Active shooter incidents have become a new normal in our society. As of Sept 24, 2019, there had been an average of 1.24 mass shootings per day in 2019, killing 377 people and injuring another 1,347 victims.

“Run. Hide. Fight®” has been the mantra of training set down by the Department of Homeland Security. We are instructed to run and escape if possible; hide if escape is not possible, and fight as an absolute last resort. While this run, hide, fight mantra offers a lot of value to give people a course of action and to help them feel more confident and prepared in the event of an active shooter scenario, there is more to the equation when it comes to prevention and preparation. It’s time to face this fact.

Here, we look at three recent incidents that should serve to remind organizations that there is much more to consider.

Historic District in Dayton, Ohio

In the early hours of August 4, 2019, a 24-year old gunman with an AR-15-style assault rifle and 250 rounds of ammunition killed nine people and injured another 27 in the Oregon Historic District of Dayton, Ohio. The perpetrator was killed by police within 32 seconds of the first shots. A search of the shooter’s home uncovered evidence of his obsession with violence and that he had expressed a desire to commit a mass shooting.

The organization Childhood Preparedness, which provides resources for early childhood professionals with emergency preparedness planning, response, and recovery, formed the following takeaways from both the Dayton shooting and the El Paso shooting, which happened in the same weekend.

Lessons Learned:

Active Threat Training Saved Lives: Dayton law enforcement agencies received previous training in active shooter response, and their quick action saved countless lives.

Citizen Training Is Important: The key to citizen survival in both the Dayton event and other mass shootings was to quickly identify the sound of gunshots.

Running Is Always an Option: In this situation, running was, in fact, a good idea. Running from the gunfire to a safe location away from the shooter helped save some lives. However, some individuals froze and needed to be prompted by others to run. Individuals who chose to lay on the floor suffered multiple injuries and were trampled by others running from the area.

Stop The Bleed Training Can Help: Participants at the scene aided first responders by treating the wounded with basic first aid, CPR, and even applying tourniquets, such as belts, to the wounded. Tourniquet use is a crucial element of Stop The Bleed Training, which teaches bystanders how to stop severe bleeding before professional medical help arrives on the scene.

Townville Elementary School

On September 28, 2016, in a small town 40 miles outside of Greenville, South Carolina, a fourteen-year-old opened fire at Townville Elementary School playground, shooting three students and a teacher. One of the students, a six-year-old boy, later died, as did the shooter’s father, who had been killed earlier in the day by his son. The suspect was apprehended by a volunteer firefighter after his gun jammed on the playground, just 12 seconds after he first pulled the trigger.

Dr. Joanne Avery, Superintendent of the district, candidly shared her experiences in dealing with the immediate response to the shooting and its aftermath, in a School Safety Webinar sponsored by Raptor entitled, Lessons Learned and Changes We Made After an Active Shooting.

Lessons Learned:

Quick Response is Crucial:  The majority of active shooter events, 69%, end in five minutes or less and 67% are over before the first police arrive. “Speedily moving towards engagement with the shooter should be the primary guideline when teaching active shooter response tactics,” according to the FBI’s report, A Study of Active Shooter Incidents in the US Between 2000 and 2013.

Shooters Do Their Research:  Active shooters study and learn from past events in order to inflict the largest amount of damage. “They want their events to be deadlier” and that “they’re on the clock…so they try to get as much damage done as quickly as they can.”

Rural Areas Are Not Immune:  The majority of school shootings have occurred in semi-rural and rural areas, which means it can take between 12 and 15 minutes for first responders to arrive.  Dr. Avery says this is one of the reasons her school was chosen by the shooter.

Create a Drill Calendar:  Have regular active shooter response training with employees and (in the case of schools) students. Create different types of scenarios (e.g., lockdowns, times of day, types of weapons used, outside vs inside).

Know How to Lock Down: You need to be able to have things in place to inform people within the building about the shooter’s whereabouts and a clear evacuation plan. In some situations, training on how to confront the shooter may be warranted.

Dr. Avery stresses that “the first action that anybody should make if they see an active shooter on campus is…to shout ‘lockdown’, call the front office, and then call 911.”

Las Vegas Country Music Festival

On October 1, 2017, between 10:05 and 10:15 p.m., a shooter opened fire from his suite on the 32nd floor of the Mandalay Bay Hotel on a crowd of 22,000 concertgoers at an outdoor music festival. Firing more than 1,100 rounds of ammunition, he killed 58 people and wounded 422; a total of 851 people were injured during the panic that ensued. The shooter, a 64-year-old man, was found dead in his room from a self-inflicted gunshot wound. His motive remains officially undetermined.

In July 2019, the Las Vegas Metropolitan Police Department released a comprehensive After Action Review report about the event, which included a set of 93 recommendations to prepare for the future.

Lessons Learned:

Plan Ahead with Partners: Work with local government and community organizations, including neighboring police, fire, hospital, and coroner officials, to be better prepared and have a more coordinated response.

Become Less of a Target: Responding officers should remove reflective vests so that they are less of a target to shooters.

Have Trauma Kits On-Hand: For large scale events, have more trauma kits on hand available to paramedics and other responders.

Secure High-Rise Buildings: Secure high-rise buildings that oversee open-air crowds and train more officers to stop a shooter in an elevated position.

If we’ve learned one thing from these devastating incidents, it’s that preparation is key. Whether it’s understanding the sounds of gunfire, having trauma kits on hand, or even being prepared to attack and take down a gunman, these actions save lives. Acting quickly and decisively means all the difference.

Every active shooter scenario will be different, but the point is that organizations must have some level of preparedness for each phase of a shooting event – before, during, and after. Those strategies should include:

• reducing the likelihood of a workplace shooting through comprehensive risk mitigation (e.g., threat assessments, training, physical security);
• having response plans in place in the event of an active shooter scenario (e.g., evacuation routes, communication with law enforcement); and
• managing the aftermath of an event (e.g., employee support, public communications).

Once in place, plans must be continually updated, drills practiced, and changes communicated regularly.

Keeping your employees, customers and other stakeholders safe and your business protected is a 24/7/365 endeavor. To learn more, download our latest whitepaper, “Coming to Grips with the Known-Known of Active Shooter Incidents.”

Treating patients is far from the only concern faced by hospitals today. To protect the safety of patients, visitors, and staff, hospitals must now take extra efforts to anticipate and prepare for security threats.

Hospitals are vulnerable to crime and violence from patients, visitors, and occasionally their own staff members. Therefore, security systems in hospitals must include proactive measures to create and reinforce effective security protocols geared towards accountability, readiness, and responsiveness.

The first step to designing an effective security system is understanding the threats themselves.

Here are some of the top security issues concerning hospitals today:

1. Abuse and battery towards medical staff

Assault and battery towards medical staff are the most common types of abuse-related injuries to occur within healthcare facilities. 80% of serious violent incidents reported in healthcare settings were caused by interactions with patients and were usually caused by patients hitting, kicking, beating, and/or shoving medical staff. There are many reasons that contribute to this. For one, patients may be victims of an incident caused by a dispute, creating a hostile or volatile environment inside the hospital. In other cases, patients may suffer from instabilities due to addiction or mental health issues.

At highest risk of patient-inflicted violence are psychiatric aides, who are more than ten times at higher risk than nursing assistants, the second-most affected group. Other high-risk groups include emergency departments, geriatrics, pediatrics, and behavioral health providers.

2. Active assailant attacks

Researchers at Brown University reported 241 hospital shootings between 2000 and 2015. Breaking this down, the majority of in-hospital shootings happened in the emergency room (29%), next to the parking lot (23%), and in patient rooms (19%).

As recent stories exemplify, simply having a plan is not enough. A recent active shooter situation at Dartmouth-Hitchock Medical Center exhibited the need for a much more comprehensive security approach. When the shooter entered the hospital and shot a patient, “Code Silver” was announced to all staff members. However, most staff did not know what the code meant, let alone how to react. The code has since changed to “Active Shooter,” along with other modifications to improve overall hospital security.

Bethesda Butler Hospital in Hamilton, Ohio is working to enhance training. They hired actors to practice emergency response to a hospital shooting. As Ronald J. Morris, the Director of Corporate Security for Tri-Health puts it, “It’s all about preparation and telling people about developing the right mindset so they can be more prepared.”

3. Infant abductions

Infant abduction is the most common type of abduction in healthcare facilities. According to the National Center for Missing and Exploited Children, 317 cases of infant abductions occurred between 1965 and 2017. The majority of cases of infant abduction occur in the mother’s hospital room, with violence inflicted on the mother in 8% of cases. Before more advanced security protocols came to form, many of the perpetrators disguised themselves as medical personnel to steal a child, usually from the hands of the mother.

In response, hospitals have cracked down on security measures and patient education practices that directly address this type of risk. The system does not need to be complex, but it should be effective. For example, access to maternity wards should be limited to qualified personnel or individuals who can prove their relationship to a patient. This can be further reinforced with badges that identify the security clearance of medical staff.

4. Supplies and property theft

From drugs, food, and medical supplies, you could make an A-Z list of items that are stolen from healthcare facilities. In 2009, hospitals reported 272 incidents of theft. By 2015, this number rose to 2,926 – a 166% increase. The result can be extremely costly. As a single example, the Santa Clara Valley Medical Center in San Jose, CA counted 383 stolen pieces of equipment between 2010 and 2014, totaling to over $11 million in value.

Culprits include patients, visitors, and also staff. An employee at the Christus Santa Rosa Hospital-Westover Hills in San Antonio, TX admitted to stealing over $400,000 worth of equipment because “it was easy and no one asked any questions.” Hospital theft is a good indication of a vulnerable security system, and also contributes to unnecessary overhead costs.

5. Pressure to cut costs

While 49% of hospitals reported an increase in crime between 2016 and 2017, nearly 1 in 4 hospitals (23%) reported a decrease in its hospital security budget over the same period. Part of this involves a reluctance to hire more security staff. In an anonymous survey, hospital workers mentioned “more [security threat] incidents, no increase in staff,” as a key challenge for hospitals.

Given its impact on security measures such as employee training, staffing, and security equipment, the pressure to cut costs is one of the most devastating restraints to an effective security solution. With $3.6 billion in federal budget cuts announced for 2018, hospitals need to prioritize security measures that combine effectiveness with cost-efficiency to strive for the best return on investment and highest possible level of security.

Security demands are changing, and hospitals must keep up to protect the security of their patients and staff. To address the increasing risk of in-hospital crime, hospitals must prioritize prediction and prevention of crime just as much as how they respond to and manage incidents. Solutions to achieve this include more advanced technology and data collection, increased security visibility to deter criminals, and bolstering in-house security presence and security response.

Now is the time to examine and refresh whether your hospital is in need of updated practices. Explore our healthcare security and risk mitigation solutions.

High reliability organizations, active assailant risk management, and healthcare security are just a few of the topics that dominated the Lowers & Associates Risk Management Blog in 2017.

Here we provide a summary of our 7 most-read articles from 2017.

1. 5 Principles of High Reliability Organizations

High Reliability Organizations (HROs) are anomalies. They exist in the kind of very complex, fast-evolving environments where you would expect chaos to prevail. But it doesn’t. HROs are able to cope successfully with unexpected conditions. That’s what makes these unusual organizations so attractive to researchers. What can we learn from them?

Read the full post >

2. When Active Assailant Situations Become Known-Unknowns

Not long ago, most Americans regarded active assailant incidents as black swan events, unpredictable and largely indefensible. However, with the increasing frequency of these events, the time is at hand when venue owners, employers, and operators of gathering places need to evaluate and mitigate the risk of these incidents, or potentially face legal consequences. And the number and type of venues at risk may increase.

Read the full post >

3. Test Your Fraud Knowledge

In case you’re thinking fraud is not an issue in your organization, you should know that extrapolating from actual fraud cases examined in 2016 and reported to ACFE, organizations worldwide lose 5% of topline revenue to fraud. Virtually every type of organization from business, government to non-profit sectors is vulnerable to fraud.

Read the full post >

4. Slideshow: What Makes a High Reliability Organization?

High reliability organizations (HROs) operate within challenging conditions. Think of air traffic control, aircraft carriers, and nuclear power plants for clear examples of such conditions. Mistakes in these settings often have catastrophic consequences. Yet they seldom fail.

Read the full post >

5. 7 Ways to Test the Reliability of Your Organization

If you are a manager in an organization, especially one that faces a complex, dynamic environment, you should be interested in learning how the principles of the High Reliability Organization (HRO) can help you. Your aim should be to develop an organization that moves continuously toward greater reliability of critical outcomes, using every failure as an opportunity for improvement.

Read the full post >

6. 18 Fraud Facts to Drive Your 2018 Fraud Prevention Plan

When it comes time to review your fraud risk management and prevention plan, it pays to have some hard statistics in front of you. This slideshow features 18 facts straight from the ACFE’s bi-annual Report to the Nations on Occupational Fraud and Abuse. The report can help you understand and respond to the threat of organizational fraud in your company, and the facts presented can serve as benchmarks for your organization while helping to uncover areas you may have failed to address.

Read the full post >

7. 3 Key Components of an Effective Healthcare Security Program

We make many assumptions about our healthcare. We assume our doctors and nurses are well trained and know what they are doing. We assume that the ER is open when we need it and the facility where we receive care is clean as well as safe and secure. While legitimate expectations, they are not always the case. When it comes to healthcare security, having an effective program requires planning, training and consistent implementation. Our latest whitepaper, 3 Key Components of an Effective Healthcare Security Program, walks through the most critical aspects of healthcare security and introduces some ways to ensure your program delivers.

Read the full post >

We look forward to continuing to deliver valuable content you can use to better protect your people, brands, and profits in 2018 and beyond. Happy new year!

Does it seem like the unthinkable news about another shooter trying to murder as many innocent people as possible has become almost routine? If it feels this way to you, there’s a reason. The number of “active shooter” incidents—cases where one or more assailants kill or attempt to kill people in a populated area—counted by the FBI has increased dramatically since 2000.

In 2000, there was 1 active shooter incident recorded.  There were 20 incidents in both 2014 and 2015.  In all, there have been 200 active shooter incidents since 2000 somewhere in America.

Some people react to these incidents as if they were “black swan” events, that is, unexpected or surprising events that are impossible to predict. But as these data show, they are rare but they are not accidental nor should they be surprising any more. An active shooter may attack in virtually any location at any time people are present.

This is not a swan, it is a known risk, and risks can be mitigated.

… Continue reading

Preparing for (or even considering) an active assailant incident is a difficult task for anyone. Sadly, we must. The number of these incidents is on the rise, and it is critical to be prepared to predict, prevent, and respond effectively to an event, should one occur.

The FBI reports that over three recent periods, spanning 2000-2015, the average number of incidents has multiplied. Between 2000 and 2006, an average of 6.4 incidents occurred annually. Between 2007 and 2013, the average increased to 16.4 incidents annually. In 2014 and 2015, the number rose dramatically again to 20 per year.

… Continue reading