concerned with booby traps or explosives left by the shooter.

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Clearing Each Area

• Police cleared and secured one unit at a time

• Every door, chase, cabinet, etc. was opened and checked

• As they cleared each unit, they posted security at each end and allowed us to come back in• TBI Unit Situation

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Recovery

• The event was over, staff was devastated• We immediately began providing employee

assistance Counseling (EAP) Round the clock meetings with president and vice presidents Pastoral care

• Increased security Security assessment and review Pediatric Unit – Full controlled access for families

Heightened fears (copy cats) and expectations

• Managing media coverage22

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Media Relations Approach

• Transparency: Cooperated with the media• Empathy

Injured, patients, staff

First responders

• Internal collaboration

• Accountability and Accuracy Took lead on correcting inaccuracies

Reported new information as available

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Media Approach (continued)

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Reserved, but confident• No speculations• Did not offer more

info than needed• Issued official

statements• Curtailed interviews

when no new info to report

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Media Results

• Accurate reporting and coverage

• Positive community support Local, state, social channels and direct

• Short news cycle Off the front pages relatively soon after incident

• No residual brand damage

• No adverse impact on referrals or admissions

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Media Lessons Learned

• Have a crisis plan in place Contact tree: PR, operations, risk management, etc.

Offsite meeting place: Back-up facility

• Maintain strong online newsroom

• Utilize social channels

• Act quickly: Issue “holding” statement

• Have offsite support Monitoring news and social channels

Do what the community expects!

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What Went Well• Communication

• Overhead page of Dr. Quick, Dr. Safe• Immediate call to 911• Activation/notification of incident command positions• Police to hospital on-site command

• Resources and Assets• Mobilization of EMS services from region• CMED Roll call of available beds / Minimally 13

ambulances on-site• 3 SWAT teams initially with 7 police departments

responding / State SWAT on-site

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What Went Well

• Safety and Security• Staff’s response to Dr. Safe• Response of Dr. Quick team• Shift Manager cell phones with pre-programmed

numbers• Quick response of Police to HSC• SWAT on-site; took over scene

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What Went Well

• Staff Roles and Responsibilities• Activation of Incident Command with activated section

chiefs effecting roles• Hospital Incident Commander, Logistics Chief, Operations

Chief, and Planning Chief allowed to operate at hospital entrance and into lobby when it was cleared.

• EMS coordination per protocols• Public Information Officer (PIO) and communications

established at R&E Center 2 blocks away

• Managing Utilities• Logistics Section Chief on-site; no utility issues

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What Went Well

• Managing Patient Clinical and Support Services• Operator remained at switchboard and continued to

manage calls in and out, primary hospital communication

• Staff on unit prioritized care effectively during lockdown

• Coordination with SWAT to allow an escorted team if medical emergency called for it

• Coordination with police to retrieve and transport victims

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What Did Not Go As Expected

• Communication• Overhead pages not heard in all areas of the hospital• No ability for staff to access incident command

communication tools or hospital assigned devices• Unable to overhead page as it could alert shooter

and compromise the situation• No real communication allowed between command

staff due to various perimeters and SWAT isolation procedures

• Hospital operator, patient units, and individual cell phones overwhelmed by calls

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What Did Not Go As Expected

• Communication• Lack of communication from SWAT/Police• Took persistent discussions on our part to prevent a full

scale evacuation• Police command post unable to communicate with interior

• Resources and Assets• Building plans not immediately available• Keys/badges not readily available for police access• Unable to access emergency items (i.e., two way radios) • No control of staff once evacuated by police• Inability to allow needed staff back into building

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What Did Not Go As Expected

• Safety and Security• Time lapse to implement complete lock down

procedures• No procedure detailed for staff to inform us where

they were holed up• No procedure or training in regards to active shooter• Did we put our first responders in jeopardy when we

activated the Dr. Quick before the Dr. Safe?• Perimeter and access controls to enter or leave the

facility

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What Did Not Go As Expected

• Staff Roles and Responsibilities• Unable to effectively run incident command with a limited

and fragmented structure• Not a clear unified command• Unified command with a liaison at table unable or

unwilling to communicate to onsite chiefs

• Managing Patient Clinical and Support Services• Responding staff evacuated with victims, 22 staff (late doc,

respiratory, and nursing leadership) unable to provide care• Difficulty for shift manager to communicate with units and

care givers

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Strong Community Support

• Connecticut Hospital Association honors HSC First Responders with Healthcare Hero Award

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Strong Community Support

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First responders and victims honored at Rock Cats HSC Night

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Law Enforcement Perspective

Prior to and During a Shooting Event

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Prior to the Event

• Facility Assessment and Target Hardening• Access control and badging• Segmentation of building• Closed circuit monitoring and recording• Notification systems• Trained and visible security staff• Strong human resources and patient advocacy

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Prior to the Event

• Clear and concise policy and procedures for employees

• Employee awareness and drills

Run, Hide, Fight: http://www.readyhoustontx.gov/runhidefightenglish.html

Prior to the Event

• Plan with First Responder Community• NIMS training• Access to building plans and all access cards• Access to facility’s communication system• Signage• Table top and full scale exercises

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During the Event

• Intelligence Information is Crucial for a Rapid and Efficient Police Response• Location and number of shooters• Physical description• Type of weapon being used• Number of victims• Best access to the incident

Hartford Distributors: http://www.youtube.com/watch?v=0hZKgtY7_5c

During the Event: Law Enforcement Goal

• Active Shooter• Force a surrender, barricade (goal - without hostages) or

neutralize• Initial officers will not stop to render aid or assist in the

evacuation• Officers will move towards the gunfire to engage the

suspect. Very aggressive approach.• Police will assist with evacuations when a sufficient

number of officers are present

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During the Event

• Police Assumptions• Significant police response that will typically involve

mutual aid• A ICP will be established and hospital representation is

essential (security, administrator, engineering, PIO)• Secondary searches and investigations take time. Hospital

operations may not return to normal quickly• Evacuees will need to be debriefed by investigators

Leadership/Facilities/Nursing – Get next to the PD Incident Commander and never leave their side!!!!!

Questions

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