1. The School Shooting Epidemic Case Studies: Virginia Tech Massacre Blacksburg, VA April 17, 2007 Columbine High School Littleton, CO April 20, 1999

2. Objectives Review major school shooting incidents Focus on VA Tech and Columbine –EMS/Police Response –Triage and Transport –Community Response –Public Affairs/Media –School Safety –Mental Health School shooting in PLANNING exercises RESPONSE –awareness –develop systems –scene safety –Integration MITIGATION –school procedures –health care response –community

3. Virginia Tech Disaster Day 1

4. Questions For Discussion What went well with the response to the disaster? What should be improved? What are the key elements of a media message during and after a disaster? Any comments about the VA Tech president’s statements? Where might the primary triage site be for a school shooting disaster?

5. School Safety Open vs Closed Campus Layout Cameras and Metal Detectors Security personnel Willingness of systems to report concerning behavior Weapons policies Interventions for high risk students Community risks

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

8. School shootings bring immediate national attention.

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

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

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

12. “Lionizing” of Killers

13. Questions for Discussion Can school shootings be described as “viral” or “infectious”? What are some warning signs and demographic factors that characterize potential school shooters? What can be done to counter the cycle of school shooting violence at the individual level? The community level?

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

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

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

17. Evacuation of Victims and Hospital Response

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

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

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

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

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

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

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

25. Lessons Learned A school shooting can happen in any community Children and adults will respond with ongoing psychological stress Refine multi-casualty response systems to include school children Review and drill school shooting scenarios “Let it end here” is a goal

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