Ep 107: Response to Hospital Shootings
Episode 107
Published Mar 3, 2025
Last updated Mar 5, 2026
Duration: 37:20
Episode Summary
A shooting has occurred at the hospital. What challenges do staff, administration and responders have to take into consideration? That’s today’s episode.
Episode Notes
Today’s episode delves into the complex challenges faced when responding to hospital-based shooting incidents and the strategies needed to address them effectively. Hospitals must grapple with the challenge of maintaining open access for critical care while ensuring security. Our panel explores several key issues including:
- Statistical insights on hospital shootings and their common locations (e.g., ERs, parking lots, patient rooms).
- The role of armed security and its impact on deterrence and response.
- Complexities of hospital lockdowns, including partial vs. full lockdowns and logistical hurdles like patient care continuity.
- The integration of Rescue Task Forces (RTFs) with hospital staff and the need for trauma-specific training.
A significant focus of the episode is the importance of coordination between hospital administrators and public safety agencies. The discussion emphasizes the need for joint training and planning to address potential conflicts between hospital incident command systems and public safety protocols. The panel discusses the critical need for proactive planning and continuous training to improve responses to active shooter events in healthcare settings.
View this episode on YouTube at: https://youtu.be/9irs8hULo7w
Transcript
Bill Godfrey:If you have an active shooter event in a hospital, does it change things? You bet it does. That's today's topic. Stick around.
Welcome to the "Active Shooter Incident Management" podcast. My name is Bill Godfrey, your podcast host. I am joined by three of my fellow instructors here at the National Center for Integrated Emergency Response. Billy Perry from law enforcement. Billy, good to have you back in the house.
Billy Perry:
Nice to be back. Thanks for having me.
Bill Godfrey:
[Bill] Bruce Scott from the fire and EMS side like myself. Bruce, always good to see you brother.
Bruce Scott:
Thank you for letting me be here.
Bill Godfrey:
And Ron Otterbacher, it has been a hot minute since you've been in the studio. It's good to have you back, Ron.
Ron Otterbacher:
Yes sir, thank you very much. I'm excited.
Bill Godfrey:
Alright, so today's topic we're gonna talk about responding to shooting events that are occurring in a functioning hospital. And I thought this one it might be helpful to run through just an overview of some quick data before we dive into this topic and kind of brief the audience on some of what these are. Karla, if you could pop up that PowerPoint for me. So first of all, a little over 6,000 hospitals in the US. In the last 15 years, we've had 154 hospital related shootings. Now, by the way, that includes more than just active shooter events, but most of these involved more than one person getting shot. 59%, almost 60% are occurring inside the hospital. And the balance are occurring outside on hospital grounds. Parking lot is a big one as you'll see later.
We've got 235 injured or dead victims. And that puts our numbers at just under three per person or three per incident, three per shooting is what we're averaging on that. The emergency department, the ER is the most common site of these shootings. Almost fully a third of these are occurring in the emergency departments. The next most commonplace is the parking lots. About a quarter of them are occurring in parking lots in the exterior. That is the most commonplace on the outside. Patient rooms, also a significant source, about one in five are occurring in patient rooms.
And then the motives for active shooter events in hospitals actually shift a little bit from what they typically do out in the public. So some sort of grudge motive is almost a third of these. They have a grudge against somebody that they're going to attack. They got bad treatment, you know, something, set them off. You've also got suicide, which is a higher propensity in the hospital than it is in the regular or active shooter events that are occurring at large in the public where that number's lower. And this one is kind of interesting. About 15% of these, 14% are people euthanizing a loved one, which is obviously a very, very different motive. But we are seeing with some commonality that when this does occur, they're shooting not only the loved one but also shooting themselves. So you end up with more than one victim.
Now this one's interesting, I wanna talk about this a little bit. Prisoner escape makes pretty big appearance here. 11% of these things are triggered by a prisoner attempting to escape or escaping in the environment. Hospital employees now, not nurses and doctors, but actually just the hospital employees, 20% of those are the victims. Nurses and doctors are a little bit lower.
This one really caught my attention and I wanna make sure we talk about that, of the shootings in the emergency departments, so remember about a third of these are occurring in the ER, almost a quarter of those are a shooting that's triggered by taking a weapon from an armed security guard. So I definitely want to hit that one. And then physicians and nurses were relatively infrequent victims of these attacks. They are pretty low to the numbers as opposed to just regular hospital employees, the transporters, the lab workers, the people that are doing the paperwork, signing in and doing registration.
And so I thought that would be, I thought that would be a helpful primer for us to kind of talk through some of the stats. So Billy, I'm gonna start with you 'cause I know that, and then Ron go over to you as well. Let's talk a little bit about this issue with the prisoner escapes and the weapons coming from the armed security guards 'cause that seems to be one that is a little bit on the preventable side.
Billy Perry:
It is, but it's also the old adage, you get what you pay for. And all officers are not the same. You were a fire chief and all your firefighters weren't the same. All police officers aren't the same and all security guards are not the same. And I think you do get what you pay for, and administrators are looking at cutting costs and it comes home in that a lot of times.
Bill Godfrey:
Ron, you're currently serving in a leadership position for a large healthcare system overseeing their security. And I know you and I have had this conversation about, you know, do you go armed? Don't you go armed? Where are you on this personally? I don't want you to speak on behalf of your organization, but where are you on this personally?
Ron Otterbacher:
Again, there's certain things you gotta look at. You gotta look at the people you have, you know, is everyone capable of being armed? I would say probably not. And it's consistent throughout the country. The other thing is the training you present, and again, how you structure your operation so that, you know, if you think about it, we do a lot of weapons screening for people coming in. Who is most likely gonna be targeted is the number place where there's an opportunity to catch them coming in with a weapon. So where do you put the armed people? What is their training? There's so many components you need to think of. You can't just take every officer you have and say, "Okay, I'm gonna give you a gun and teach you how to shoot 60 rounds," and you're done. Because there's so much more to it than that.
Bill Godfrey:
Yeah, and this is, I think it's a pretty hot topic in the healthcare community about whether to have armed security at the hospitals. Most of the hospitals that I can think of in our local area, they have a fairly substantial security presence, but I'm not aware that any of them are armed. Bruce, how about your experience up in northern Florida? What's your thoughts on that?
Bruce Scott:
Well, our trauma center up in northeast Florida obviously has an armed presence at the very beginning. However, I really believe it's more of a deterrence, right? I think that they're carrying weapons to deter something from happening in the, you know. As opposed to, obviously there's a training issue, right? If you're actually gonna bring that firearm to bear that we're probably lacking holistically across the whole spectrum of armed security. Would that be fair? But I do believe just like in so many other instances, the main reason I think that most folks are carrying weapons at the entrance to a hospital facility is to really focus on deterring anything from happening more than acting when it does.
Bill Godfrey:
It's really interesting. One of the things that, because both of these items together, the number of prisoner escapes and the armed security thing, caught my attention. One of the other things that caught my attention was half of these shootings that are involving the hospitals, half of them are occurring at hospitals with small bed counts, the smaller hospitals. And as you go up to larger hospitals, the number of occurrences, the frequency of occurrences begins to fall pretty quickly. Which you can't really draw conclusions from that alone, but it does kind of seem to suggest that the larger healthcare institutions with a more...
Billy Perry:
Robust.
Bill Godfrey:
Thank you, more robust security presence or security posture may be deterring some of those things. Any thoughts on that?
Billy Perry:
I think you're right. But in truthfulness, I used to not believe in deterrence. I used to think because bad people really just generally don't care. Then I'll look back at other active shooters and you can see where they've looked at other venues and they've chosen not to do venues because they had a robust security. And so I had to rethink and change my, I had a paradigm shift in that arena. So I definitely think it can be a deterrent in that sense.
Ron Otterbacher:
And I think that supports what Bruce was saying. You know, you have a large hospital, you got a large security component there. You got a smaller one, you may have one person checking people as they come through the door, and then one roving. And you may only have three or four people for the entire hospital. So you lose that deterrence because they don't see them. They're out doing whatever they're doing. So I think it supports Bruce's theory on deterring is a good part of what is done.
Bill Godfrey:
So let's shift topics a little bit, or not topics, sorry, let's shift gears. We've had a shooting event. The hospital needs to get itself into lockdown, and not all lockdowns are created equal when it comes to hospitals. There are quite a few challenges and of course the size of a facility is going to matter as well. Ron, I know that this has been a topical concern for you. What are some of the questions that you've got or the concerns that you've got on this lockdown issue?
Ron Otterbacher:
I think the biggest thing is understanding what a lockdown is. You know, is it a partial lockdow? Is it a complete lockdown? What authority do you have if you go on lockdown to keep people from inside the hospital from leaving the hospital? You know, there's all kinds of components you need to consider, but also the understanding of how are we gonna lock down because so much of the hospital, most patient rooms, unless you're storing your narcotics or you know, certain areas are lockable, most of those other areas are not lockable. So how are you going to do it? What are your responsibilities during a lockdown?
There's so many things you have to consider when you say, "I'm gonna do a lockdown." We go on lockdown almost on a daily basis. If we have gunshot wounds arrive at the ED and we don't know where the shooter is, we'll lock down the ED. So again, just determining how big the spectrum is for the lockdown and what resources you're gonna use because you've got a finite number of people to perform the lockdown, so how are you gonna do it? And it all comes back to training and writing the right policy.
Bill Godfrey:
Billy, your thoughts on some of the challenges. You're working in a school setting now, but still large campus.
Billy Perry:
Large campus. Agree a hundred percent with Otter. And I would go a step further to not only defining a lockdown, but also what defines an active incident still. Because one of the things that we've had to all change is known bleeding is still an active incident. And I think when you've got people in a hospital that can't care for themselves and that are in critical care, literally, I think that constitutes, is this still active? You betcha and... Does that make sense?
Bill Godfrey:
Yeah, in fact, it's a perfect segue, Bruce. I mean one of the challenges, even with a smaller hospital of doing a lockdown, you've got a shooter in the building and it's been reported, but you may have OR cases going on, you've got people in ICU that are on ventilators that need constant care and attention. The outpatient clinics could be in the middle of outpatient surgeries. You know, all of those issues. From your perspective, you know, applying some of the healthcare background, what are some of the challenges that you see in getting a facility into lockdown when you've still got care that can't be interrupted?
Bruce Scott:
Right, so I think first off, we have to kind of expound on what Billy said as well. What is a lockdown? And the first responders are gonna be responding to that facility probably need to have an idea of what that lockdown means, right? I think that's kind of paramount. I'll also say that I think that once you get into the building, knowing what doors are locked and which ones aren't, how to get in, you gotta get out. You know, what are your options? Do you take somebody from the hospital staff with you as part of a rescue task force to allow you to move about the building? Are you familiar with the, I mean, hospitals are mazes. Every hospital I've ever been in is a giant maze. And again, if I haven't been in that facility recently, I might not even understand how the building is laid out, much less what's locked down, what's not.
And to Otter's point, there's a lot of things can happen in a hospital that make things worse, right? Number one, as you mentioned, you have people that cannot take care of themselves, right? That's the first one. They're already bedridden. They are our most vulnerable population in that hospital. You have, you know, your neonatal, your pediatrics, your cardiac care, all those folks need constant care. How about the staff that works there, Bill? What's their normal, are they gonna be caregivers or are they going to evacuate themselves for their own safety, right? And you never know. So as a paramedic going into that space, I have to understand that this isn't a typical load and scoop people out like we normally do on these type things. There's some additional levels of care that may need to be taken once that building goes into lockdown where people can't get into that space where they're normally getting into.
Bill Godfrey:
I think another, before we leave that topic, Bruce, to piggyback on something you just said, another thing that worries me, like you as a paramedic, we're taught how to deal with the first hour or something. That's not what's going on in a hospital with somebody that's on vent and four IV drips and pumps that I've never seen and equipment I've never seen and monitors I don't know how to use. I mean, we are literally, we're not even talking about taking care of the gunshot folks yet. But if staff has fled or evacuated for their own safety, we're potentially facing just the regular patients in the hospital that we have no idea how to care for.
Bruce Scott:
Right.
Billy Perry:
Right.
Bill Godfrey:
We don't know how to pick up the slack. And so I think that that has to be part of the discussion as well. So you mentioned does the staff become part of the caregivers and part of the triage process? It seems to me that in many cases it's just a reflexive action no matter whether it's a, you know, a nurse, a physician, a tech. It seems a reflective action that once you're not in immediate fear of your life, if you see somebody that's injured near you, you're gonna go start to try to render care. But how does that fit? Are there formal policies on that? Ron, why don't you...
Ron Otterbacher:
Are they prepared to render care? Everyone thinks because it's a hospital, they've got everything they need. But I ask you to think about this. Hospitals all have code carts. If someone's working a code, they push a code cart. Do hospitals have a trauma cart? No, they don't. Maybe that's something they need to consider because they say, "Well, I've got everything." But if they have several trauma patients right there in the hallway, how are they gonna treat them? Do they have tourniquets everywhere? Do they have multiple tourniquets everywhere? You know, again, stop the bleed can happen in the hospital too.
And we've just gotta talk about Billy's paradigm shift. We've gotta think beyond what we've always looked at. And you're talking a hospital. Hospital treats everyone. That's where everyone goes when they're hurt. Except in these situations, are they prepared to handle those patients that aren't their normal day-to-day patients? And also, are they trained, you know, I understand nurses are well trained, please don't think, I'm not saying they're not, so are doctors, but are they well trained in trauma treatment and is that something we need to expand maybe in the training that we do?
Bill Godfrey:
It's interesting, Bruce, go ahead.
Bruce Scott:
Well, I was just thinking that, and I was gonna build off one thing that Otter just said. The, I'm gonna call it street medicine, that a paramedic knows how to do, right? The stop the bleed, the tourniquets, the starting IVs, you know, dropping ET tubes in in the dark, right? We've all been there and done that. There's a lot of times that, you know, your typical staff that work in a medical facility do not have that skill set. They may have started one ET tube while they were in school, right? They don't do it on a normal basis. So in my experience, they're an incredible amount of help, right, and assist. But as far as taking the lead in some of this early on, especially the trauma victims, is probably better suited to a paramedic or an ED doctor or an ED nurse, right? Not your normal staff that's running throughout the building. But again, that's just, you know, it's just one way of looking at it.
Bill Godfrey:
And I think that's interestingly a very difficult challenge for hospital administrators to craft a policy because you could have an ICU nurse that spent 20 years in the ER or a floor nurse that...
Billy Perry:
[Billy] 30 years.
Bill Godfrey:
Spent 30 years in the ER, spent time in a trauma center, you know, used to fly on the trauma helicopter or something like that. I mean, everybody has a little bit of an individual background. And I completely agree with what you're saying. Just because it's a nurse or a physician doesn't mean that they've had recent experience in dealing with trauma. But you never really know until you actually have a conversation with that person about how squared away they may be to be able to render...
Bruce Scott:
Which is an additional burden on your rescue task force as they get in the building, right? They may be expecting one level of care that's not there. And then the last thing about our, you know, those supplies that you may need, those crash carts, those trauma kits, are they on the other side of that locked door, right? Who has the ability to breach that door, right? So again, definitely increases your level of difficulty as part of a paramedic on a rescue task force is understanding the staff that's there to help what their capabilities are. And it usually becomes apparent really quickly what their comfortable doing.
Ron Otterbacher:
And I think another thing that we need to consider is do they know what to expect once the RTFs arrive?
Bruce Scott:
[Bruce] Yeah, exactly.
Ron Otterbacher:
You know, most of them probably don't have an idea of the concept of a rescue task force and how they operate. So that's something that, again, coming back to train, like Iannone says, "A well-trained agency is a well disciplined agency." You provide that training so they have an understanding this is what to expect if we have an active shooter event, you know. And yes, we expect you to help roll in or tell us what you've got is we're going through, but what you can expect, you know, what do you do with your hands? What do you do with your phone? What do you... Those are all things that we cover, when we provide training, you've just got to ensure that everyone has that training.
Billy Perry:
I bet you're one of the few that does that.
Bill Godfrey:
I would guess that Billy's spot on there. It seems that when faced with challenges that don't have clear answers, the answer is to move on to a different topic.
Billy Perry:
Correct. Too difficult. Too uncomfortable.
Bill Godfrey:
Yeah, but we don't have any data on that. So I guess we don't gotta be careful circulating.
Billy Perry:
Right. But I will say to piggyback on that, it does drive home the point that in here in Florida, 776 dictates what we do with justifiable use of force. And I think it does expedite that. I think just the nature of where it is expedites that. And I'm sure you do with your staff enforces that and says, "We don't have the luxury of waiting. Expediency is key. We have to end this quickly." And I think that from a law enforcement side, we need to do a better job of explaining that to the responding officers. This is not just a normal, it's already an urgent situation, but it's even urgenter.
Bill Godfrey:
Yeah. Well and it's...
Billy Perry:
It's a word, Bruce.
Bruce Scott:
More urgent.
Billy Perry:
More urgenter.
Bill Godfrey:
You know, here's a question I'll pose to you guys before, 'cause I do want to dive into the rescue task force a little bit. But with the structure of a lot of hospitals, the units, and now I'm gonna leave aside the units that are locked all the time, the memory care units, pediatric units, but just a regular floor that's got fire doors on it that are not lockable and stairwells that are not lockable and fairly open access, is part of the strategy of getting those contact teams, those early contact teams in place. And instead of having five contact teams or six contact teams hunting, starting to lock down floor by floor, the stairwells and the hallways and things like that. Does it change your tactical strategy, the nature of the building?
Billy Perry:
Yes and no, I think. And the reason I say that is I think the security team, by nature of the cameras, by the nature of everything, they're gonna have a really good idea of where it's happening. Am I right or wrong? Because I'm in a school and I think we're gonna have a...
Bill Godfrey:
Silence speaks volumes.
Billy Perry:
It does. It's voluminous. I know we're gonna have an idea of where it is and I think, you know, we need a guide. And one of our things is there's three of us and we're gonna try to put all three of us when we engage. But if we don't, we're gonna have one of them that is gonna bring the responding people to us. And I would think that y'all probably do the same thing. And I think that would be expedient when you have a guide, one of the security staff to help take the initial responding or at least the first contact team, maybe the first two contact teams where it is.
Ron Otterbacher:
Absolutely. Something we have, is we have go bags that are set up, that have the blueprints, that have the capability of looking at cameras while they're moving and that have access control badges so you're not limited to where you can go. But I get back to, there's so many open areas that can't be locked. So I think you look back at the naval shipyard shooting where the fellow kept going up and down the stairwells, I think it's something we have to consider. But who's going to the secure them?
Billy Perry:
And a barrier doesn't have to be a locked door. What Bruce was saying, a barrier can be a maze. You know, I mean we can't find him or her as it were.
Bill Godfrey:
Good points, so let's dive back into the rescue task forces. So the rescue task forces come in and of course we're talking about a team that is there for a medical purpose, but also has security that's traveling with it. When they do make access to those that have been injured and shot, how does that play out differently, if it does at all, in the hospital setting? And let's leave the ER 'cause I wanna have a specific conversation about this shootings in the ER separate from somewhere else, whether it's the lobby, the cafeteria, the floor, you know, whatever. What's different about being on a rescue task force when you're landing in one of these things in a hospital setting?
Bruce Scott:
Well, I think you're not limited to the folks that were shot, you're limited to the patients that were in that space, whether it's a cardiac care unit or a pediatric unit, right? You've definitely upped the level of difficulty, if you will, because now those are your responsibilities as well, at least early on, right? And to your point earlier, Bill, there's a lot of respirators out there that I have no idea how to run them, right? Do we have to fall back on our normal way of doing business, you know, and do what we know how to do. So I think that's that increased level of difficulty as a rescue task force.
The good news is, is that you have typically have people that have some training and experience that can help you. If they're in that space, you have a, you know, a nurse, or you know, an anesthesiologist or you know, respiratory therapist or somebody that can help you while you're in there. So you have that force multiplier that you may want to consider. The other thing is as a plus is you potentially have access to a whole lot of equipment that you would normally not have, right?. You're basically limited normally with what you carry into the building. Now, potentially you have access to IV setups and cardiac monitors and oxygen and some of those things that you may be able to put your hands on.
Bill Godfrey:
[Bill] Beds, stretchers.
Bruce Scott:
Yeah. Gurneys, exactly that. So again, I think that's the upside of it if you will.
Ron Otterbacher:
Now the downside, where do you put your casualty collection point? If you got several people in the hallway that are down, do you put them in a patient room with someone else? You know, depending on what the status of that patient, you know, there's so many things you have to consider that are different from what we would normally consider when we're creating a casualty collection point or you know, that we have to look at that are different variables, I'm sorry. But those are all things that we need to consider and it changes how we operate just because of that.
Bruce Scott:
Well it's just like everything else we do, Otter, you and I get in that space. You and I have to make a decision, right? Where's the best place we can put these patients? Where's the best place for you to be able to protect, right? There is no absolutes in this business. There is no guarantees that anything's gonna work all the time.
Billy Perry:
No cookie cutter response.
Bruce Scott:
There is absolutely not. So you just have to trust your teams that are down range, sharing that information with command, what you're trying to accomplish, where you're trying to accomplish it. And then to Billy's point, start applying some strategy, right, to this whole response instead of this whack-a-mole response that we sometimes get into, right? Start putting some strategy onto it. How we can protect the stairwells, where we're gonna set up our ambulance exchange points if you're gonna have them or your casualty collection points. There has to be some thought that's put into it. But you have to be dependent on those teams that are inside at that particular moment to try to make the best decisions possible.
Bill Godfrey:
I completely agree with you and I want to a tangent and talk about the incident management and coordinating the event. But before we leave that, Bruce, something you said made me think on the rescue task force. Now, obviously not the first rescue task force going through the door, but as we begin to move into stabilization, should our rescue task force potentially include a physician, a respiratory therapist, an ICU qualified nurse, somebody that is familiar with the equipment, that's familiar with how they do things in this facility and could be part of the team moved with some safety. Obviously there's some risk to rescue task forces, but moved into an area so that if we did have an area where the staff evacuated, fled, or god forbid was part of the victims, how do we replace those teams early on and should we look at a model where maybe by the time we're getting into the third RTF, we're trying to find some medically trained hospital staff members to supplement the team?
Bruce Scott:
Well I'm gonna quote my favorite one of our co-instructors, Travis Cox. "It depends." Right? And it depends on what level of risk those folks are willing to take. They don't have that same level of training as a paramedic or a law enforcement. What kind of risk are they willing to take? But secondly to that, yes they can be a force multiplier, but have we trained on it? Have we talked about it. Are you trying to figure this out when bad things are happening to good people or have you talked about it in advance? And I think Otter mentioned it earlier, training has to be ongoing all the time in regards to how you're gonna act if.
Bill Godfrey:
It's an interesting question, interesting question. And I do think talking about that stuff ahead of time and training on it ahead of time is a gap. But back to one of the things you said earlier on, what are the policies, you know, and what are they doing?
So let's tangent over and talk about the incident management of this and coordinating with the hospital administrators. Now most hospitals use the Hospital Incident Command System sometimes called HICS, which is simply a variant of the regular ICS system with some hospital stuff thrown in. Some facilities take that very seriously and are well-trained and execute it pretty well. There are some that do it in paper only and a lot that are somewhere in the middle.
One of the realities that has struck me just in the casual contact that I've had with hospital administrators and CEOs is that they're under the impression that their Hospital Incident Command System is gonna be in charge telling law enforcement and fire and EMS what to do. And it was always in social settings. So I never really engaged in the other side of the conversation, but let's talk a little bit about what reality is gonna tend to more look like and where we've got some gaps and some opportunities to plug those in together. Ron, you wanna set the stage or would you rather remain silent?
Ron Otterbacher:
Sure. No, no. We've all got places that we can learn from. We can all do better. One of the first things I look at is where's your HICS, Hospital Incident Command System, set up at? It's probably right within the hospital where you're active shooters taking place. Can you get to it? Can they get to it? Or should we be looking at different components of where to set up our HICS for different scenarios?
Billy Perry:
[Billy] A different if you'll.
Ron Otterbacher:
Yeah, again, it goes back to Travis.
Bruce Scott:
[Bruce] It depends.
Ron Otterbacher:
Yeah, it depends on the situation. But I think a lot of times they do think that we will be in the middle of the hospital incident command system so they can... And I try to explain to them from experience that no, we'll be probably running this whole thing outside the hospital and taking... So what they need to do is send a liaison from the hospital out there so we can keep them updated as to what's going on. But you know, again, we can't tell them what to do on patient care from the public safety side of things.
So we've gotta learn to work together and maybe work together apart, if that makes any sense. Because we won't be standing next to each other and the person we would send into the Hospital Incident Command System, probably a hundred percent of the time won't be the incident commander for public safety. So, you know, we need to understand that. But how can we understand that? We've gotta train with them. We've got to show them. You know, they know how to run their Hospital Incident Command System. They do it all the time, but do they know what to expect from our incident command system or unified command, whatever we wanna call it at that time? Do they know what to expect? Because I think that's part of the issue is we think we know what each other's talking about, but we really don't because we haven't been together to learn it.
Bill Godfrey:
Billy, this has some interesting parallels with trying to work with schools and school administration who have, you know, some legal responsibility for the students here. The hospital has legal responsibility for the patients that were in their care and they've had a criminal event that occur that's disrupted their operations. And now we've got these two elements. And as Otter said, you know, the command post for public safety is gonna be on the exterior. You may or may not be able to access the location in the facility where they planned on setting up their incident command post. But also you've got this issue of how do we work these things together? What are your thoughts about how to effectively coordinate the law enforcement response with the leadership from the hospital who may not be expecting that they don't get to call the shots?
Billy Perry:
There's a lot of similarities between that and a school with one of the big differences. I think one of the things is how do you address that is more importantly when do you address that? And it's before it happens. And I think you need to have an open, candid conversation about that. And I think one of the things like with my school, and I think even before Otter, the administrators may not have understood, law enforcement runs reunification. And reunification is gonna be very different in a hospital. So as a crime scene, your crime scene may have people in it 'cause they're in ICU what a... So I mean there's a lot of different variables that are completely different from a, air quote, "normal," you know, situation. And I think these things have to be talked out and addressed and war gamed before it happens.
Bill Godfrey:
Completely agree. Bruce, you have a tremendous and in addition to your incident management background, a tremendous amount of emergency management experience, including deployments in areas where hospitals are under disaster conditions and have had to be managed and evacuated. What are your insights on this topic with us trying to get our active shooter incident management connected to the hospital's expectations for their incident command system?
Bruce Scott:
I'm gonna start off with a conversation about HICS, right? And not all facilities do it the same way, but generally speaking, I have found that most HICS, Hospital Instant Command Systems, have this very elaborate org chart, right? And it starts with this person needs to be in this box, this person needs to be in this box, this person needs to be in this box. And the problem with that scenario is, what happens if that person's not here? Does the whole set of boxes just continue to not operate?
So that even is more important explaining to our facilities about the incident command system is it expands as necessary. We don't need to fill every box, we just fill the ones we absolutely need to. And to Otter's point, we have to have a conversation with each other. You know, the same thing with schools. Law enforcement owns this small spot where those bad things happen. The school and the hospital own this larger area that they're responsible for. We can't do things apart from each other that potentially could make things worse in those other areas, right? So the conversations have to happen between the incident commander and whoever's responsible for that school. And then understanding that even though hospitals practice HICS, a lot of facilities do not understand that you just don't have to put a person in every box. And then what are you gonna do if somebody's not in that box? Is that fair, Otter?
Ron Otterbacher:
Yes, sir.
Karla Torres:
Hi, I'm Karla Torres, your producer. Thank you for joining us in this week's discussion. If you haven't already, don't forget to like and subscribe and you can also find us on all your favorite podcast platforms. Join us next week in another exciting topic. See you then.