How do you spot the signs of potentially violent behavior?
There is little evidence that the violence is spontaneous or random. Violent offenders usually plan to target specific individuals such as a current or distant intimate partner, supervisor, or co-worker. Behaviors that may indicate that an individual may be acting violently with the intent to harm themselves or others include:
- Repeated incidence or history of bullying, harassment, assault or bullying.
- Increasingly pathological preoccupation with an individual or institution.
- Close association with weapons, military or law enforcement paraphernalia, or former attackers or assassins.
- Financial difficulty.
- A story of physical violence towards others.
- Threats communicated directly or indirectly.
Ultimately, you have to trust your instincts. If someone’s behavior seems worrisome, don’t ignore the situation or assume someone else will deal with it. Nurses who suspect that someone may pose a threat to their health and safety or that of others should follow their facility’s procedures and chain of command for reporting such concerns.
What kinds of action plans should nurses prepare for an active shooter?
Every crisis is unique, and healthcare facilities present unique challenges for active shooter planning and response. To prepare, the Joint Commission and others recommend that nurses be aware of their facility’s emergency response policies and procedures, including those regarding the following:
- Activation of emergency response measures and internal security alerts.
- Emergency containment and evacuation procedures.
- Expectations for the protection and care of patients on your unit during an emergency response.
- What to expect when law enforcement arrives.
- How to identify a clear directive.
There are also some strategies the U.S. Department of Homeland Security and other experts recommend for putting distance and barriers between you and the shooter:
To run. Get out and help others evacuate if there is an accessible emergency exit. When you go outside, keep your hands visible so law enforcement can see that you are unarmed.
To hide. If there is no safe exit or the patients lack mobility, hide. Seek shelter without windows or away from windows, and draw curtains or blinds. Lock the door and push all available furniture against the door. Turn off all appliances and turn off all other sources of light or noise. Get out of sight and stay hidden until the alarm signal is given.
Struggle. As a last resort and only if your life is in imminent danger, try to distract and/or incapacitate the shooter. Act aggressively: Yell and throw objects.
Are there any HIPAA considerations?
Nurses should remember that law enforcement officers are not required to comply with HIPAA. Nurses must balance their professional and legal duty to protect patient health information with their obligation to cooperate with law enforcement.
The HIPAA privacy rule allows healthcare providers to offer law enforcement personal health information to help identify or locate a suspect. However, nurses should be careful to limit the information they disclose to what is specifically permitted by HIPAA. This includes the suspect’s name, date of birth, type of injury they may have sustained, date and time of treatment/incident, and a description of distinguishing physical characteristics. Other information, such as DNA samples from the individual, may only be released in response to a court order, warrant, or written administrative request.
Nurses should also be sure to follow state law and their facility’s policies and procedures regarding sharing information with law enforcement. If problems arise, nurses must be empowered to go up the chain of command and call on their organization’s risk management or legal professionals for assistance.
Preparation can save lives
Unfortunately, in the current environment in the United States, no organization is immune to the threat of gun violence. Maintaining situational awareness, reviewing your facility’s emergency response plans, and participating in training and drills can and will make a difference for nurses in the event of an active shooter incident. .
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