Is the Marion County Community Prepared for an Active Shooter?

MAP – IT Project :

Run. Hide. Fight. - Utilizing the Stakeholders to Achieve Community Goals.

Jasmin Smith, RN

College of Central Florida

 

 

 

 

 

 

 

 

 

 

 Is the Marion County Community Prepared for an Active Shooter?

Abstract:

                        Being healthy is considered a basic human right of all individuals (Dreher & Skemp, 2011) . When one thinks of health, they usually focus on lifestyle choices, weight, and existing conditions, such as diabetes, and not so much about if they are prepared to respond to a disaster; although, this can effect their lives just as much as any of the other health areas. In the past couple years active shooter incidents have risen to all time highs, with no decline in sight (Date, Thomas, & Levine, 2016). In order to respond to this new “epidemic” communities must be trained to react when active shootings occur, so fatalities can be decreased and awareness increased. The first proposed area to start is with the community of healthcare workers.

Mobilize:

                        The Florida Department of Health in Marion County is currently, to my research and knowledge, the only entity in the community providing active bystander and active shooter preparation classes. This semester I attended four of these events, the first two being educational sessions on the above scenarios and the last two role-playing scenarios.

The health department’s motive for providing these educational sessions and drills is that there is a preparation need the community is not acknowledging. The health department’s goal is “to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts” (Florida Department of Health, n.d.). Behavioral- health related problems are usually underreported and under recognized making recognition and action important for improved community health (Dreher & Skemp, 2011). Community health is a shared responsibility among its families, residents and organizations (Dreher & Skemp, 2011). A community is made up of individuals living and interacting in relative proximity to one another (Dreher & Skemp, 2011). Furthermore, a community is comprised of stakeholders, or target populations, which are utilized to accomplish goals. In this particular MAP-IT project the stakeholders are healthcare workers.

Assess:

                        Marion county is home to over 343,000 individuals, whereas Florida as a whole is comprised of close to 20 million residents (United States Census Bureau, 2015). Ocala is a predominantly White community with 82.6% of its population claiming this ethnicity in 2015 (United States Census Bureau). This is a relatively higher reporting than the state of Florida as a whole claiming 77%. The other predominant race is African Americans at 13.3%, which is lower than the state’s reported 16.8% (United States Census Bureau, 2015). The U.S. Census also shared that over 21% of Marion county residents reported being uninsured, compared to a little over 16% in Florida as a whole, and only 17% held a bachelor’s degree or higher compared to Florida’s 26%; additionally, close to 18% of the population of Marion county is in poverty, which is higher than Florida’s overall poverty rate of 15.7% (United States Census Bureau, 2015). Although there have been various motives when it comes to active shootings, stressors such as being uninsured, unemployed, living in poverty, and feeling like a minority could push one to a mental break. “Before committing an attack, most perpetrators have felt bullied, threatened or persecuted by others” (Live Safe, n.d.).

                        Although Marion County is the home of many healthcare resources, including three hospitals and many outpatient clinics, hardly any information is available regarding active shooter preparedness. The Marion County health department holds both Active Bystander and Active Shooter education seminars, which are to my knowledge open to the public. Problems with this resource is that classes are typically offered during the weekdays and not on the weekend, there are limited educators for the material, limited advertisement, and a small turnout- leaving the community unprepared. If it would have not been for my BSN Community course, I doubt I would have ever been involved in Active Shooter training because to be honest I did not know it existed. Being part of the stakeholder community for this proposed project, I believe it is important to spread awareness about how to respond in a active shooter situation. Although an exact statistic in regards to how many healthcare workers reside in Marion county are vague, Marion county currently employs over 2,000 nurses, and between the three hospitals over 4,500 staff (HiersStaff, 2015). Hopefully our community never faces an active shooter situation, but in order to combat the problem areas of limited education availability, small stakeholder reach, and low community preparedness, a change must take place in Marion County. Without change these problem areas could result in community unpreparedness during an active shooting.

Plan:

                        The Department of Homeland Security, DHS, is dedicated to preparing for and preventing domestic emergencies (Department of Homeland Security, 2016). In response to the increase in active shootings, DHS has coined the phrase “Run. Hide. Fight.,” in order to prompt civilians on how to respond in an active shooter situation (Department of Homeland Security, 2016). In the Ohio State University stabbing attack a few weeks back this mantra was quickly spread among students via the college’s alert system, as the attack was initially thought to be an active shooting situation, an ultimately decreased the number of victims (Binkley, 2016).

                        In order to tackle the healthcare communities’ preparedness for an active shooting it is necessary to establish and EAP, better known as an emergency action plan. “An emergency action plan must be in writing, kept in the workplace, and available to employees for review. However, an employer with 10 or fewer employees may communicate the plan orally to employees” (United States Department of Labor, n.d.) . During my community course one of the volunteer exercises involved participating with MRMC and ORMC during a mock active shooting scenario. Although it was commendable for these hospitals to work together to conduct such a drill it was quite evident that they did not have a solid EAP in place as confusion and burnout ensued. During the drill administrators and unit managers were utilized to play the role of doctors and nurses responding to the disaster. In an actual scenario, administration may be involved but more than likely not hands on triaging the wounded. My suggestion is to hold another mock shooting scenario using actual floor nurses and doctors to triage the patients. Utilizing the proper responders will provide a more accurate idea in how an actual disaster would be handled, and identify the real barriers needing addressed. In order to not cause staffing issues on the units, participants would need to be staff not scheduled to work the floor that day. In order to participate staff may be offered incentives, whether monetary compensation, or matched drill time in paid time off. Even though an active shooting may not be anticipated in our area, it would be beneficial for the hospitals to carry out these drills routinely so that staff are kept up to date on the EAP. In addition to the drills, an EAP needs to address areas such as :

• Chain of command – who is to be notified and the proper proceedings , as long with a preferred method of contact based on different emergency scenarios
• An alert system to notify employees, whether this be via managers, and overhead code, or a phone call alert system
• A plan of, if necessary, to exit the building and alternate routes to take
• A plan of contact with other local hospitals, emergency response units and law enforcement.
• A plan to respond to family members calling into the hospital to check on victims.
• Emphasize : Run. Hide. Fight. In active shooter situations.

 

Since there is limited teaching availability in Marion County, in order to reach a larger stakeholder population one must utilize a method that reaches the masses. One proposed method is to reach out to the Chief Education Officers at the respected hospitals and pitch the idea to implement a hospital specific mandatory continuing education module. Continuing education modules are a good way to get new information across to staff. Many hospitals already have hospital specific contact hours that employees are required to complete in order to remain employed. By making the module mandatory, staff are more likely to pay attention to what information is being presented. Not only does this method get the message across but employers could also offer continuing education hours for completing the assignment.

Addressing the limited education availability is a little trickier, which is why a continuing education module is an easy proposed solution. However, after the stakeholder population has been educated on the importance of being prepared in an active shooting scenario, the general community is still needing to be informed of the risk. The health department is a great teaching resource for the community; however, funding and available teachers are needed. One proposed idea is for licensed registered nurses who have completed active shooter training, to partner with the health department and offer classes to the community during times hard to meet by the health department, such as evenings and weekends. If held at local community establishments, such as libraries and fire departments, the RN’s may utilize projectors and seating which otherwise they may have to worry about funding.

Implementation:

            In order to establish an EAP I will need to get in contact with my House Supervisor. Although the facility more than likely already has a plan of action in mind, based on my recent education I could pitch ideas on how to make this plan more effective and how to raise awareness among employees. In order to avoid mass chaos, and potentially more fatalities, if an active shooting occurs in our facility there needs to be a code word that is announced on the intercom so staff are made aware and can secure themselves and their unit. Also, I plan to propose bi-annual mock drills to keep the hospital and staff up to date and prepared for an actual active shooting. These drills need to be conducted using actual doctors and nurses in order to identify wrinkles in the response plan. Time is of the essence, but it is also the holiday season so many of the higher ups are on vacation, so my proposed time to addressing my concerns with the supervisor is by January 15, 2017.

            In order to get an education module approval I will first contact the Marion County health department to see if we could use their PowerPoint slides to model ours after. Next I would present the completed education module powerpoint to Employee Education by January 30, 2017 and let it be reviewed for approval. Once approved, I would work with Employee Education to generate flyers to hang in each of the units informing them of the new mandatory CEU. Three months would be granted to complete this module with goals of 95% or higher compliance rate. The CEU would be mandatory for doctors, nurses, respiratory therapists, and nurse aids, but would also be available to other hospital employees such as dietary and maintenance. Licensed medical personal completing the assignment would receive 1.5 contact hours and a voucher for a free drink from the cafeteria, while unlicensed employees would receive a free meal voucher for the cafeteria if they elected to enroll and complete. Employee Education may increase their levels of completion by offering a pizza party to the unit with the highest compliance rate.

            In order to give back to the community I will be contacting six of my fellow classmates who participated in the active shooter scenarios over this semester to see if they are willing to volunteer their time to help educate our community. If they are willing to assist, I will proceed to contact Kimberly Pike to see if the health department can assist us with leads on locations that will let us use their facilities free of charge in order to teach the course to the public. There would be 2-3 available classes each month for a course of six months. The goal would be to reach and teach 250 non-healthcare community members during this time.

Tracking:

            In order to track the effectiveness of these implementations different methods would be utilized. For the EAP a survey would be sent out prior to the existing plan's modification to see how many employees are aware of the hospitals’ and their specific unit’s emergency response activation process. After the adjustments and the first bi-annual drill a second survey would be sent out to see if any change in level of awareness occurred. A rise of 10% or more awareness from the initial survey response would be considered effective. Also, unit managers would review the EAP at their monthly staff meetings and staff would be required to answer 5 associated EAP questions such as chain of command notification, code word, evacuation plan, and the three words (Run. Hide. Fight.) associated with responding to an active shooting, in order to be signed off as competent in the plan. EAP competency would be evaluated annually by unit educators.

            Once the continuing education module came out managers would be notified on a monthly basis whom on their unit still needed to complete the module. Lists of those still needing to complete the module would be placed in the break room so employees could be reminded. Upon completion of the module a certificate of completion would be printed off and turned into the manager who would in turn provide them with the appropriate voucher. The manager and Employee education would use these certifications to track unit compliance. A ranking board will be placed at the employee entrance so upon arriving to work each day employees can see how many on their unit have completed the module, the first unit to reach 100% enrollment and passing completion will receive the pizza party. As stated a 95% compliance rate will be the goal.

            The goal of the RN’s in the community is to reach at least 250 additional community members through the active shooter classes. Attendance sheets will be kept by the instructors and numbers tallied on a monthly basis and at the end of the six months. Attendance statistics will be provided to the health department. If during the first couple of months community turn out is low, the RN’s will collaborate with the health department to brainstorm advertisement methods.

Conclusion

            Community health is focused on its individuals as a whole and disaster prevention/response is a emerging health concern area. Many members in the community have not been trained to respond to an active shooting scenario, thus making Marion county a prime place to strike. In order to combat this dilemma, healthcare personal must be educated on the appropriate emergency response for an active shooting in order to reduce fatalities and activate a quick response. Once the stakeholders are educated they can use this knowledge to spread awareness throughout Marion County. The health of the community is a shared responsibility (Dreher & Skemp, 2011). Through active planning, implementations, mobilization, assessment and tracking, community awareness regarding the proper response to active shootings can be achieved even if it as basic as remembering to run, hide, fight.

 

 

 

 

 

 

 

 References:

Binkley, C. (2016, November 28). Run, hide, fight: Ohio state attack advice is a new mantra - ABC news. Retrieved from http://abcnews.go.com/US/wireStory/run-hide-fight-ohio-state-attack-advice-mantra-43828102

Date, J., Thomas, P., & Levine, M. (2016, June 15). Active shooter incidents continue to rise, new FBI data show - ABC news. Retrieved from http://abcnews.go.com/US/active-shooter-incidents-continue-rise-fbi-data-shows/story?id=39876178

Department of Homeland Security. (2016, October 25). Active shooter preparedness | Homeland security. Retrieved from https://www.dhs.gov/active-shooter-preparedness

Dreher, M. C., & Skemp, L. E. (2011). Healthy places, healthy people: A handbook for culturally informed community nursing practice (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.

HiersStaff, F. (2015, October 25). As health care demand increases, so does the need for professionals - News - Ocala.com - Ocala, FL. Retrieved from http://www.ocala.com/news/20151025/as-health-care-demand-increases-so-does-the-need-for-professionals

Live Safe. (n.d.). Who becomes an active shooter? - LiveSafe. Retrieved from http://www.livesafemobile.com/becomes-active-shooter/

United States Census Bureau. (2015). Marion county: Florida. Retrieved from http://www.census.gov/quickfacts/table/PST045215/12083

United States Department of Labor. (n.d.). Emergency action plans. - 1910.38 | Occupational safety and health administration. Retrieved from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=9726&p_table=standards