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THE BLACK BOOK: Active Shooter Training

West Florida Hospital Training Presented By: Active Shooter 360, LLC 850-240-1283 www.ActiveShooter360.com

December 2016 This guidebook accompanies specific classroom training. Students and organization accept full risk for implementation of the following information. If any information conflicts with existing regulations, procedures, or policies students should follow local protocols.

Active Shooter Training – West Florida Hospital Developed By: Active Shooter 360, LLC

www.ActiveShooter360.com Page | 1

AS360 Training Program Contents

Program Details ....................................................................................................2

Module One - How we got to Where we Are ......................................................4

Active Shooter History ................................................................................. 4

ASHE Evolution ........................................................................................... 6

ASHE Preparedness ..................................................................................... 8

Module Two - ASHE Response ........................................................................ 11

Situational Awareness ............................................................................... 11

AS360 – The 3Gs: Get Out ......................................................................... 14

AS360 – The 3Gs: Get Down ...................................................................... 15

AS360 – The 3Gs: Get Ready ..................................................................... 16

The ASHE Terrorist .................................................................................... 17

Law Enforcement Response ........................................................................ 18

Module Three - Lessons Learned and Decision Making .............................. 19

Lessons Learned for Medical Facilities .......................................................... 19

Medical Practitioners and Law Enforcement Officers Think Differently .............. 22

The HIPPA Wall and Hospital Incident Command ........................................... 23

Hospital Preparedness ............................................................................... 24

Exercises and Practical Training .................................................................. 25

What is a Black Swan? ............................................................................... 27

conclusion ......................................................................................................... 29

Active Shooter 360 – WFH Active Shooter Training ........................................ 29

AS360 Staff ........................................................................................................ 30

WFH Hospital Training Team: ..................................................................... 30

AS360™ Information ......................................................................................... 31

Active Shooter 360.................................................................................... 31

Active Shooter 360 ............................................................................................ 32

Related Reference Material: ............................................................................. 33

http://www.activeshooter360.com/



PROGRAM DETAILS

Program Name West Florida Hospital – Active Shooter Awareness Training

Program Name November 17th, 2016: 0800 – 1600 hrs.

Program

Scope

Provide West Florida Hospital administrative staff an overview of Active

Shooter Preparedness and Response for Hospitals and Medical Facilities.

Program Type Didactic – Custom designed for West Florida Hospital

AS360

Presenters

K. Worley - AS360 CEO

R. Christen – AS360 COO

D. Folley – Curriculum Developer / Technical Specialist

H. Christen – Human Performance Technology

Location West Florida Hospital

Duration Approx. Two Hours

AS360

Points of

Contact

K. Worley - AS360 CEO – [email protected]

R. Christen – AS360 COO – [email protected]

STUDENT NAME: ____________________________________

DATE _______________




www.ActiveShooter360.com

This material has been produced exclusively by

Active Shooter 360, LLC for West Florida Hospital

For additional Information on AS360 and our custom

training programs contact:

Kenneth Worley

Chief Executive Officer / Owner Active Shooter 360, LLC 850-240-1283 (Office)

[email protected] www.ActiveShooter360.com

Ryan G. Christen

Chief Operating Officer

Active Shooter 360 LLC

850-240-9652 (Mobile)

[email protected]

www.ActiveShooter360.com

This material has been produced exclusively by

Active Shooter 360, LLC for training use by West Florida Hospital as supplemental training material. This material is used solely at the client’s

risk and AS360 makes claims or warranties regarding the information. Further, WFH absolves AS360 for any all liability related to any material

contained within this book or the training provided. Where applicable all state, federal, and local laws and regulations prevail. Additionally, this

program is a guide to suggested actions only and does not supersede any existing policies or procedures of WFH, its parent company or affiliates.

All content and material Copyright: Active Shooter 360, LLC Published December 2016


mailto:[email protected]




MODULE ONE - HOW WE GOT TO WHERE WE ARE

Active Shooter History

Active Shooter events have increased significantly in frequency and complexity over the last few years. Since the Columbine event is has become obvious that not only must Law Enforcement adjust procedures, but schools, hospitals, and business must proactively prepare and train for these events!

Columbine: A wake up call to America

(Slide 3)

April 20th, 1999

Two assailants

13 Killed and 20 Injured

Multiple explosive devices deployed by

attackers

Responders also targeted

Rounds Fired by Assailants: 188

Shooters took their own lives

SWAT teams entered the school 47

minutes after the shootings started.

Five hours passed before law enforcement

declared the school under control.

Columbine: Critical lessons learned

(Slide 4)

Motivations were not the motives of

“traditional” criminals.

ALL communities are vulnerable.

“Contain and negotiate” was not

appropriate as a tactic.

A much faster response was needed.

Those under attack may need to abandon

“compliance” and “engage” assailants.

Comprehensive preparedness must be

practiced.

KEY FACTORS:

Prior to the Columbine school shootings most “mass violence” incidents were managed with standard law enforcement response tactics. Agencies would attempt to contain the location and then wait for negotiators and SWAT units to arrive on scene.

Following Columbine detailed analysis and review of the incident reveled that this approach allowed the killing and aggression to continue.

It was immediately discovered that a new response model was needed. It was shortly after this incident that the term “Active Shooter” emerged.

RELATED FACTS: Bombs Deployed by Assailants:

48: Carbon Dioxide bombs

27: Pipe bombs

11: 1.5-gallon propane bombs

7: gas or napalm bombs

2: 20-pound propane bombs

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Active shooter History: The rise in Active Shooter events is far more than media hype. These incidents have been increasingly

steadily since Columbine. Further, the more recent threat of non-firearm attacks has not yet been

integrated into statistical analysis.

Other High-Profile Active Shooter

Incidents - Since Columbine (Slide 5)

Active Shooter events are becoming

increasingly more common!

Sandy Hook

Aurora, CO

San Bernardino, CA

Charleston, S.C.

Orlando, FL

What makes an Active Shooter event

different from “common” criminal

violence?

(Slide 6)

Escape from the police is usually

not a priority.

Attacker motivation varies

tremendously.

Attackers are bent on mass

indiscriminate violence.

Active shooters often have made

detailed plans for the attack.

Intent on killing as fast as possible.

KEY FACTORS: Numerous studies and FBI reports provide clear

evidence of a rapidly increasing trend.

DISCUSSION:

• Can you list other high-profile Active

Shooter events?

• How well could your community manage a

similar event?

• What if a similar event occurred at your

hospital?

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ASHE Evolution

Faced with an evolving threat and unprecedented violence responders are taking bold and rapid action to

stop the assault. In the private sector, businesses and hospitals are teaching staff how to respond if an

ASHE incident occurs. Could you have imagined this training being essential in 1999?

How has the response changed?

(Slide7)

Early efforts must be driven at engaging

and stopping the attacker.

LE – Officers are trained to make solo

entries.

LE – Victims may be ignored in pursuit of

attacker.

FD / EMS – Responders may enter into

“warm zones” to extract injured.

FD / EMS – Equipped with ballistic

protection and trained in tactical

maneuvers.

Active Shooter is no longer the only threat:

(Slide 8)

The ASHE term is a more comprehensive

identifier

of the modern threat.

Attackers are using diverse methods to

implement harm

and conduct attacks.

KEY FACTORS:

Today, responders are following procedures

that were unimaginable when Columbine

occurred.

Police are entering into an active threat area

pursuing assailants under “solo entry”

procedures. This is common despite the fact

that statistics indicate the first arriving officer

entering alone may be shot one/third of the

time when engaging an active shooter.

We also see a time in which combat body

armor is becoming standard equipment on fire

apparatus!

NEW TERMINOLOGY EMERGES:

ACTIVE

SHOOTER

HOSTILE

EVENT

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ASHE Evolution




ASHE events have the potential to cause mass chaos and disrupt critical systems as well as injure large

groups. ASHE response protocols, planning, training, and exercises must consider the full spectrum of

threats without focusing solely on Active Shooter events.

Active Shooter Hostile Event (ASHE):

(Slide 9)

Active Shooter

Mass Stabbings

Vehicle Borne Attacks

Ambushes / Snipers

Bombings

Mass Disruption

Chemical

ASHE does NOT mean “Mass Fatality.”

Notable (non-firearm) ASHE incidents:

(Slide 10)

August 5, 2015 - Nashville

Theater Attack

3 people injured – Chaos ensued

Weapons: hatchet, pepper spray, pellet

gun.

January 9, 2016 -Vancouver

Outdoor Crowd

15 people injured – Chaos ensued

Weapon: pepper spray

November 28, 2016 - Columbus, OH.

Outdoor Crowd

11 People injured – Extended chaos

Weapon: vehicle and knife

KEY FACTORS:

An ASHE event does always result in mass fatalities. Multiple injuries can cause significant panic and complications.

Imagine if your ED received 12 hysterical patients (without warning or without prep time) from within your hospital. All 12 presenting signs of chemical exposure.

All while the attacker is still potentially at large in the building.

Are you prepared?

KEY DISCUSSION:

Can you think of other (non-firearm) attacks?

Have similar non-lethal events or close calls occurred at your hospital?

How many non-lethal ASHE events do you think have occurred across the U.S. without significant news coverage or reporting?

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ASHE Preparedness

The evolution and response changes occurring among first responders are significant. They have

recognized the threat and are evolving to combat the new hazards. Sadly, many private business,

schools, and hospitals are unaware of the need to do the same. When firefighters start carrying bullet

proof vest on fire trucks it is past time to take notice. Be proud that your hospital is taking positive

steps to adopt proactive training and preparedness posture!

An evolving threat requires an evolving

preparedness model:

(Slide 11)

ASHE annual training

ASHE annual policy analysis and review

ASHE training exercises

ASHE vulnerability assessments

How does your ASHE training and preparedness

compare to other threat training: Fire, Hurricanes,

Etc.?

Surviving an ASHE incident requires a change

in mindset:

(Slide 12)

Compressive planning does not replace

essential training.

ASHE assailants are not “common”

criminals. To be prepared you must train

and understand the need to shift our

mindset:

Stopping an ASHE incident may require

aggressive action from the victims!

KEY FACTORS:

As with firefighters and law enforcement,

agencies must adopt a new mindset. Proactive

training championed by hospital administration

is a powerful step.

However, all members must recognize that

responding to and surviving an ASHE incident

requires them to also adopt a new (perhaps

uncomfortable) mindset.

Surviving an ASHE incident requires

comprehensive training, and immediate action

based on that training!

NEW TERMINOLOGY EMERGES:

ACTIVE

SHOOTER

HOSTILE

EVENT

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ASHE Preparedness Statistically ASHE events are brought to a conclusion by one of three general outcomes. In some cases,

the Assailant stops the attack either by committing suicide, or leaving. Although the cases study from

2000-2016 show the assailant leaves in less than 5% of the incidents. In approximately, 95% of the cases

some action must stop the assailant whether it is suicide, victim action, or law enforcement arrival.

This illustrates a clear fact of what defines an ASHE incident. As opposed to traditional crime where the

suspect flees these events require some application of force. Thus, the violence continues (or remains

active) until something forces it to stop! This definitive difference is the basis for a required change in

our collective mindset!

SURVIVING AN ASHE EVENT REQUIRES A CHANGE IN MINDSET: (Slide 11)

KEY FACTORS:

In ASHE events that conclude prior to the arrival of Law Enforcement, the outcome is a result of the shooter stopping the assault, or the victims stopping the attacker. ASHE incidents studied from 2000-2010 show that victims have stopped the attacker in nearly 40% of cases where the assault ceased before LE arrival. This can only be done with a new thinking, training, and preparedness!

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ASHE Preparedness ASHE training provides significant benefits. Through an understanding of the AS360 3Gs™ you have a

foundation of knowledge guiding your actions, as opposed to blindly following “crowd mentality”

which could lead you inadvertently into danger. Further, ASHE training improves critical hospital

compliance requirements and produces a safer workplace with resilient capabilities.

What do you do if an event occurs here?

Active Shooter 360:

(Slide 13)

The 3Gs

Get out…

Get down…

Get ready!

What are specific medical facility benefits of

Comprehensive ASHE preparedness?

(Slide 14)

Compliance

Continuity of Operations

Resiliency

Faster Recovery

Managed long-term impacts

KEY ACTIONS:

We live in a time where we must be prepared

to take action.

We must be prepared (as an absolute last

resort) to fight at all costs to defend ourselves

and others.

This change in mindset is not be easy. It will is

scary. It will be effective with training and

preparedness.

KEY FACTORS OF ASHE TRAINING:

Comprehensive ASHE training not only

provides confidence and safety, but

organizational benefits are substantial as well.

Compliance with HIPPA, JCAHCO, and

OSHA along with protection of core

capabilities provides substantial value for

hospitals conducting ASHE Training.

Congratulations on choosing to be ready!

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MODULE TWO - ASHE RESPONSE

Situational Awareness Wikipedia states that Situational Awareness is, “is the perception of environmental elements and events

with respect to time or space, the comprehension of their meaning.” ASHE Incidents, it is important to

ask what “Situational Awareness” is in respect to ASHE vulnerability.

WHAT IS SITUATIONAL AWARENESS?

(Slide 18)

MORE INFORMATION: SITUATIONAL AWARENSS PRACTICE:

SITUATIONAL AWARENSS AT HOME PRACTICE: YouTube is a great resource for informative videos. To practice situational awareness or further sharpen your skills go online to YouTube and search “Situational Awareness Training.”

In addition, Active Shooter 360 provides advanced an SA course with classroom activities and interactive exercises designed to specifically hone your skills for ASHE events. Contact us to learn more: www.ActiveShooter360.com

STUDENT NOTES: __________________________________________________________________________________

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Situational Awareness Honing situational awareness skills can be done easily. This ability van realistically save your life in an ASHE event. It is as simple as paying attention to the things around you. As you practice more SA will become second nature!

Know your environment

(Slide 19)

Structure

Blueprints

Walkthroughs

Entrances / Exits

Fire Alarms

Phone Systems

What is normal and what

is not normal

SA: Get to know your people

(Slide 20)

Identify employee problems

Learn

Habits

Home life

History

Goals

Accurate and consistent

documentation

KEY FACTORS:

Situational awareness practiced daily will become part of your routine. Practicing SA will not interfere with your normal activities. It does not mean you must scrutinize everything under a microscope. It does not mean you are paranoid.

SA MEANS YOU ARE PREPARED TO REACT AND RESPOND SAFELY TO A VARIETY OF SCENARIOS!

REAL-WORLD EXAMPLES:

Countless lives have been saved and attacks

avoided through individuals using strong SA:

May, 2010

Times Square Attempted Bombing

Lives saved from street vendors

observing smoking car.

December, 2001

Richard Reid was attempting to light a

shoe-bomb on a commercial flight.

Passengers saw this and stopped him.

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Situational Awareness Active Shooter events often occur without warning. But on occasion there may be some early indicators: suspicious behavior, unusual persons, people in unauthorized areas. The smallest, early observation can save your life. If it doesn’t “feel” right… it might not be. Be alert!

Situational Awareness = Readiness:

(Slide 21)

Practice a heightened

state of alert

Situational Awareness = Readiness:

(Slide 22)

SA arms you with another tool to more

effectively implement the AS360 3Gs!

Get out…

Get down…

Get ready!

KEY FACTORS:

Situational awareness practiced daily will become part of your routine. Practicing SA only takes seconds. Examples include:

Where are the nearest exits to your seat in a movie theater?

When you go out to eat, can you see the front door from where you are sitting?

Do pay attention to what cars are normally in your business parking lot during early or late hours?

SA EXERCISES:

Ask yourself questions to see if you are aware

or operating in your own bubble:

Do you notice when your spouse

changes their hair? (YOU BETTER!)

Situation Awareness Red Alert:

Do your mental alarms go off when

your spouse says, “Notice anything

different?” Do you go into “panic

mode?” = BAD SA!

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AS360 – The 3Gs: Get Out The 3Gs are a road-map to increase your chances of surviving an ASHE incident. But these steps require practice, practical training, and exercises to become second nature. You are considerably more prepared if you, and those around you train and practice various “what-if” scenarios!

3Gs: GET OUT…

(Slide 23)

Do not hesitate

Easiest route

Avoid dangers

Take others with you

Leave items that may slow

you down

3Gs: GET DOWN…

(Slide 24)

Isolation from the threat

Recruit others if possible:

Strength in numbers

Close and lock doors

Barricade

Turn off lights

Mute phones

ASHE RESPONSE: The 3Gs can save your life…

Carefully consider the concept of the 3Gs. It is best to RUN, RUN, RUN! But do not do so without evaluating your situational awareness. Where do the shots sound like they are coming from? Now that you are aware of primary and secondary emergency exits, which is the safest route? With your new SA skills, can you make it out?

3Gs PRACTICE EXERCISES:

With basic SA familiarity, you can run simple “drills” at your hospital. Individual offices can gather staff and take five minutes to practice and discuss how you would apply the 3Gs for different scenarios.

The most effective way is to conduct formal classroom training with practical evolutions, and computer simulations of various events.

AS360 can facilitate comprehensive readiness training for your facility and also host and develop full scale exercise.

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AS360 – The 3Gs: Get Down Look around your room right now. What resources are at your disposal to protect yourself? Remember,

these can include makeshift weapons, and human resources for forming a team!

AS360 – The 3Gs: Get out… Get Down…

GET READY!!!

(Slide 25 – 26 - 27)

Get Ready: First steps…

Isolation from the threat

Recruit others if possible – Strength

in numbers

Close and lock doors

Barricade

Turn off lights

Mute phones

Utilize the tools available to you

Surprise

Darkness

Silence

Maneuvers

Continue your attack until the threat is

neutralized

“Fight or Flight”

Image courtesy of: Department of Homeland Security

THE CRITICAL IMPORTANCE OF “GET READY!”

It is vital that you are prepared and willing to fight. Remember, “Get Ready” is a last resort for dire emergencies. The Marines have a saying, “If you’re going to die, Die Moving!” If you cannot get out, and have found concealment…and are discovered… you could die under a desk, or potentially save lives by stopping the attack. YOU MUST PREPARE YOURSELF FOR MAKING THIS DECISION!

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AS360 – The 3Gs: Get Ready Once you have determined intervening or defensive action may prove necessary and you have

improvised a spontaneous offensive strategy there are tools that can reinforce your ability to effectively

carry out your plan.

AS360 – The 3Gs: Get out… Get Down…

GET READY - OODA LOOP

(Slide 28)

Get Ready:

THE OODA LOOP

Observe

Orient

Decide

Act

THE CRITICAL IMPORTANCE OF

“GET READY!”

It cannot be stressed enough. THIS IS A LAST RESORT.

Deciding to fight could save your life and countless others!

THE OODA LOOP BY JOHN BOYD: Courtesy of Wikipedia

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The ASHE Terrorist As discussed in module one, the ASHE assailant does not produce violence as a result of common “criminal activity.” The motivations are vast and often difficult to understand. Through that recognition hesitancy to take offensive action can be reduced if not eliminated. Not motivated by money or material goods ASHE perpetrators seek only to cause violence.

The Modus Operandi of a terrorist

(Slide 30)

Extremists

Shock

Violent

Personal or political

Goal is to cause

maximum havoc

ASHE Attacks: The Assailant

(Slide 31)

Attacks typically ended upon

confrontation with law enforcement.

Most end in suicide or suicide by cop.

Most active shooter situations end with

10-15 minutes

KEY FACTORS:

Recognizing suspicious terrorist activity can

save lives. Often these individuals conduct

extensive planning accompanied by visits to

their target location. They may test doors,

security procedures, or take photos of unusual

areas. Ultimately, if you observe behavior that

appears questionable you should report it.

Review your local procedures or contact you

Emergency Management Office for more info.

You could be the one to stop a terrorist before

they can carry out their plan of mass violence!

RELATED MATERIAL:

According to the DHS:

IF YOU SEE SOMETHING, SAY

SOMETHING:

Contact local law enforcement and be prepared

to report: Who or what you saw; When you

saw it; Where it occurred; and Why it's

suspicious!

STUDENT NOTES: __________________________________________________________________________________

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Law Enforcement Response Many people have a misunderstanding of what to expect when law enforcement arrives. Some believe they will charge in and begin carrying injured to safety. Others expect to run to the officers for them to protect them. It is critical to remember that the first arriving officers may be entering the most stressful situation of their career. They may know that one/third of them entering alone are likely to be shot. What they do not know is who is a victim and who is an attacker. It is vital to understand their initial behavior so you do not jeopardize their safety or your own!

Law Enforcement Objectives:

(Slide 32)

Arrive

Rapidly gather intel if possible

What

Where

Who

Access points

Keys

Etc.

Immediately locate and neutralize the

threat(s)

Secure the location

Render aid

Considerations

(Slide 33)

Responders have 10-15 minutes to

end the carnage.

May be the 1st person on scene that

seeks out and engages the threat.

Will pass the dead or injured

KEY FACTORS:

The first officer to arrive will likely charge directly to the sound of gun fire or violence. Victims may be bypassed. Survivors may be aggressively told to “get on the ground.”

Until the killing is stopped, the healing cannot begin!

LEARNING ACTIVIES:

To better understand this, as you encounter

video or still images from an ASHE event look

for the scenes of people rushing out hysterically.

Image if you were there and the individuals

were rushing to you. You have seconds before

they are upon you. Maybe less time if they are

assailants.

In those few seconds of rapid hysteria can you

confidently identify victim from threat?

Could you do it alone, in a dark hallway with no

backup?

STUDENT NOTES: __________________________________________________________________________________

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MODULE THREE - LESSONS LEARNED AND DECISION MAKING

Lessons Learned for Medical Facilities

CASE STUDY: THE BOSTON MARATHON ATTACK

The Boston Marathon is an ideal case study for ASHE incidents. It was considered a terrorist attack that

lends valuable information for Hospitals and Health Care Facilities that may encounter an on-site attack,

or deal with the aftermath of an off-site event.

14:50 – An explosion occurs close to the finish - 673 Boylston St

(Slide 37)

KEY FACTORS:

A review of this event presents valuable and specific lessons learned for hospitals.

STUDENT NOTES: __________________________________________________________________________________

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Lessons Learned for Medical Facilities

CASE STUDY: THE BOSTON MARATHON ATTACK

Boston’s five Level-One Trauma Centers were overwhelmed by mass casualties including burns,

fragmentation injuries, and multiple traumatic amputations.

(Slide 38)

(Slide 39)

14:55 - Reported Explosion at the John F.

Kennedy Library, 5 miles away in Dorchester

Mass casualties on Boston’s sidewalks.

14:50 – An explosion occurs close to the finish - 673 Boylston St

(Slide 38 and 39)

KEY FACTORS:

An ASHE event similar to the Boston Marathon Attack could happen in Pensacola at a mass crowd event such a Blue Angel’s Airshow.

STUDENT NOTES: __________________________________________________________________________________

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Lessons Learned for Medical Facilities CASE STUDY: THE BOSTON MARATHON ATTACK The attacker placed a pressure cooker explosive device among the crowd and casually walked away

from the scene. The attacker could have arrived at a new location. Does your hospital have preparedness

procedures?

(Slide 40)

(Slide 41)

The last minutes of Mark’s life

The assailant disappears into the crowd

KEY FACTORS:

Hospitals learned valuable lessons from this event and other ASHE.

STUDENT NOTES: __________________________________________________________________________________

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Medical Practitioners and Law Enforcement Officers Think Differently Hospital collaboration with Law Enforcement Officers is critical, yet complex. Each entity has a different mission and different language that results in misunderstandings.

Law Enforcement vs. Medical:

(Slide 42)

Medical practitioners see trauma, contamination,

and disorientation.

Law enforcement officers see a potential

perpetrator, witness, and evidence.

Patient Identification Nightmare

(Slide 44)

Ms. Liu, casualty of the blast, was initially

identified as a survivor.

It was later determined she was one of the

fatalities. The misidentification was a result of

her driver’s license found on another victim.

The misidentification was only discovered after

Ms. Liu’s parents identified the surgery patient

as Ms. Liu’s friend.

It was at this time they became aware their

daughter was deceased.

WHAT DO YOU SEE?

Hospital staff and Law Enforcement offers see this person through different

perspectives. What do you see, victim or threat?

SIGNIFICANT PATIENT

IDENTIFICATION PRODLEMS AROSE?

Patients were misidentified. Does your hospital have a procedure to remedy that in

an ASHE incident?

STUDENT NOTES: __________________________________________________________________________________

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The HIPPA Wall and Hospital Incident Command Victims were dispersed among multiple hospitals. Social services agencies had difficulty linking family members together because hospital legal staffs disagreed about the release of PHI.

HIPPA – Lessons Learned:

(Slide 46)

There were major discrepancies regarding

HIPAA interpretation. Lessons learned are

still debated. It is important that you consult

your legal staff to interpret HIPPA

regulations in an ASHE event.

Some family members were transported to

separate facilities. HIPPA concerns prevented

staff from communicating patient conditions

between facilities for family members or

releasing information for social services.

H.I.C.S – Lessons Learned

(Slide 47)

HICS

Incident Command

Operations

Logistics

Finance/Admin

Plans

THE HIPPA WALL?

HOSPITAL INCIDNET COMMAND

SYSTEM (HICS)

HICS is a nationally recognized system for managing hospital crisis events.

STUDENT NOTES: __________________________________________________________________________________

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Hospital Preparedness The changes emerging since the Columbine have not only brought about changes in response procedures, but command decisions as well. First responders consistently analyze and test their critical decision making skills in high-stress environments. When was the last time you trained on critical, immediate decision making processes? As with any skillset, it should be practiced, evaluated, and tested regularly!

Tourniquets are Back:

(Slide 48)

Backboard straps and belts were used to control

massive bleeding.

Unsung Heroes – Hospital Social Services

(Slide 49)

Social services were a major factor in supporting

family members of attack victims. Other, they

helped unit parents and children that were

separated at different Boston medical Facilities

Hospital social services and Boston citizens

provided housing and shelter for many of the

victims’ families.

KEY FACTORS:

Hospitals should strategically position ASHE response kits at key locations through the facility. These should include a collection of tourniquets and basic trauma dressings. While hospitals have tremendous medical capabilities, they are useless if you cannot access the ED or supply storage. Small ASHE medical caches should be strategically located like fire extinguishers or AEDs.

KEY FACTORS:

When developing an ASHE response procedure, it is important to address these post-incident concerns illustrated in slide 49.

ASHE training events and exercises should include Social Services, and specific injects to test the effectiveness of managing unexpected situations.

STUDENT NOTES: __________________________________________________________________________________

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Exercises and Practical Training

ASHE events are rare, which means hospitals cannot rely on previous experience. Realistic exercises,

simulations, and training is essential to create ASHE experience. A real-world event is too late to test

your best practices.

In story after story, hospitals tout the benefits of realistic exercises.

This includes: Seminars, Workshops, Drills, Functional exercises, Tabletops, Full Scale exercises.

(Slide 50)

ADDITIONA INFORMATION:

AS360 can provide comprehensive assessments, trainings, and preparedness exercises in accordance with Homeland Security Exercise Evaluation Program standards to develop experiential learning.

STUDENT NOTES: __________________________________________________________________________________

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Exercises and Practical Training Effective ASHE preparedness and training should involve a comprehensive cycle including a variety of events and exercises.

Decision Making Table-Top: (Slide 51)

Tabletop exercises are an effective means for discussing decision making problems supported through custom designed AS360 simulation technology.

Hospitals admit witnesses

and collect evidence (Slide 52)

KEY FACTORS:

Hospitals must expect and plan for law enforcement agencies to descend upon the facility to question patients and collect evidence from clothing and patient’s bodies.

How would your hospital manage this? Have you trained for such an event?

ADDITIONAL INFORMATION

Hospitals and medical facilities should develop a training an improvement cycle. One of the best methods for this is to follow the Homeland Security Exercise Evaluation Program (HSEEP). This framework provides a detailed model for scheduling various events to develop an ongoing, living improvement system.

AS360 can provide HSEEP certified instructors, planners, and exercise development teams.

STUDENT NOTES: __________________________________________________________________________________

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What is a Black Swan?

Most of us have never seen a black swan, so we incorrectly believe that must it not exist and we are

surprised when we encounter one. This is why an ASHE incident is called a Black Swan event.

Decision Making Table-Top: (Slide 51)

The changes emerging since the Columbine have not only brought about changes in

response procedures, but command decisions as well. First responders consistently analyze and test their critical decision making skills in high-stress environments. When was the last

time you trained on critical, immediate decision making processes? As with any

skillset, it should be practiced, evaluated, and tested regularly!

Are you and your hospital staff ready to make instant decision when the “Black Swan,” ASHE

incident occurs?

KEY FACTORS:

Traditional decision making fails because a black swan event is big things, bad outcomes, with little information and no time.

This is a perfect description of an ASHE event were decisions have to be made in minutes not hours or days.

ADDITIONAL:

Critical Incident and Crisis Leadership decision

making takes practice and training.

However, implementing the concepts of the

OODA Loop in conjunction with a “Sense,

Decide, Respond™” offers a basic foundation

from which your educated guesses become

informed and rationalized decision.

Advanced ASHE programs offered by AS360 can

provide in depth sessions to test participants in

high-stress simulated events and then provide the

necessary tools to make better, faster, and more

informed decisions under extreme pressure!

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Black Swan Crisis Leadership Traditional management, on a normal day, means resistance. However, in an ASHE incident resistance

collapses and resilience is required to protect core capabilities. The Sense, Decide, and Respond process

is a decision-making model for fast tempo high-consequence events where there is little information and

no time.

Dynamic Resilience Model

See one, Do one, Be one!

KEY FACTORS:

Dynamic resilience means using a sense, decide, and respond template. To replace traditional decision making.

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CONCLUSION

Active Shooter 360 – WFH Active Shooter Training

Awareness Program Overview:

This awareness program introduces students to the Active Shooter Hostile Event (ASHE) threat and teaches basic response and preparedness principals. By the conclusion of the program students have learned how to implement the AS360 3G’s™ in response to an ASHE. This program provides the foundational skills for more advanced programs focusing on comprehensive ASHE planning and preparedness. Learning Objectives and Core Competency Review:

Understand the modern ASHE threat

Understand basic components of ASHE response including the AS360 3G’s™

Understand the fundamental response shift required to manage ASHE impacts

Identify critical lessons learned from high-profile ASHE incidents

All programs developed in accordance with:

Hospital Incident Management System (HICS) practices

Homeland Security Exercise Evaluation Program (HSEEP) standards

Various Industry Compliance requirements

Recommended Advanced Programs:

ASHE response awareness is essential for any hospital or health care facility. However, to ensure

compliance with industry regulations and standards, as well as comprehensive preparedness Active

Shooter 360 recommends the following programs:

Vulnerability and HIPPA Hazard Assessment

Comprehensive Response Policy Analysis

Annual staff training for ASHE response

Annual training for policy review

Annual Full Scale Exercise

Development of an HSEEP Improvement Plan

Implementation of an HSEEP Training Cycle

AS360 is more than a team of businessmen and women. Our staff have served and responded to actual

terrorist’s events, military combat, SWAT deployments, shootings, hostile events, hazardous materials

incidents and more. AS360™ provides all three critical elements of the learning triad: Training,

Education and Experience.




AS360 STAFF

WFH Hospital Training Team:

Please feel free to contact any AS360 staff member with training questions:

Kenneth Worley Chief Executive Officer / Owner Active Shooter 360, LLC 850-240-1283 (Office) [email protected] www.ActiveShooter360.com

Ryan G. Christen Chief Operating Officer Active Shooter 360 LLC 850-240-1283 (Office) 850-240-9652 (Mobile) [email protected] www.ActiveShooter360.com

DJ Folley Curriculum Developer / Technical Advisor Active Shooter 360, LLC 850-240-1283 (Office) [email protected] www.ActiveShooter360.com

Dr. Hank Christen Human Performance Technology Active Shooter 360 LLC 850-240-1283 (Office) 850-218-3742 (Mobile) [email protected] www.ActiveShooter360.com


mailto:[email protected]





AS360™ INFORMATION

Active Shooter 360

In 2015 AS360 founder Kenneth Worley recognized that there were few opportunities for organizations

to receive high quality Active Shooter and Workplace Violence training. After compiling a highly-

experienced group of SMEs he founded AS360 in 2016. Today we exist to deliver cutting edge solutions

to train and prepare your organization for the worst.

Active Shooter 360, LLC offers cutting edge training and program development opportunities

customized to fit your organizations needs and budget. While we focus on specific core competencies

and company objectives we also continuously develop new and modern approaches to ensure your staff

receives the best possible training and preparedness. From security assessments, to computer based

incident re-creations, to advanced custom simulators we have the experience and technology to meet

your company's Active Shooter and Workplace Violence training and preparedness needs.

AS360 has a complex mission driven by a single objective: Simplify the Planning, Preparedness and

Training operations of your organization to reduce the lives lost due to Active Shooter events and

Workplace Violence. We are here to help you survive and recover from the worst-case scenario.

Provide Active Shooter Training

Provide Workplace Violence Training

Help your Organization Plan and Prepare

Train Your Staff

Help You Develop New Procedures

Improve Safety and Survival

AS360 is company backed by years of practical real-world experience. Our staff come from a diverse

range of agencies. Our experience includes Military Tactical Experience, Law Enforcement, SWAT,

Emergency Response, National Disaster Response, Investigations, and Terrorism Preparedness. Our

staff have operated for years as firefighters, police, and soldiers gaining actual experience through real-

world engagements, disasters, and emergencies. Through our decades of combined experience, we have

developed a team of individuals with a unique skill set to help you and your staff prepare for and

respond to worst case events.

Preparedness Assessments

Security Vulnerabilities Assessments

Response Plan Development

Operating Procedure Reviews

On-Site Staff Training

Custom Program Development

Incident Response Analysis

After Action Review

Training Exercise Development

Simulator Based Exercise Training

On-Line Learning Programs

Readiness Products and Equipment


http://www.activeshooter360.com/about.php


















ACTIVE SHOOTER 360

AS360 would like to thank the staff of West Florida Hospital for providing us this opportunity to train with your staff. We would also like to recognize and applaud WFH for recognizing the dire need for ASHE training. Evolution begins one step at a time a time and clearly from this advancement in preparedness WFH is committed to leap into progressive training. Adopting a new mindset and (as required by the ASHE threat) WFH is showing that patient and staff safety are paramount. The entire staff of AS360 look forward to continuing to develop cutting-edge solutions to assist WFH with furthering their commitment to preparedness and safety. If you have further questions regarding this material, or other programs offered by Active Shooter 360 please feel free to contact our staff present on the final page of the guidebook! Thank you for your time. Stay safe. Stay Prepared. Sincerely, Kenneth Worley Chief Executive Officer / Owner Active Shooter 360, LLC 850-240-1283 [email protected] www.ActiveShooter360.com




RELATED REFERENCE MATERIAL:

“Fifty Terror Plots Foiled Since 9/11: The Homegrown Threat and the

Long War on Terrorism” http://www.heritage.org/research/reports/2012/04/fifty-terror-plots-foiled-since-9-11-the-homegrown-

threat-and-the-long-war-on-terrorism

“IF You See Something, Say Something” https://www.dhs.gov/see-something-say-something

“The Police Response to Active Shooter Incidents” http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20act

ive%20shooter%20incidents%202014.pdf

FBI – Active Shooter Resources https://www.fbi.gov/about/partnerships/office-of-partner-engagement/active-shooter-resources

Active Shooter Events from 2000 to 2013 – FBI

https://www.fbi.gov/news/stories/fbi-releases-study-on-active-shooter-incidents/fbi-releases-study-on-

active-shooter-incidents

Summary of the HIPAA Security Rule

http://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/

THE HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM http://www.aha.org/advocacy-issues/tools-resources/advisory/96-06/011107-disaster-adv.shtml

Workplace Violence Prevention

https://www.jointcommission.org/wpv_healthcare_aspr/


http://www.heritage.org/research/reports/2012/04/fifty-terror-plots-foiled-since-9-11-the-homegrown-threat-and-the-long-war-on-terrorism

http://www.heritage.org/research/reports/2012/04/fifty-terror-plots-foiled-since-9-11-the-homegrown-threat-and-the-long-war-on-terrorism

https://www.dhs.gov/see-something-say-something

https://www.fbi.gov/news/stories/fbi-releases-study-on-active-shooter-incidents/fbi-releases-study-on-active-shooter-incidents

https://www.fbi.gov/news/stories/fbi-releases-study-on-active-shooter-incidents/fbi-releases-study-on-active-shooter-incidents



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