The Hospital Association of Southern California (HASC) Security and Safety Committee hosted an active shooter Drill for health care professionals March 19 at LAC + USC Medical Center’s old campus. More than 230 people from local hospitals and communities experienced a simulated emergency in a clinical and office setting, including security, emergency room and nursing staff; human resources; risk managers; social workers; and administrative and executive personnel.

We used the Incident Command System’s (ICS) unity of command and span of control for efficiency. As we developed the event, every element was looped back to the safety of our participants. Even with this attention to detail, however, there were a number of ways to improve the drill. The following list offers some best practices and lessons learned for those interested in developing their own drill.

COMMITTEE SELECTION

• Committee members should have decision-making authority to develop the event, such as a C-suite administrator, directors, safety officers and law enforcement leadership. Other participants, like risk management, social workers and HR, should attend the first meeting and lend their expertise during the planning process. All team members should be present the day of the event to coordinate their area of expertise and troubleshoot if necessary. 

• Designate a minimum of two administrative support individuals who attend all meetings and whose sole responsibility is to capture conversations and decisions. Avoid having a member of the development team take notes as this hinders their full participation.              

View the photos of this active shooter drill.

DRILL/EVENT DEVELOPMENT

• Develop job action sheets for each event participant so everyone knows exactly what is expected.

• Establish rules and guidelines for the event. For example, will photographs be permitted? Will participants be allowed back in the facility once they leave the event area? Will on-site registrations be permitted? Will late participants be allowed to enter the area once the drill commences?

• Define your event agenda. In addition to the drill, HASC’s agenda included an educational seminar, a panel discussion and two simulations on rotation throughout the day. Facilitated by California Hospital Association, the seminar covered regulatory requirements and recommended responses for workplace violence. Panelist included experts on health care security.

VENUE

• Choose a venue that can accommodate the size and type of event you want to develop, and ensure any environmental issues are addressed (e.g., enough clean restrooms; hand sanitizers; trash receptacles distributed throughout the area and serviced during the event).

• Consider the proximity of other events and activities to the drill location.
• Ensure the facility is available and develop an alternate plan should an unforeseeable event interfere with your original plans. It is easier to direct participants to a new location than cancel and reschedule the event. 

• Send a written notice to the event or activity coordinators describing the drill. Provide a script to ensure a clear and consistent message. It is important that no unauthorized attendees enter the drill area. Again, safety is paramount.

• Distribute and post drill flyers. Provide clear instructions on what to do, what to avoid, what participants may see or hear and a number to contact if they have any questions or want to register for the event.

• Provide clear parking instructions for participants, actors and staff. Signs should be posted noting parking and shuttle pick-up and departure times.

• Test all audio and video equipment for proper functioning. If in doubt, have an outside company provide and test the equipment. Have a representative at the event to troubleshoot.

• Some communication devices may have a poor signal due to thick walls or other barriers. Test all communication devices and have runners on standby to deliver important messages, if needed.

• Do a walk-through the day prior to the event to ensure everything is set up, functioning and ready to go. 

DAY OF DRILL/EXECUTION

• Staff should arrive two hours early to ensure there are no issues and prepare for the arrival of the participants.

• Test all communication devices and distribute a list of all organizers’ cell phone numbers. Provide a site map and the cell phone list to each organizer. 

• Provide water and light snacks throughout the event. 

• Designate two individuals as the leads to handle any issues. Rely on your leads to run their areas and provide them with simple instructions on who to contact if they have questions or something goes wrong. Follow the unity of command and span of control.

• Each group should verify their area’s readiness, such as signage posted in the proper locations; accessible facility elevators, stairways and fire exists; audio visual equipment available and working; and ambassadors are briefed and positioned in the parking lots and inside the venue.

• Demonstrate the weapons by firing a live round so participants know what to expect and have the opportunity to opt-out of the drill. Have the law enforcement safety officer fire the test rounds so the participants will not know what the acting gunmen look like when the event begins.  

• All participants including vendors, actors, staff, speakers, panelist, committee members, and the host must register, sign a release, and receive an event package with a site map, protective eye gear and ear wear. Have checks and balances to ensure a waiver is received prior to issuing event package. 

• Review in detail the security and safety instructions. Read the instructions to ensure you cover everything. Do not paraphrase. 

• Explain the day’s events in detail. Instruct everyone to review the “event board” for updates and special instructions. This board is where you provide day-of changes such as the event running late or ahead of schedule, breaks, lunch,  and any other changes. 

• Designate safety officers to pick up the bullet shells.

• Station safety officers/staff members at each exit to stop participants from leaving when escaping the area. The safety officer/staff member will provide a “safety sticker” to anyone who successfully escapes the scene to show they are out of play and can now watch the remainder of the drill.  This will also show the acting gunman the participant is out of play. 

DOCUMENTATION

• Assign scribes to different locations during the event to document everything they can.  

HOT WASH

• Conduct hot washes after each drill allowing the actors and observers to immediately discuss their experiences. 

OBSERVATIONS

• Participants who escaped the area stated they wanted to return to help others. Education on what to do once out of immediate danger with tips on how to remain calm, who do you notify, using plain speak and what to do if you do not have your cell phone all should be included. 

• Many commented that they
  did not know what to do if they were injured and still in danger of the shooter returning. This issue should be explored for suggestions or recommendations to help the injured better cope with the event.

• Some doctors and nurses tried to help victims who were shot. They became victims once the shooter returned to the area. The importance of knowing how to protect yourself — whether hiding or waiting until the area is deemed safe—cannot be overemphasized.  

• Many individuals who attacked the shooter were unsuccessful. Escaping the danger area is the best response to increase the chances for survival.

To help facilitate the planning of a similar event for your hospital or facility, and for more information about HASC’s drill and hospital safety resources, please visit www.hasc.org.

Daniel J. Holden, BBA, BS, MBA, CPP, CEM serves as the Director of Healthcare Services for the Southwest Region of AlliedBarton Security Services where he coordinates the development and implementation of security and emergency management programs. He also chairs the Hospital Association of Southern California (HASC) Security and Safety committee.

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