Hospital Code Silver Activation; Active Shooter Planning Checklist

Hospitals are required by facility security plans, CalOSHA and The Joint Commission to incorporate Workplace Violence plannin into their operations! Hospitals coordinate plannin "ith trainin to maintain a safe "orkplace for patients, staff and #isitors! This includes plannin for an armed indi#idual such as an acti#e shooter! Healthcare or ani$ations are increasin ly #ulnerable as e#ents in#ol#in armed indi#iduals and uns are on the rise! %ncidents of a #iolent nature can ne#er be entirely pre#ented& the challen e is to plan and protect the occupants in a healthcare facility from a threat "ith potential for si nificant consequences! The acti#e shooter 'Code Sil#er( e#ent may be o#er in )* to )+ minutes, lea#in little time to react! The success of the acti#e shooter policy "ill depend on plannin "ith the appropriate multi, disciplinary response partners! -rotectin patients, #isitors and staff are key ob.ecti#es! /ife sa#in options such as lockdo"n or s"armin the perpetrator are not typical to the healthcare emer ency preparedness e#ent or trainin ! %t is critical to educate staff to respond to these types of e#ents and train staff actions they mi ht take to remain as safe as possible . %t is not the intent of this document to address e#ery aspect for plannin or respondin to an acti#e shooter e#ent! This checklist is intended to assist in the discussion and decision,makin process and facilitate the de#elopment of plans for an acti#e shooter situation! This checklist is desi ned to prompt consideration of critical decision,makin factors, determine protocols for acti#ation, lockdo"n or e#acuation plans "hile considerin facility risk, safety and community threat assessment re#ie"s of an acti#e shooter scenario!

Plan Component Overview

A! 0ocument acti#e shooter, 'Code Sil#er( scenario policy and procedure 1! 0efine scope and applicability C! %dentify acti#ation authorities 2immediate3 0! 0efine acti#ation criteria and decision,makin

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!. "itigation
A! Ha$ard Vulnerability Analysis 2HVA3 %nte rate facility HVA "ith la" enforcement response partner4s HVA 5e#ie" facility HVA "ith la" enforcement response partners annually 1! 5eference lockdo"n as potential response to e#ent 2for e6ample, dis runtled family member enters area, takes hosta es! 'Code Sil#er, /ockdo"n( o#erhead pa e announcement C! 5eference miti ation acti#ities that may support /ockdo"n plans 2for e6ample ' o kits( for arri#in la" enforcement responders& food and comfort supplies for units under /ockdo"n and la" enforcement responders& unit specific plans for specialty areas such as 7%C8, O5, %C8, etc!3 0! -erform facility 9ap Analysis for the 'acti#e shooter(& 'Code Sil#er, /ockdo"n( e#ent :! 5e#ie" community threat assessment data to e#aluate adequacy of facility policy and protocol

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7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e ) of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

Plan Component
>! Conduct re#ie" of associated or ani$ational policy and acti#ities 2for e6ample, 'Code Sil#er(& 'Code 9ray(& /ockdo"n #s! e#acuation response directi#es& H%CS under short,term #s! e6tended scenario timeframe& communications under acti#ation3 to assure the appropriate multi,disciplinary team has been included in the plannin process! 9! Consider usin standardi$ed emer ency codes ? such as the Hospital Association of Southern California 2HASC3 Codes 2)3 to a#oid confusion or miscommunication! H! -erform facility site assessment "ith security and la" enforcement response partners

7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e < of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

$. Preparedness
A! -reparedness acti#ities are based on re#ie" and analysis of facility and la" enforcement Ha$ard Vulnerability Analysis 2HVA3, community threat assessment data, the facility ap analysis and risk assessment re#ie" %nclude a thorou h re#ie" of sur#eillance camera capabilities on a re ular basis %ncorporate sur#eillance #ideo in e6ercises and use to au ment plannin 1! 5esponse plans incorporate lockdo"n and@or e#acuation option2s3 as appropriate! 0e#elop a coordinated plan for trainin staff in the critical elements in the plan C! %nte ration and coordination of hospital plans "ith la" enforcement responders plans to identify; /a" enforcement response protocols Coordination@communication plans "ith hospital security and emer ency mana ers %nformation@resources needed to assist in response 2e! !, floor plans, entrances and e6it dia rams, etc3 0! Communication -lans 0e#elop 5isk Communication 2-re,e#ent& and in coordination "ith ap analysis and community threat assessment re#ie"s3 0e#elop internal alert@notification 2staff, patients and #isitors3 0e#elop e6ternal communications plan 2la" enforcement, community response partners, media3 Test la" enforcement communications equipment in all areas of the hospital to ensure #iability such as basement, CT@6,ray rooms, A5%, ele#ators, lab, etc! Consider enrollin all staff cell phones in te6t alert system similar to "hat may uni#ersity no" use for similar situations 5e#ie" protection of critical nodes in area of facility "ith po"er, as, communications partners :! Conduct #iolence in the "orkplace trainin addressin acti#e shooter and other threat situations consistent "ith facility emer ency codes and plans! :mployee records document staff trainin 2such as, ne" employee orientation, 'Combati#e -erson( acti#ation codes, 'Code Sil#er( and@or '/ockdo"n( response plans3 >! 1uild critical connections 2for e6ample "ith community la" enforcement response partners, "ith area healthcare partners, "ith labor "orkforce representati#es, "ith the media3 9! Sta e critical access and entry supplies 2( o kit(3 for la" enforcement responders 2e6ample contents of ' o kit(; facility maps, keys@card access entry options, location of Hospital Command Center, etc3 >amiliari$e@brief la" enforcement personnel in ad#ance to
7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e B of =

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Hospital Code Silver Activation# Active Shooter Planning Checklist

facilitate kno"led e of contents ahead of potential e#ents H! -repare for mental health needs and support for on,duty staff, patients and #isitors, patients, family and staff 0e#elop protocol to pro#ide mental health support for affected indi#iduals in coordination "ith Human 5esources and facility 5isk Aana ement 0e#elop protocol to conduct immediate post e#ent stress debriefin s

$. Preparedness %Contin ed&

0rills@e6ercises incorporate critical decision,makin acti#ities and realistic 'acti#e shooter( response options into facility trainin e#ents! 5epetiti#e and focused trainin can assist by ha#in a positi#e impact on reaction and response in 'sur#i#al situations( Check po"er redundancy, o6y en supply redundancy, Confirm computer dri#en lockdo"n actions i!e! can security acti#ate remote door locks #ia computer pro ramC Assure communications redundancy i!e!, in house pa in system #s! SAS or net dri#en backup -repare business continuity and reco#ery plans and protocols in coordination "ith facility 5isk Aana ement and finance officers 0ocumentation of drills@e6ercises 0ocument e6ercise summaries 0ocument e#aluation 2After Action 5eports3 0ocument %mpro#ement -lans 2Correcti#e Action -lans3

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%! J!

'. Response
A! %ssuance of alert for code for lockdo"n acti#ation 1! 8tili$ation of Hospital %ncident Command 2H%CS3 tools for the scenario Job Action Sheets :#ent,Specific -lannin 9uides and 5esponse -lans 2<3 Hospital policy and@or protocol clearly identify critical response acti#ities, as appropriate to circumstances 2for e6ample e#acuation, lockdo"n, barricade, counter and s"arm3 C! %nitiation of facility lockdo"n and@or e#acuation acti#ities@plan clearly indicatin "hich area2s3 are bein locked do"n Criteria and decision makin process Assessment@reassessment of 'real time( e#ent %nformation@%ntelli ence Assessment@reassessment of internal response Assessment@reassessment of facility needs if under lockdo"n

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7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e D of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

0! Acti#ation of the Hospital Command Center 2HCC3 under 'acti#e shooter(& 'Code Sil#er, /ockdo"n( declaration :! :stablishment of a coordinated command and communications bet"een local la" enforcement, SWAT and@or >1% and the Hospital Command Center 2HCC3 -rocedure to desi nate an a ency representati#e from the facility to liaison "ith arri#in la" enforcement and communicate "ith hospital officials i!e! hospital security, facility@buildin en ineer or equi#alent "ho ha#e facility kno"led e critical for la" enforcement4s response >! 0e#elop protocol and procedures for e#acuation of the immediate hospital areas not impacted by the e#ent, as necessary, and in coordination "ith security and la" enforcement 5ee#aluate need for further e#acuation on an on oin basis and implement safe and effecti#e e#acuation 9! -rocedure to %nitiate@maintain %nternal and e6ternal e#ent communications :nsure communications into the incident area

7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e + of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

'. Response %contin ed&
H! Acti#ate policy and procedure2s3 to pro#ide mental health support for on,duty staff, patients and #isitors, patients, family and staff :nsure Human 5esources and 5isk Aana ement department2s3 inclusion in policy and procedure de#elopment Aaintain communications "ith community response partners such as la" enforcement, :mer ency Aedical Ser#ices 2:AS3, :mer ency Operations Center 2:OC3, other healthcare facilities, media etc! -rocess to ensure on oin communications "ith la" enforcement responders 5outinely communicate the situation and pro#ide re ular updates to patient4s family members, in coordination "ith la" enforcement and hospital -ublic %nformation Officer -rocess to pro#ide staff@medical staff alerts and on, oin e#ent notifications Communicate the situation and pro#ide re ular updates to the media, in coordination "ith la" enforcement and hospital -ublic %nformation Officer Assure appropriate process and procedure for required notifications and@or "ai#ers to local authorities, State licensin a encies and@or >ederal a encies should temporary re,location or sta in of patients occur Address hosta e support needs 2"ater, medications, illness@in.ury3 under the direction of la" enforcement 2as rele#ant to the scenario3 -lan pro#ides for any hosta e family@friends to ha#e a quiet room in secure area "ith support ser#ices "hile the incident e#ol#es 2as rele#ant to the scenario3 -rocess to coordinate situation status updates and briefin s "ith hosta e family, under the direction of la" enforcement -rocess to document operational response procedures 2"hat, "ho, "here, ho"3 that are coordinated "ith la" enforcement, such as protocols for; /ock,do"n and access control :#acuation of non,impacted areas! Ao#ement of patients, staff and #isitors to safe locations -ro#idin supplies, equipment, pharmaceuticals, "ater and food to /ockdo"n areas 2as rele#ant to the scenario3 >acility census, updates and reportin in coordination "ith /ockdo"n

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%!

J!

E! /!

A!

7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e F of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

7! Aana ement of facility and perimeter security in coordination "ith la" enforcement -rocess to establish and coordinate internal safety and security -rocess to acti#ate facility and perimeter security plans -rocess to control access and mo#ement in the facility -rocess to coordinate communication of facility lockdo"n status "ith area healthcare partners O! -rocess for "hen the facility is under lockdo"n for monitorin , conser#in and alternati#es for /ife Safety critical systems and utilities 2for e6ample fire safety systems, o#erhead pa in , patient call li hts, etc!3

7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e G of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

'. Response %contin ed&
-! -rocedure for mana ement of continuin clinical and support acti#ities %mplement patient mana ement plans in coordination "ith facility emer ency mana ement plans 2such as sur ery cancellations, di#ersion, emer ency care, patient trackin 3 Aana ement of patient clinical acti#ities 2such as nutritional needs of in house patients, critical procedures, ancillary support acti#ities etc3 >ull or partial e#acuation 2see CHA :#acuation Checklist 2B33 0ocumentation and trackin of patient clinical information Specific responsibilities by department or identified need 2such as 'Code 1lue( response procedures, /abor -ool, Au6iliary@Volunteers, :mer ency 0epartment, 0ietary, :n#ironmental Ser#ices, -lant Operations, -harmacy, 5espiratory Therapy, Social Ser#ices3

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(. Recover)
A! -rocess for termination of facility lockdo"n acti#ities@plan! Coordinate an) 'all clear( declaration "ith la" enforcement -rocedures to update and local area notifications 2such as declaration of 'Code 1lack(& :A Systems& 5eddi7et, etc!3 1! -rocedures to first restore critical care ser#ices and reopen unit2s3 to normal operations C! -rocess for acti#ation of facility reco#ery procedures for acti#ities initiated durin response phase 2for e6ample areas "here e#acuation "as ordered& cessation of electi#e procedures& :mer ency 0epartment di#ersion, etc!3 0! -rocess to secure and initiate clean,up and decontamination of any contaminated facilities or rounds in coordination "ith >ire and Safety :! -rocess to address hosta e support needs after the e#ent has concluded -rocedure to reunite hosta es "ith family -rocedure to coordinate press conferences "ith hosta es -lan for pro#idin mental health support and debriefin ser#ices to the hosta e2s3 >! -rocess to address facility staff support needs after the e#ent has concluded Acti#ation of protocol and mechanism to pro#ide mental health support and debriefin ser#ices for hospital staff Coordinate Staff reco#ery and re,entry into the "orkplace "ith Human 5esources 9! -rocedures to return facility to normal operations 2phased, appro#als, priorities, checklists3 in coordination "ith la" enforcement in#esti ations and post e#ent demobili$ation procedures Conduct immediate debriefin "ith la" enforcement response a encies -rocess for e#idence collection and preser#ation

Reference/Loca tion

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7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e H of =

Hospital Code Silver Activation# Active Shooter Planning Checklist

H! -rocess to coordinate comprehensi#e e#ent e#aluation Aulti,disciplinary incident debriefin :#aluation of response plans 2After Action 5eports3 %mpro#ement plans@:mer ency Operations -lan update 2Correcti#e Action -lans3
>ootnotes; 2)3 Hospital Association of Southern California IHealthcare >acility :mer ency Codes; A 9uide for Code Standardi$ationI 2<3 H%CS %ncident -lannin 9uides 2such as Hosta e@1arricade and :#acuation3 H%CS %ncident 5esponse 9uides 2such as Hosta e@1arricade and :#acuation3 2B3 California Hospital Association 2CHA3 :#acuation Checklist

7ote; There is no requirement for hospitals to reor ani$e their plans to coincide "ith the checklist! This checklist assumes a facility,specific "orkplace #iolence pro ram is in place! Version; )<,)=,)< -a e = of =