1. Armed Aggressor Training

2. RUN. HIDE. FIGHT. Surviving an Active Shooter Event
Over the summer NY Times and other media ran a story with interviews with several Police Chiefs who state persons facing an active shooter incident should not be passive, they cited Run Hide Fight as a means to achieve this.
Click on image to access the (You Tube) Run. Hide. Fight. Video
NOTE: Need to be able to have internet connectivity and access to You Tube
After showing video inform participants that it is available on YouTube, encourage them to share with family and friends.

3. Some of these images are from training exercises, others are from actual incidents.
Incidents have occurred and continue to occur. Incident in Herkimer NY this past year, Washington Navy Yard, Reno Medical Center to list a few. (Add any recent one to your presentation)
Recent report by Texas University (Oct 2013) states that while violent crime has dropped in many areas of the country active shooter incidents have increased. Two years ago we were seeing 1 incident every 2-3, today is is 1+ incident a month.

4. In Memory and Honor of
These events are local, it is not just occurring in major urban areas hundreds of miles away. It is happening in our own back yards.
More events are occurring in the smaller communities, whoever heard of Newtown CT before 2012?
Yes, in several of the incidents, healthcare has been the target!

5. What is an Active Shooter?
An active shooter is an individual aggressively engaged in killing or attempting to kill in a confined and populated area.
The situation occurs rapidly and without warning. The shooter’s objective may be a specific target such as an estranged spouse or former boss or may just be all persons present. In either case anyone within weapon range is a probable victim.
Most end in less than 15 minutes so the arrival of Law Enforcement may have little effect on the outcome. The shooter often commits suicide or is looking for “suicide by cop.”
Individuals need to prepare physically and mentally to respond to an active shooter incident
Pretty much read the items cited.
For time line an incident often only lasts 4-8 minutes.
Emphasize that these are well planned events, as a rule they are not spontaneous.

6. Some Known Active Shooters
Eric Harris & Dylan Kiebold
Columbine High School
James Holmes
Aurora, CO
Adam Lanza
Newtown, CT
Harris and Kiebold: Occurred 15 years from this coming April. 13 dead, 24 injured, both suspects committed suicide
Cho: 32 dead, 57 injured, Cho also committed suicide. He was follower of Harris and Kiebold. Still a serious problem after the years since Columbine. Albany Oregon, end of 2012 school year, PD got tip student had made a bomb at home. Search found multiple bombs, napalm, and detailed plans for attacking his school last week of classes.
Bishop: Biology Professor, University of Alabama at Huntsville failed tenure, notified of termination end of semester. At staff meeting shot 6 colleagues, killing 3, claims does not remember doing it. Discuss warning signs shooters usually show: For instance, Bishop killed her own brother and was involved in pipe bombing incident, yet still hired. Serving several life sentences.
Holmes: Shooter in the Aurora CO Dark Knight movie premiere. 12 dead, 58 injured, case still in the courts, pursuing an insanity defense.
Lanza: Shooter at Sandy Hook Elementary School. 27 shot none survived, he committed suicide.
Loughner: On a Tucson weekend he opened fire on a shopping plaza crowd. Killed 6 including 9 yr old child and federal judge, injured 13 other including former Congresswoman Gifford. Serving several life terms.
Dr Amy Bishop
University of Alabama
Seung-Hui Cho
Virginia Tech
Jared Lee Loughner
Tucson, AZ

7. Lakeside Hospital and Canandaigua
Local Active Shooters
Spengler: Shooter in Xmas Eve 2012 killing of 2 firefighters in Webster along with his sister, 2 others wounded. Committed suicide.
Garcia: On Valentines Day 2009 shot and killed an employee and bystander at former Lakeside Hospital, also injured a 3rd person. Then drove to Canandaigua, broke into a house, torturing a wife and husband before killing both. He and the wife had worked in a healthcare facility, her complaint led to his termination. Serving several life sentences, had worked in several Rochester area healthcare facilities including Unity Health System.
Frank Garcia
Lakeside Hospital and Canandaigua
William Spengler
Webster NY

8. Some Disturbing Statistics… (Source: New York City Police Department)
98% of active shooting incidents are committed by a single attacker
96% of active shooters are male
In 78% of active shooting incidents there is a connection between the shooter and at least one of the victims (family, academic, professional)
29% of incidents occur in a school setting, another 55% occur in commercial settings such as an office.
40% of incidents end with the shooter committing suicide with another 46% being terminated through applied force (Law Enforcement, Security, Others).
Go over bulleted items
For incidents in commercial settings, cite healthcare examples
Jan 2013, Newport Beach CA, 75 yr old patient shoots and kills his Urologist in an exam room because he was unhappy about outcome of prostrate surgery.
Summer 2013, Detroit. Former employee enters a medical office building, fires off several rounds. Forces his ex-girlfriend who still works there into the basement and sets the building on fire. Bodies removed several hours later.
December 2013, Rene NV: Former patent opens fire in medical building alongside an area hospital. Killed a physician and critically injured 2 others before committing suicide. Reportedly angry over a botched vasectomy.

9. Don’t assume it will never happen to you!
Preparation
Don’t assume it will never happen to you!
Be aware of your surrounding at all times along with any possible dangers
Blocked Exits
Broken Locks
Unlighted Areas
Know your exact workplace address
Street address, suite number, etc.
Have an escape plan, same as in a fire.
Look for at least two exits for any facility you visit or work in.
Work as a team to pre-plan for these types of incidents. For instance, what is a safe location to assemble once you escape?
Avoid “it won’t happen to me” or “maybe it will happen to me.” What you want is “I’m going to be ready for it to happen to me!”.
Constant vigilance is critical.
Use Mall example for looking for two exits. Emphasize that as you move around you have to update the plan.

10. Indicators of Potential Workplace Violence by Employees, Clients, & Others
Increased drug or alcohol use
Increased unexplained absenteeism
Decreased attention to appearance & hygiene
Depression/Withdrawal
Resistance/overreaction to policy changes
Repeated policy violations
Increased severe mood swings
Unstable emotional responses.
Explosive unprovoked outbursts
Suicidal comments; Desire “to put things in order”
Paranoid type behavior. “Everyone is against me”
Increased talk of problems at home
Domestic problems escalating into the workplace.
Severe financial problems
Talk of past incidents of violence
Empathy with individuals who commit violent acts.
Increased interest in firearms and other weapons.

11. Response to an Active Shooter
Run!
Hide!
Fight!
Emphasize the three steps in order. If Fight is left that is what you have to do, the 4th choice is being shot.
Do not try playing dead. Was tried by some students at Virginia Tech when Cho came back. He shot them again. Other students barricaded themselves, he left them alone.

12. Run! Use your escape plan! Get out at the first sign of danger.
Leave belongings behind
Take others with you if possible.
You may need to leave wounded behind.
You cannot help others if you become a victim yourself.
Try to prevent others from entering
Keep your hands visible
Follow orders of Law Enforcement
Call 911 when safe to do so.
Keep in mind in a crowded location that others may be doing the same.
Go thru the bulleted items
If you think its gunfire its gunfire until proven otherwise.
1st group in video left right away and went right to a safe spot, obvious they had pre-planned.
For taking people with you, emphasize that it is their choice, even in a clinical setting with patients. Talk about the teacher at Sandy Hook who pushed all students into a closet and shielded them with her body. None survived but it was her call.

13. Hide! Find a place to hide where shooter is less likely to find you.
Plan this out ahead of time in your workplace.
If possible determine a place that will not trap you.
Stay out of the shooter’s view
Lock the door, barricade with heavy furniture if possible.
Hide behind heavy objects (desks, file cabinets, etc.)
Remain quiet. Silence your cell phone ringer and other sources of noise.
Dial 911 if possible.
If you cannot talk just leave the line open
***You cannot text 911!! (Probably)**
Emphasize they should be on lookout for hiding places as they do routine duties. Get them in their minds early. Remind them of the video, woman in copier room. Pushed copier in front of door, turned off lights, silenced cell phone. Also got down low, this helps if shooter decides to fire into doors or walls.
Call 911 if you think it is safe to do so, wait if you do not.
Texts in NYS will reach Monroe, Onida, Steuben, Chemung, and Montgomery Counties (so far). If you text 911 in an area where it is not functioning you will get a bounce back message stating message not delivered to 911, use alternate means.

14. Fight!
As a last resort to save your life you may need to attack the shooter
Act as aggressively as possible!
An attack by a group is more effective than by a single person (Remember United Flight 93)
Improvise weapons (chair, laptop, paperweights, sharp objects)
Throw things
Yell and shout, try to disorient the shooter
Commit to your actions!
Go over bulleted points.
Point around the room, point out items right there that can be used as an improvised weapon.

15. If You Reach 911 Before Law Enforcement Arrives
Provide the following information, if known:
Exact address of incident location (Critical)
Number of shooters, descriptions, their location
Number and type of weapons seen
Number and location of potential victims.
Address is critical because in many areas a 911 center covers there are often streets with the same name (provide example if possible)
For other questions, answer if you know the answer, otherwise just say I don’t know and they will move on.
For weapons if you have knowledge and can describe, great. Use hands to demonstrate difference between long gun and handgun. Tell what you know, not what you guess.

16. When Law Enforcement Arrives….
They will probably enter in teams.
May be in standard uniform or SWAT style attire
May be armed with rifles and shotguns
They won’t usually know what the shooter looks like.
Be prepared for them to be shouting orders and pushing people to the ground.
Keep your hands empty and in plain sight
Follow their orders to the letter. Save your questions for later.
Understand that rescue of the wounded will not occur until the scene is secured.
Expect to be taken to a safe location and held there for identification and debriefing
Officers in video are a Reactive Containment Team. Many Police Officers around the country trained in it (check on your local jurisdiction). They don’t wait for SWAT. Upon arrival first Officers gather weapons and intelligence and make entry if they believe scene is still active.
Demonstrate keeping hands open and visible.
Discuss need for Police to conduct investigation once scene is secure and victims cared for. Everyone should expect to have a long wait and be interviewed before being released to go home.

17. Follow-up by Management and Others
At assembly point/ safe location perform an accountability check of all employees to determine anyone is missing and potentially injured. Inform Law Enforcement of any person unaccounted for.
Determine a means for those who are safe to notify their families.
Address notification to families of casualties. Coordinate this with Law Enforcement.
Provide for physical and psychological care for all involved (including yourself!).
A designated safe gathering point greatly increase ability to conduct accountability and report findings to Police/Command Center. But emphasize that the employee’s first priority is to be safe, if you cannot safely get to gathering point do whatever is necessary to protect yourself.
Discuss need to control calls to family and outsiders. Discuss that news media and social media will report anything they hear as accurate.
Only call family if Police give the OK and you are 100% confident in the accuracy of who you are calling and why. If in doubt, wait, double check, get help.
Remind attendees that the psychological will last a long time (years). Get help if offered, both immediate and long term.

18. Lockdown
A Lockdown is a process to secure an area from a threat. It can include containing an incident in it’s area of origin through the movement of people
If a Lockdown is announced all exterior doors are secured and checkpoints are established at vehicle entrances. Law Enforcement may be called to assist. Movement of those inside is restricted and visitors are prevented from entering. Allowing employees with proper photo ID to enter is situational based and will be determined by the Incident Commander.
Your Actions:
Cease normal operations
Clear all hallways
Secure doors
Shelter in Place until directed otherwise by those in authority or All Clear is announced.
Discuss lockdowns in general and use this opportunity to review your facility policy with attendees.

19. Your goal is to return home in the same condition you arrived in!

20. Share with Family and Friends
Acknowledgment
Training Program Developed by:
John A. Cassin, MPA, CEM, ENP
Emergency Planning Specialist
Unity Health System
Jerrold Seldes, CHSO
Director, Corporate Security and Emergency Preparedness
Run, Hide, Fight Video (available on YouTube)
Courtesy of the City of Houston, Texas
Share with Family and Friends
It is Important!

21. For Further Information
Insert appropriate contact information
for your facility here