Q&A: Active shooter response and prevention

Editor’s note: This Q&A was taken from the January ASHE webinar, “Active Shooter - Best Practices for the Worst Case,” with speakers Kevin M. Tuohey, executive director for research compliance at Boston University & Boston Medical Center; Constance Packard, CHPA, executive director, support services for Boston Medical Center/Boston University Medical Campus; and Thomas Smith, CHPA, CPP, owner of Healthcare Security Consultants, Inc.

Here they discuss the unique risks in healthcare facilities, emergency rooms, mental health services, and other treatment facilities, and they address preparedness through operations and design.

Q: Can you tell me how an active shooter incident at a hospital can affect the staff who work there?
Constance Packard: A son came into an institution [Brigham and Women’s Hospital] months after his mother had died and went looking for the cardiologist. He shot that cardiologist and then shot himself. I can tell you a year and a half later that there’s people at that hospital that are still traumatized today. They still talk about it today: the safety, the security, the concerns, and were they ready? These things happen so unprovoked and are unpredictable, but they can happen.

Q: What is the best way to start planning for violent incidents such as active shooters in a hospital?
CP: We go through assessing risk many times, and so we’re prepared for many things, although it doesn’t always go right.

If you don’t educate and train and communicate to your staff to see how prepared they are, then you could have the worst-case scenario. Doing risk assessments is time-consuming; they’re required, but they don’t have to be done annually. They could be done more often.

This past winter in Boston, where we used to take our homeless people was to a shelter over a bridge called Long Island. Well, the bridge failed, and we had nowhere to put 1,200 homeless men and women each and every day. They ended up near my neighborhood at Boston Medical Center, so going back and reviewing that risk assessment was important.

What did those risks bring to the hospital quality of life, dealing with the homeless population and making sure we could give care? We had to have another risk assessment done for that type of change in our environment.

Q: Tell us something about the importance of getting leadership support for conducting drills.
CP: We were doing our first tabletop exercise and then it was going to go into a live-action drill, which was the first time active shooters were being talked about in healthcare facilities. It took us 18 months to plan that drill—law enforcement, clinicians, suspects—a whole lot of work in an outpatient setting, and we were able to close a building down to do it.

And lo and behold on that morning, somewhere around 9:30, I got a phone call from the president of the hospital that said, “There’s been a shooting at a hospital in Baltimore; we need to cancel this drill.” And with all due respect, we’re not going to cancel the drill, and I got the leadership to support us.

They were concerned that employees would [disrespect] the sympathy and empathy of our colleagues in Maryland and that we were just going to push through and not care about that. That’s not the case. What we did was go with the drill so our employees felt that we were concerned about their safety and we wanted to learn the lessons then.

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