1. The School Shooting Epidemic Case Study: Thurston High School Springfield, Oregon May 19, 1998

2. Objectives n Review recent school shooting incidents n Focus on Thurston –EMS/Police Response –Triage and Transport –Hospital Response –Community Response –Public Affairs/Media –School Safety –Mental Health –Ongoing Issues n Use school shooting in PLANNING scenarios n RESPONSE –awareness –develop systems –scene safety –drill and integrate n MITIGATION –school procedures –health care response –community

3. Multiple Fatality US School Shootings n 1997/98 Academic Year –Pearl, Mississippi 10/1/97 –West Paducah, Kentucky 12/1/97 –Jonesboro, Arkansas 3/25/97 –Pomona, California 4/28/98 –Springfield, Oregon 5/21/98 n 1998/99 Academic Year –Littleton, Colorado 4/20/99

4. Multicasualty School Shootings Are Not A New Phenomenon n 1989-1993 –Stockton, California 1/17/89 –Brooklyn, New York 2/9/92 –Olivehurst, California 5/1/92 –Grayson, Kentucky 1/18/93 n 1996-1998 –Moses Lake, Washington 2/2/96 –Bethel, Alaska 2/19/97

5. Single Victim US School Shootings n HS student - Florida 1/12/93 n HS student - Missouri 3/25/93 n HS student - Pennsylvania 5/24/93 n teacher - Maryland 4/8/94 n 23 yr old alum - Washington DC 4/5/96 n HS student - New York 5/1/97 n HS student suicide- Washington 3/25/98

6. Springfield, Oregon May, 1998 “If it can happen here, it can happen anywhere”.

7. EMS Response n Notification n Scene control and assessment n Search and rescue n Triage and initial stabilization of victims n Transport to definitive care

8. DEBRIEFING -Psychological Impact -Medical Care Review -Systems Review

9. DON’T BECOME A VICTIM…… Responders are becoming targets too.

10. Hospital Response n Assess for plan activation n Handle convergence phenomenon n Triage and emergent care n Death and donors n Ongoing hospitalization n Debriefing –Psychological impact –Medical care and systems

11. When does an MCI become a DISASTER? Consider dealing with -multiple victims -perpetrators -heroes -fatally injured as patients.

12. The Convergence Phenomenon n Law Enforcement n Parents and Family n Healthcare Personnel n The Media n Spectators

13. Your scene and medical facilities will be flooded with - Parents and family - Students and friends - Community - Media

14. School shootings bring immediate national attention.

16. Placing the Blame n Shooters parents/upbringing n Other students n School officials and policies n School design and safety n Law enforcement n Gun access n Litigation

17. Shock and disbelief turn to anger and blame…. How could we have known? What could we have done differently? Who is responsible?

18. School Safety n Open vs Closed Campus n Layout ie: breezeway vs single entrance n Cameras and Metal Detectors n Security personnel n Willingness and systems to report concerning behavior n Weapons policies n Interventions for high risk students identified n Community risks

19. The incident is only the beginning. As more information is revealed, there is more to process psychologically for victims and community.

20. Psychosocial Issues n Victim n Bystanders n Parents and Family n School, Healthcare, Police Personnel n Community

21. Children deal with becoming celebrities and activists as a result of being victims and heroes.

22. The community as victims and as a support for recovery.

23. Adolescent Reactions n Immediate –disbelief, denial, anxiety, relief, grief, altruism n Short Term –clinging, appetite/sleep disturbed, regressive behavior, somatic complaints, apathy, anger, hostile delinquent acts, risk taking n Long Term –reconstruction, anniversary and other triggers n Post Traumatic Stress Disorder –3 major categories greater than 1 month –Re-experiencing, avoid reminders, irritability

24. Most students will cope well. Some will not and we need to find ongoing ways to identify them and provide help long term.

25. Life goes on…. Returning to routine is important. Striking a balance is an ongoing challenge.

26. Lessons Learned n A school shooting can happen in your community n Children and adults will respond with ongoing psychological stress n Refine your multicasualty response systems to include school children n Review and drill school shooting scenarios n “Let it end here” is a goal, but unfortunately not yet a reality.

27. Long Term Impact n Psychological –Reminders –Vulnerability n Catalyst for change –Activism –Frustration –Remedies