Policy Scope:

This policy applies to the AHN entities and individuals outlined in the policy applicability section below.

Policy Statement:

It is the policy of AHN healthcare facilities to provide a safe and secure environment for their patients, visitors and staff. In the event that an individual on the site of an AHN healthcare facility displays or uses a weapon, healthcare facility staff, Highmark Health Police and contracted security officers will implement an emergency response plan and necessary procedures to evacuate, lock down or shelter in place until law enforcement arrives.

Policy Purpose:

The purpose of this policy is to provide detailed procedures to Highmark Health Police, contracted security officers and AHN healthcare facility staff to minimize the risk of injury or death to staff, patients and visitors in the event that a person displays or uses a weapon on an AHN healthcare facility premise.

Policy Definitions:

1. Active Shooter--An Active Shooter is a person or persons who is actively discharging a firearm at staff, patients, visitors and/or vendors with the general intention of killing as many persons as possible until subdued and/or ammunition is expended. In most cases active shooters use a firearm(s) and display no pattern or method for selection of their victims. In some cases, active shooters use other weapons:  knives, box cutters, improvised cutting implements, etc and /or improvised explosive devices to cause harm to additional victims and act as an impediment to law enforcement and emergency responders. These improvised explosive devices may detonate immediately, have delayed detonation fuses, or detonate on contact.
   The active shooter may be a present or former employee or may have had a prior experience with the AHN healthcare facility either as a patient or visitor. In many instances the Active Shooter holds a serious grudge, real or imagined, which has resulted in their decision to seek redress through as much violence and harm as they can perpetrate.
2. Active Shooter Event--An Active Shooter Event is any incident in which a firearm, knives, box cutters, improvised cutting implements, etc.  have been brandished or discharged. In instances involving firearms, persons have likely been injured or killed, however there are also Active Shooter events where a firearm has been discharged for effect with no persons harmed. Either of these Active Shooter situations warrants the same response.
3. Code Silver "location"--Report of a person displaying or using a weapon inside or outside the healthcare facility. Example: "Code Silver Parking Lot". When practical, plain English is recommended. This will ensure that everyone within the sound of the announcement will clearly understand what is happening and what areas are to be avoided.
4. Facility Lock Down--Locking of all exterior doors to the facility or suite.
5. Evacuation--Evacuation of the facility/suite using the facility/suite's specific fire evacuation route.
6. Shelter in Place--In this scenario, the door is locked, lights are turned off, patients and visitors are advised to stay within the secured area and to hide from danger.  Items that make noise, cell phones, radios, etc., are silenced.

Guidelines/Procedures:

1. Mitigation
   1. AHN healthcare facility Incident Command Team (ICT), of which Highmark Health Police and Contracted Security Officers will likely have a role, or AHN healthcare facility's Senior Management, is to establish a procedure for review of existing emergency plans on a regularly scheduled basis (at least annually).
   2. AHN healthcare facility ICT, or its Senior Management in consultation with Highmark Health Police and Contracted Security Officers, are to establish a procedure for performing a hazard vulnerability analysis review and threat assessment to determine necessary resources to respond to an Active Shooter incident (at least annually).
   3. The AHN healthcare facility is to conduct annual drills/exercises to test its response to an Active Shooter emergency that includes all areas/personnel as well as local, regional, state and private sector partners.
2. Preparedness
   1. Active shooter situations are unpredictable and evolve quickly. Typically, the immediate deployment of law enforcement is required to stop the shooting and mitigate harm to victims. Because active shooter situations are often over within 5-10 minutes, before law enforcement arrives on the scene, individuals must be prepared both mentally and physically to deal with an active shooter situation.
   2. An active shooter in the AHN workplace may be a current or former employee or an acquaintance of a current or former employee. Staff may notice characteristics of potentially violent behavior in an employee. A staff member should notify his/her manager who will, in turn, notify the Human Resources Department.  The Human Resources Department is to be alerted if it is believed that an employee exhibits potentially violent behavior.
   3. To best prepare AHN healthcare facility staff for an active shooter situation, an Active Shooter emergency plan/procedure must be created and training exercises conducted. This will prepare healthcare facility staff to effectively respond and help to minimize the loss of life. The most effective way to train healthcare facility staff to respond to an active shooter situation is to conduct mock active shooter training exercises. Highmark Health Police and at large law enforcement are excellent resources in designing training exercises. These exercises should be conducted at least annually.
   4. To adequately prepare for an Active Shooter Event:
      1. Ensure that the AHN healthcare facility has at least two evacuation routes.
      2. Post evacuation routes in conspicuous locations throughout the AHN healthcare facility.
      3. Be aware of indications of workplace violence and take remedial actions accordingly.
      4. Institute access controls (keys, security pass codes).
      5. Make sure Active Shooter Event plans include relevant information and address individuals with special needs/functional needs.
      6. Crisis Kits will be maintained within the faclity.  When needed by Law Enforcement, Emergency First Responders, etc. they will be distributed by Highmark Health Police and Contracted Security Officers.
      7. Assemble crisis kits, which include:
         1. Radios
         2. Floor plans (hard copies and also saved on thumb drives)
         3. Department Head roster with contact information.  The rosters should be updated at least quarterly for accuracy.
         4. First aid kits
         5. Flashlights
         6. Master Keys/Elevator Keys
         7. Access Card programmed for all hospital locations
   5. Components of an Active Shooter Training Plan
      1. Recognizing the sound of gunshots
      2. Reacting quickly when gunshots are heard and/or when a shooting is witnessed
      3. Evacuating the area
      4. Hiding out
      5. Acting against the shooter as last resort
      6. Calling 911
      7. Reacting when law enforcement arrives
      8. Adopting the survival mindset during times of crisis
3. Initial Actions
   1. AHN healthcare facility's emergency number should be called and a Code SILVER (with the location of the incident) should be announced as well as a description of the person(s) with the weapon, and type of weapon if known.
   2. Patients, visitors, and staff should be evacuated, if safe to do so.
   3. The Operator (or Communications Center - depending on the site), upon notification, will:
      1. Overhead page "Code SILVER (and the location)" three times as well as on the mass notification system.
      2. Give all available information to the Highmark Health Police Officers and Contracted Security Officers.
      3. Call 911 and the Enterprise Security Operations Center (ESOC) and give all available information.
      4. Notify AHN healthcare facility administration; if after hours, the Hospital Operations Administrator (HOA).
   4. Highmark Health Police will respond to the threat immediately and taken any necessary action.
   5. Contracted Security Officers will remain safely out of harm’s way but close enough to be an asset to those attempting to egress and to assist and guide additional Law Enforcement as they arrive: 
      1. Assess the situation
      2. Secure the area if not already completed
      3. Report to the Communication Center and/or 911 the following information to relay to the local law enforcement agency:
         1. Number of shooters;
         2. Number of victims;
         3. Exact location of the shooter; and
         4. Type and number of weapons possibly in the possession of the shooter.
4. Managing the Event—Staff, Patients, Visitors-In the event of an Active Shooter incident, AHN healthcare facility staff, patients (those physically able to do so) and visitors should be instructed to do the following:
   1. Run -If possible, evacuate the building, adhering to the following guidelines:
      1. Have an escape route and plan in mind.
      2. Evacuate regardless of whether others agree to follow.
      3. If possible, assist any injured in the escape effort.
      4. Leave all belongings behind.
      5. Seek refuge as far from the site of the incident as possible.
      6. Call 911 when safe. Keep in mind no one else may have done so.
   2. Hide-If not possible to evacuate, hide adhering to the following guidelines:
      1. Seek a hiding place remote from the Active Shooter and out of view.
      2. Hide behind or beneath furniture, filing cabinets, doors, etc., that will provide protection if shots are fired.
      3. Do not hide, unless impossible to do otherwise, in an area that will trap or restrict options for further movement.
      4. If in a room, try to secure the door either via locking the door or blocking it with heavy furniture.
      5. Silence cell phones and/or pagers.
      6. Turn off any sources of sound (e.g. radios, televisions, computers, faxes).
      7. Remain quiet.
      8. If the Active Shooter is not nearby, dial 911 and alert authorities to the Active Shooter's location, if known, and that of the caller.
      9. If unable to speak, leave the line open, enabling the 911 Communication Center to listen.
   3. If unable to run or hide-If unable to evacuate or hide and confronted by the Active Shooter and person believes his/her life is in imminent danger, he/she should attempt to:
      1. Engage the Active Shooter in conversation, attempting to calm the situation.
      2. If not feasible, attempt to disrupt and/or incapacitate the Active Shooter by:
         1. Acting as aggressively as possible.
         2. Throwing anything available at the Active Shooter.
         3. Using improvised weapons, act quickly and with purpose.
         4. Screaming.
         5. Fully committing to all actions.
      3. If able to successfully incapacitate the Active Shooter, remove all weapons and wait until law enforcement officials arrive on the scene. Remember: should the Active Shooter have laid their weapon down, law enforcement officers will not be sure who the Active Shooter is. Hands should be raised and fingers spread.
      4. If wounded, "play dead" until sure the Active Shooter is no longer in the area or has been contained.
   4. What to do when law enforcement arrives
      1. Law enforcement officers responding to an active shooter are trained to proceed immediately to the area in which shots were last heard in order to stop the shooting as quickly as possible. The first responding officers may be in teams; they may be dressed in normal patrol uniforms, or they may be wearing external ballistic vests and Kevlar helmets or other tactical gear. The officers may be armed with rifles, shotguns and handguns.
      2. How to react when law enforcement arrives:
         1. Remain calm and follow the officers' instructions
         2. Put down any items (i.e., bags, jackets)
         3. Immediately raise hands and spread fingers
         4. Keep hands visible at all times
         5. Avoid making quick movements toward officers such as attempting to hold on to them for safety
         6. Avoid pointing, screaming and/or yelling
         7. Do not stop to ask officers for help or direction when evacuating, just proceed in the direction from which officers are entering the area
      3. When the law enforcement officers arrive the following information should be available:
         1. Number of shooters
         2. Number of individual victims and any hostages
         3. The type of problem causing the situation
         4. Type and number of weapons possibly in the possession of the shooter
         5. All necessary individuals still in the area
         6. Identity and description of participants, if possible
         7. Keys to all involved areas as well as floor plans.
         8. Locations and phone numbers in the affected area
      4. Staff will be expected to remain on campus for the duration of the Active Shooter event, as
         1. An accounting will made of all staff, patients, and visitors; and
         2. Law enforcement officials may wish to conduct post-event interviews.
   5. All Clear-An "All Clear Code SILVER" will be announced overhead when the situation has been addressed and the scene is declared safe by law enforcement officials.
5. Emergency Manager Responsibilities-Working with the healthcare facility's Highmark Health Police Supervisor or Police Officer On Duty, the Emergency Manager (assigned at each facility) has the following responsibilities pertaining to both preparing for and responding to an Active Shooter event:
   1. Institute access controls (e.g., keys, security system pass codes, etc.).
   2. Distribute critical Active Shooter event resources such as training evolutions, table top discussion and active drills to appropriate manager and department heads. Coordinate with facility's Highmark Health Police Supervisor or Police Officer On Duty to ensure physical safety and security are protected.
   3. Assemble and provide Active Shooter crisis kits to include:
      1. Radios
      2. Floor Plans (hard copies and also saved on thumb drive)
      3. Staff roster (obtained via time clocks or manager) and emergency contact numbers
      4. First aid kits
      5. Flashlights
      6. Master Keys/Elevator Keys
      7. Access card programmed for all hospital locations
   4. Place temporary floor plans at entrances where emergency/law enforcement responders will enter.
   5. Working with the Operator(s) to activate the facility's emergency notification system.
6. Highmark Health Police, Contracted Security Officers and Enterprise Security Operations Center (ESOC) Response
   1. Highmark Health Police and/or Contracted Security Officers will advise the Enterprise Security Operations Center (ESOC) to contact external law enforcement and provide as much information as possible.
   2. The ESOC will contact the Hospital Operator and ask for an overhead page "Code SILVER—location inside of building"— to be announced three times.
   3. Contracted Security Officers and Facilities Services will immediately respond to lock down all key-controlled exterior doors to the facility per AHN healthcare facility lock down procedures.  Highmark Health Police Officers will immediately respond to the location of the Active Shooter.
   4. AHN healthcare facility Operators or the equivalent can then send a page alert to all employees with pagers. The hospital operators or equivalent will be responsible for sending a mass email throughout the healthcare facility.
   5. The ESOC will utilize the camera system to attempt to track the suspect and inform Highmark Health Police, external law enforcement and Contracted Security Officers if there are cameras in the area.
   6. Contracted Security Officers on interior patrol will respond to the general vicinity to observe and report suspect information to the ESOC, Highmark Health Police Officers and external law enforcement. A safe distance will be maintained to ensure safety.
   7. The ESOC will notify the Director of Corporate Security & Employee Safety, the Manger of Hospital and Clinical Security, the Administrator-On-Call and the Hospital Operations Administrator as soon as possible
   8. Assist law enforcement with evidence preservation and investigation.
7. Law Enforcement-Highmark Health Police will be the first responder on the scene and will be responsible for bringing the situation to an end as soon as feasible with a minimum number of deaths/injuries.
   1. Understanding the above, Contracted Security Officers will coordinate with and ask that external law enforcement agencies and staff assume the following responsibilities in preparation for an Active Shooter event:
      1. Be well familiar with the AHN healthcare facility's design and layout.
      2. Provide healthcare facility administration with the agency's Active Shooter response plan as appropriate.
      3. Conduct on-site Active Shooter training in association with healthcare facility's Highmark Health Police, contracted security staff and administration.
      4. Identify other local and state law enforcement agencies that may be involved under existing mutual aid agreements.
   2. Law enforcement agencies at large will have the following responsibilities once notified of an Active Shooter situation:
      1. Confirm to healthcare facility administration/command that help is on the way.
      2. Confirm access to the healthcare facility and confirm what entrances(s) should be used.
      3. Contact healthcare facility authorities and Highmark Health Police once on-site and obtain an up-to-date briefing.
      4. Move immediately to the area in which the Active Shooter is believed to be in conjunction with Highmark Health Police.
      5. Move only injured persons out of harms' way but do not stop to provide medical assistance.
   3. Unless absolutely necessary and the circumstances dictate, multiple officers will always respond.
   4. The law enforcement response strategy of Highmark Health Police will be based on the following:
      1. Number of officers responding.
      2. Location of the Active Shooter.
      3. If possible, an attempt will be made to disarm and subdue the Active shooter.
      4. If not possible, the Active Shooter will be neutralized.
      5. Weapon(s)—type used by Active Shooter.
      6. Whether hostages have been taken.
      7. Whether the Active Shooter is attempting to kill.
   5. When external law enforcement arrives at the area of the Active Shooter event:
      1. Safe corridors will be established for persons to evacuate.
      2. The Active Shooter will be identified.
      3. Officers will be on alert for explosive incendiary devices.
      4. If possible, an attempt will be made to disarm and subdue the Active Shooter.
      5. If not possible, the Active Shooter will be neutralized.
      6. In either situation, the Active Shooter will be secured and guarded until removed from the area.
      7. The Active Shooter event area must be cordoned off and treated as a crime scene until released by external law enforcement.
      8. The Active Shooter event area will only be unsecured after the scene is released from processing.
   6. If there is any doubt about additional Active Shooters, the area will remain secured.
   7. All persons who are able to walk will be escorted from the facility to the pre-designated staging area.
8. Training-The AHN healthcare facility will educate all AHN healthcare facility personnel on this policy at least annually.

Sponsorship and Authorizations:

1. Policy Authority: James Benedict, AHN COO

Cross Referenced and Related Policies:

AHN Best Practice: Active Shooter Events

AHN Policy: Work Place Violence Prevention and Response in development

AHN Policy:  Hostage Situation

AHN Policy:  Violent Intruder

External or Regulatory References:

Department of Homeland Security—Active Shooter: How to Respond, October 2008.

Attachments:

Hospital Emergency Numbers List

Policy Applicability (Scope):