DHMC Shooting September 12, 2017 - StarChapter...DHMC Shooting September 12, 2017 Lessons Leaned Jim Alexander & Jim Gregoire D-H Emergency Management & Risk Management Materials were

New England Regional Healthcare Risk Management Conference

DHMC Shooting

September 12, 2017

Lessons LeanedJim Alexander & Jim Gregoire

D-H Emergency Management & Risk Management

Materials were created for presentation at the 2019 New England Regional Conference.

Reproduction or reuse without written permission from the primary speaker is prohibited.

Dartmouth-Hitchcock is a nonprofit

academic health system serving

communities in northern New England

Dartmouth-Hitchcock Medical

Center


State’s only tertiary care & regional

referral center

Only level-1 trauma service (DHMC) , only

NICU, only air ambulance service (DHART)

High volume, high acuity MIX (top 5%)

9,600 Employees 1000 providers

Approx. 400 Inpatient Beds

22,000 surgeries

1.7 million Appts (with CGP’s)

1,100 Births 31,000 ED visits

Could it happen here?


US News & World Report consistently ranks New Hampshire as one of safest

states in the nation

Brown University study: New England is least-likely region in US for hospital

shootings

Johns Hopkins study: Patient rooms are the least common site for violence

with weapons

FBI statistic: Most active shooter events are five minutes or less

September 12, 2017: Timing of

Incident


1:24 pm – A visitor (son of a patient) signs in and goes to the ICU

1:25 pm – First incident call of a shooting on the ICU unit

1:25 pm – 911 is called

1:26 pm – “Code Silver” Alert is triggered (appearing on D-H

computers and sent through mobile app)

Simultaneously: Code Blue Alert for non-responsive patient

Event Description


Responding Officers:

• Initially - Lebanon PD: 13 Officers

with 5-10 minutes

• By event’s end, total mutual Aid –

approx. 160

Unknown assailant location

• Unable to verify leaving the hospital

• Security camera captured only some

images

Event Description:

Initial response and partial

evacuation


• Numerous hospital staff, ambulatory patients and visitors exited to various parking areas

• “Run – Hide – Fight” philosophy/training

• Thousands of hospital sheltered in place around the hospital.

• “Run – Hide – Fight” philosophy/training

• High-acuity care continues. Surgeries and clinical procedures taking place – but we could not move between procedural areas

• ED is secured by a tactical team so emergency services can continue.

Immediate evacuation issues


Clinical personnel outside the hospital

waiting to re-enter: Some inside – Some

outside

Once evacuated…. concerns

• Continuing patient Care inside and outside

• Basic supplies, staff, medications

• Communication

• Exposure to suspect

• Exposure to weather (water/heat/ cover…)

• Bathrooms

Event Description - ongoing


• Some personnel continue to shelter

in place while tactical teams clear

areas. Hospital maps/schematics

were used to divide the hospital and

assign search teams

• Homicide scene in active Intensive

Care Unit with other patients,

providers, victim’s family etc.,

present.

• Growing media presence and social

media swirl of information and

misinformation.

Suspect Captured


At 2:49pm a vehicle was spotted

stopped in traffic on Lahaye

Drive near the intersection of Mt.

Support Rd.

Police from multiple agencies

approached the suspect and took

him into custody without incident

- about 1 ½ hours after shooting

Reoccupation of Hospital


• After suspect arrested D-H staff was not back in the hospital.

• Concerns of police, taken from other active shooter incidents and based on time frame the suspect was unaccounted for

• Possible Suspect wasn’t alone?

• Could there be devices within hospital or parking areas?

DHMC is reoccupied at 5:12 pm

Swift Response: Managing the

Situation – D-H ICS


D-H ICS was initiated immediately (off site) at

time of shooting and a team was in place.

Issue communications as incident

unfolded

Support staff wherever they were

located

Attempting to establish liaison to

police/fire

Transitioned the next day to

“Corrective Actions Task Force” for

immediate improvements and better

response

D-H Lessons Learned:

Improved Planning


Updated plan for shooting Incidents

Active Shooter & Violence with Weapons in plain language

Changed “Run – hide – fight” philosophy to “Avoid – hide – fight”

Specified actions for “in the immediate area” and “NOT in the immediate

area”

Shelter in place verse “Run” for those “NOT in immediate area”

Updated EM Guidebooks with basics / Badge Buddies / ELearning


Improved Planning

Updated EM Guidebooks with basics / Badge Buddies / ELearning



Improved Planning



Communications


Prioritize efforts on concise “alert” messages

(LOCATION): There is a report of an active shooter in

_____. Seek shelter immediately, secure your doors,

and assess your situation. Police are responding.

Those in the immediate area should use the Avoid –

Hide – Fight response.


Communications


• Repeated, frequent messaging (remember: some staff are hiding)

• Be able to communicate to all on your campus – College staff on different systems

• Other staff on your property should take your emergency training

• Expanded use of Mobile App and cell texting to non-employees

• Alerting slips (order of initial communications at switchboard)

• Cell texting not set on initial alert sheet

• IT barriers: can highly secure, restricted clinical computers receive emergency

notifications?


Safety Concerns


Reoccupation of building issues

Have an agreement and plan with police prioritizing how units will be “retaken” and held – systematically establish control of building

Local police to have plan / “run cards "and maps

Lock Down – Securing spaces

Nursing inpatient units need the ability to “Self” lock down

During this event, Security had the ability to initiate lockdown

Ability to “physically” lock down - secure all Inpatient units and Procedural areas

Evacuation planning (if necessary for many situations)

Workgroup project established to enhance this capability

Our D-H teams made the difference

maintaining patient care during

event


Community partnerships made the

difference dealing with the response


Participation by local police and fire in past drills, and regular, ongoing contact with EMS was key to our success

Heroes among us


“You two helped us to feel secure

and to be secure, so that we could

continue taking care of the

patients we had,”

said Vice President of Perioperative and

Surgical Services Daniel Herrick.

“You enabled the rest of the team

to be able to stay focused on the

job, knowing that someone had

their backs.”

Questions?

Documents

DHMC Shooting September 12, 2017 - StarChapter...DHMC Shooting September 12, 2017 Lessons Leaned Jim Alexander & Jim Gregoire D-H Emergency Management & Risk Management Materials were