Improving Active Shooter Planning, Dissertation Example

Improving Active Shooter Planning and Response to Mitigate Harm in a Freestanding Emergency Center

Chapter One: Problem Description

Background

According to the US Department of Justice (2022), an active shooter is a person who makes an effort to kill someone or someones in a public or private crowded location. The events preceding or causing the active shooter incident are often unpredictable, can occur anywhere, and evolve quickly. In the US, active shooter cases are on the rise at a 7% rate, as reported by US DoJ (2022). According to this report, the most frequent trigger for ASI is mental health issues, trauma, and political or socio-economic reasons. The threat is also caused by a lack of communication and the inability of people in power to handle or hear the grievance of a specific group, who may eventually resort to violence. Crimando and Collar (2022) explain that the US DoJ has trained many communication experts whom the security team can use in an ASI to brainstorm with the shooter and lower the risk of injury to people in the area or building.

The US Department of State has set up general guidelines for good practice in the case of an active shooter and how to cope with such a situation. Sanchez et al.  (2018) write that one of these measures is that the person should entail knowing as much as they can about the environment they are in, and any additional danger, such as live wire loosely hanging that can harm them in case of shooting or falling object and so on. The second guideline is that the victim should note at least two nearest exits in as many facilities as possible. Where possible, Sanchez et al.  (2018) urge that the victim should move around or survey the area if there is no imminent threat and find all the possible exits, especially if the shooter has got to them yet. If the victim is in an office, they should try to secure the door and all other possible points of entry. Hiding behind or in a second hideout increases the chance of survival as they primarily serve the purpose of showing no activity and reinforcement if they can be secured too. For example, if the office has a secure room, a volt, or an underground hideout that can be connected, it serves a better purpose to hide there than in the office. In buildings and rooms with hallways, the victims should avoid these and find a room or secure door where they can be locked. Kim et al. (2021) explain that in an active encounter, DHS advises the victim to take the shooter down by whatever means. In self-defense, the victim should target the impact on vital organs during a fight should it come to that. The chances of survival reduce as the shooter comes close to range; thus, hindering them from afar, such as shooting from a hidden spot or an ambush, and fleeing after incapacitating them, is a great move and increases the chance of survival. While taking all these measures, the victims should have dialed 911 at the earliest convenience and waited for help if there was nothing else they could do.

Problem Statement

The US health facilities have been on high alert to assess and report patients with a higher risk of violent behavior. Kim et al. (2021) state that therapists in freestanding emergency centers area center diagnose and treat mental illnesses that can trigger violence leading to active shooter incidents. People receiving specialized care are at a higher risk of exhibiting such behavior, which can be triggered by denial or delay of the results they want. Some people have difficulty with arguments or the services they do, which can trigger such an incident. According to Kim et al. (2021), the first measure to prevent active shooters is safe gun-keeping storage at home, workplace and policies on who can carry a weapon. Planning such incidents is not always accurate, and sometimes loss of lives occurs. Most incidents happen in learning and hospital institutions where children and patients have lost their lives in the last decade. Many schools have heightened the security measures following several directives by the ministry of health and prevailing circumstances to prevent harm to learners, teachers, and staff in school. Unfortunately, this has not fully succeeded in preventing gun violence and mass shooting cases and Kim et al. (2021) argue that hospitals are lagging in active shooter incident preparedness and training.

Brown et al. (2018) advise active shooter planning and training in hospitals and other work to reduce causalities. Additionally, a need exists for increased monitoring of the kind of visitors entering a building where a large crowd is congregated. The industry regulations of companies and organizations include experts from Medicare, Medicaid, DOJ, homeland security, OSHA, FBI, DHS, and FEMA, among others. The Federal Emergency Management (FEMA) has been critical in ensuring preparedness at the workplace and schools by offering government-sanctioned training and planning protocols in various public institutions. In order to boost people’s chances of surviving an attack, FEMA provides training on protective measures that are based on the considerable expertise of specialists who have dealt with active shooters. The Justice Department creates statutes and rules about its tasks which includes knowing how to handle a shooter in action, which is more policy-based. Kim et al. (2021) explain that Homeland Security teams often help the shooter get a fair chance of survival or communicate their grievance to prevent a future situation occurrence for the exact cause.

Occupational safety and health administration (OSHA) has been critical in establishing safety guidelines at the workplace and measures that the management must take to ensure preparedness and response capability in case of n attack. Some workplaces need to train all workers; there are security clearances that visitors and people entering the building should have. In other circumstances, there exists a means to monitor and record who enters a location for safety reasons. OSHA also certifies the training expectation and capabilities of various trainers on active shooter incidents. According to OSHA director Doug Parker’s speech in August 2021, it is no secret that the US is facing gun control problems, and there are more active shooters. While, unfortunately, there are no universal laws to prevent gun ownership to the public, people have a lot to do to ensure responsible gun use and control. Brown et al. (2018) explain that the chance of a workplace fire is thirty percent lower than that of an active shooter. This is a more immediate threat than one hundred since a climate disaster has a 60% lesser probability of happening than an active shooter situation at work. Twenty-five times lowered chance of occurring compared to a chemical event. According to this report, 27% of American companies are adequately equipped and trained to deal with an armed assailant. While no one wants to find themselves in such a horrific situation, employers must train their workers to handle such an incident. The 2017 OSHA enforcement procedure ensures that certified trainers and assessors inspect all workplaces and schools from this department to ensure the institution has adequate security measures.

Rationale

The researcher chose the social cognitive model as the theoretical framework on which this project is based. Windsor (2020) states that the theory analyzes the behavioral principles and predictions that healthcare facilities use to assess people who exhibit violence and are likely to choose active shooting to solve their problem. This theory states that participant behavior is a crucial motivation and source of empowerment for the self-efficient methods they deem fit to solve their problems. The practice is to assess patients, improve the quality of decision-making and problem-solving techniques, and train them on ways of solving problems they have not mentally developed. Kim et al. (2021) write that the effectiveness of this didactic method is an interactive active shooter simulation exercise and use of knowledge to find self-efficacy measures for the measure that freestanding emergency centers can use.

The initiative can potentially reduce or mitigate the primary objective of understanding the active shooter in eight weeks by staff at a workplace and appropriate response to such an aggressor. According to the Joint Commission (2021), this initiative’s long-term objective is to develop organization policy in active shooter training requirements and standards for joint commission employers to ensure healthcare preparedness in handling active shooters.

Specific Aims

Secondary objective

To attain the development of an organizational policy for future mandatory active shooter training for employees as specified by the Joint Commission

Primary objectives

To increase staff knowledge, self-efficacy, and safe response to active shooter events.

Chapter Two: Methods

Context

This study is in a Houston-based freestanding emergency center. Mannenbach et al. (2019 explain that freestanding emergency centers occur critical care and treatment on a twenty-four-hour basis. The security of such facilities is thus vital to the hospital and the communities they serve—the plan to improve active shooter planning and response at the freestanding emergency center. Argintaru et al. (2021) explain that healthcare facilities are not immune to an active shooting. Measures are put in place in free-standing emergency rooms to guarantee the security of employees, guests, and clients. Sanchez et al. (2018) explain that the easiest way for an active shooter to get into such a facility is by hijacking an ambulance since the security clearance is heisted to save the lives of incoming patients. As such, the clearance and security measures should be quick but efficient to avoid letting a shooter into a facility. This study’s survey on intervention measures in a hospital with sixty-nine staff capacity will assess the standard for potential mechanisms of mitigating harm to visitors, patients, and staff. The intervention aims to instill self-efficacy mechanisms and knowledge of responding to active shooter scenarios and create hospital policy from the training based on what is the workable and best approach to the problem. Ghoreishi et al. (2019) and Lopez-Garrido (2020) assert that such an initiative where participants experiment and train based on specific scenarios of what is best practice empowers the employees and build a more comprehensive capacity and workplace to reduce harm in case of an active shooter at the hospital.

Before the training and active shooter simulation begins, Lopez-Garrido (2020) advises trainers that the staff should receive a briefing that the exercise is for training purposes and that the drill is vital for their survival in case such an incident occurs. The researcher will also seek their consent to participate in the drill/simulation and adhere to hospital guidelines on protecting the patient’s psychological well-being. There is a need to train on high-pressure handling situations and stress management in such simulations for the sake of the participant’s mental well-being.

An essential aspect of their simulation is helping medical professionals navigate the ethical issue in a healthcare facility’s active shooter incident. For example, a nurse or doctor may be forced by circumstance to choose between themselves and a patient. According to Windsor’s (2020) survey, clinicians have mixed feeling about such scenarios, and the simulation should guide the doctors and nurses on such ethical dilemmas in a healthcare-based simulation. The outcome of this step is to impact and ensure clinicians can quickly assess personal duty and risk and make the right choice. This simulation includes steps when hiding from a shooter in scenarios where patients cannot hide or run.

Project design

This study will use a quasi-experimental design to create a pre-post intervention design. The study aims to survey and collect data on what to plan, what to do, and what action model to implement in the active shooter prevention and intervention plan directly. The location of this study is in a freestanding emergency medical center with sixty-nine employees. The administration of the response will be attendance and participation in a simulation activity. The center is situated in an urban setting where emergency medical collaboration with the Houston police department is ongoing. The research initiative will be performed using the best practices identified by DHS in conjunction with the American Hospital Association.

Population

The researcher will collect data from the participant. These participants will be selected through systematic random sampling and data collection via a survey, as stated above. The aim of the plan, do, study, and act model is to find measures that can be employed by PSDA personnel in freestanding emergency medical centers.

Intervention

This intervention will take three weeks, beginning the third week after the project’s onset. The intervention will be carried out by hospital staff, and the clinicians totaling sixty-nine nurses and doctors, will be the participants. The intervention aims to assess the risks and vulnerabilities within the hospital setting. The intervention aims to prevent and respond to active shooting incidents. Additionally, the simulations will determine the mechanism of reducing violence at the workplace, which is one causal trigger as directed by DHS and in Kim et al. (2021) findings. The planning and the drill must simulate the occurrences in an active shooter incident; thus, the exercise and training must have a mechanical and realistic basis. The collaboration includes external law enforcement officers present during such an incident. The trainers will foster good communication awareness in response to a shooting incident. The worst can happen, and the simulation’s last exercise will include the steps toward recovery and debriefing when a shooting occurs in such a facility as the freestanding emergency center.

In the simulation exercise, the staff will get a briefing to view the training positively and take it seriously, as it can help them in such an incident. The activity will begin with a training video where staff will watch different responses and actions in an active shooter incident. The movie, which lasts for eight and a half minutes, was produced by the Baptist Memorial Center and is an approved tool for active shooter drills in healthcare settings. The video is available from the FBI and is based on the run, hide, and fight procedure one should take in such an incident. The staff will participate in the video simulation that the local law police will offer and participate in how they respond to such an emergency within the facility. Then there will be the pre and post-survey to analyze the knowledge and decision capability of the staff in response to an active shooter incident.

The researcher will collect data that entails participants viewing the videos and their simulation activity pre-and post-intervention. The researcher will collect data on preexisting knowledge and perception of active shooter incidents and identify hiding places, safe exits, and self-protection approaches. Other data will include emergency communication and the measurement via the Likert scale to measure the outcome and effectiveness of the intervention.

The variables include the number of participants viewing the video and aspect of the training, including the participant simulation activities, knowledge acquisition, response actions, and self-report efficacy for a new plan. The variable also includes the time and response changes the staff takes to respond accurately to active shooter incidents.

Risks and benefits of the intervention

Study of the interventions-approaches used to establish the observed outcomes following the intervention, how to establish outcome was due to intervention

Measures-ongoing assessment and the contextual elements. The cost, efficiency, and procedures for evaluating the correctness and fullness of the data were factors in success or failure.

Analysis- Inference-making techniques that combine qualitative and quantitative approaches, understanding techniques for data variance, and temporal variable impacts

Ethical considerations

The ethical issues in such a survey include the psychological well-being of participants. The research took Ketterer and Austin’s (2022) measure and sought the consent of the participants before starting the research. The written permission indicated that the staff members voluntarily participated in the study and were free to opt-out anytime. The researcher also explained the nature of the training and simulation and offered them adequate psychological preparation. The researcher will also take necessary measures to ensure the participant’s privacy and keep the data confidential. During analysis, the participant’s identity will be coded, and data will be used for research and policy change only. The trainers and participants will adhere to the hospital guideline to ensure operations at the facility are ongoing during the research and no patients are in danger because the medical professional took part in the study.

References

Argintaru, N., Li, W., Hicks, C., White, K., McGowan, M., Gray, S., & Petrosoniak, A. (2021). An active shooter in your hospital: a novel method to develop a response policy using in situ simulation and video framework analysis. Disaster Medicine and Public Health Preparedness, 15(2), 223-231. https://doi.org/10.1017/dmp.2019.161

Brown, R. G., Anderson, S., Brunt, B., Enos, T., Blough, K., & Kropp, D. (2018). Workplace violence training using simulation. AJN The American Journal of Nursing, 118(10), 56-68. DOI: 10.1097/01.NAJ.0000546382.12045.54

Crimando, S., & Collar, M. (2022). The 2022 active shooter threat landscape: Risks and resources [Webinar]. https://go.everbridge.com/2022-active-shooter-landscape-webinar.html

Ghoreishi, M. S., Vahedian-Shahroodi, M., Jafari, A., & Tehranid, H. (2019). Self-care in behaviors in patients with type 2 diabetes: Education intervention based on social cognitive theory. Diabetes & Metabolic Syndrome: Clinical Research and Reviews, 13(3), 2049-2056. doi:10.1016/ j.dsx.2019.04.045

Ketterer, A. R., & Austin, A. L. (2022). An ethical framework for conducting active-shooter simulation in the healthcare environment. Simulation in Healthcare, 17(4), 270-274. DOI: 10.1097/SIH.0000000000000632

Kim, J. J., Howes, D., Forristal, C., & Willmore, A. (2021). The Code Silver Exercise: a low-cost simulation alternative to prepare hospitals for an active shooter event. Advances in Simulation, 6(1), 1-8. https://doi.org/10.1186/s41077-021-00190-0

Lopez-Garrido, G. (2020, August). Self-efficacy theory. Simply Psychology. www.simplypsychology.org/self-efficacy.html

Mannenbach, M. S., Fahje, C. J., Sunga, K. L., & Sztajnkrycer, M. D. (2019). An in situ simulation-based training approach to active shooter response in the emergency department. Disaster medicine and public health preparedness, 13(2), 345-352. https://doi.org/10.1017/dmp.2018.39

Sanchez, L., Young, V. B., & Baker, M. (2018). Active shooter training in the emergency department: a safety initiative. Journal of Emergency Nursing, 44(6), 598-604. https://doi.org/10.1016/j.jen.2018.07.002

Windsor, L. (2020). Active Shooter Training in an Integrative Health Clinic (Doctoral dissertation, The University of Arizona).