Download ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.) SYNOPSIS

ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
SYNOPSIS
Mitigation Dynamics, Inc. (MDI) has prepared a series of documents specifically related to hospitals, with the intent to
offer suggestions to consider for implementation while creating a policy related to an armed violent intruder. The various
elements contained within the attached Armed Violent Intruder Response (A.V.I.R.) Policy Template and appendices are
products of MDI’s “real world” critical incident problem solving experience. Based on that experience, we know that
policies and procedures that dictate “always and never” quickly become obsolete when unpredictable, dynamic
circumstances are present, such as an active shooter. As a result, MDI strongly subscribes to principally based products
and services with this endeavor being no exception.
The policy portion of the enclosed documents is intentionally simplistic and direct. Policies such as this do not need to
consist of multiple pages in order to be efficient and effective. Relative, direct information, supported by other principally
based documents have been tested and proven under the scrutiny of “real world” conflict.
Additional appendices included with this A.V.I.R. Policy Template series such as the Quick Response Guide, Out
Principles and R.A.L.M. Principles are designed to serve as the foundation for the overall, collective response portion of
the policy template. In other words, the three appendices are the “meat and potatoes”. Realistically, hospital staff is not
likely to review the policy more than once annually or during an incident. Therefore, we encourage the dissemination of
the one page Quick Response Guide to all hospital staff. The Quick Response Guide contains all relative policy
information, as well as personal tools that will likely engage the employee so that they are able to make informed
decisions, should they ever encounter an armed violent intruder.
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ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
(Sample Policy)
POLICY
Statement of Policy:
All hospital staff will receive training regarding how to respond to an Armed Violent Intruder(s).
Purpose:
The purpose of this policy is to provide guidance to staff in response to an armed violent intruder.
Historically, armed violent intruder incidents are dynamic in nature and quickly jeopardize the
welfare of patients, visitors, physicians and staff. The continuity of service throughout various
departments within the hospital will be jeopardized as a result. Therefore, these types of incidents
require an immediate, collaborative response on behalf of all staff and physicians.
The spirit of this policy is to offer principally based personal tools and protocols to assist all staff
and physicians with the appropriate response based on each unique circumstance.
Definitions:

Armed Violent Intruder: A person(s) who is on hospital property who has the means (weapon),
opportunity (patients, visitors, physicians and staff) and apparent intent (thought process) to
carry out the act of violence against another person(s), which may result in serious physical
injury or death.

Out Principles: A series of reactive principally based action steps, designed to be utilized by an
individual as a Quick Response Guide to assist with proper decision making when the threat of
an armed violent intruder(s) exists within their immediate area.

Restricted Access / Limited Mobility (R.A.L.M.) Principles: A series of proactive principally
based action steps, designed to restrict and/or limit the mobility of an armed violent intruder(s)
within the confines of hospital property (exterior or interior).
PROCEDURE
Response: All Staff
Upon recognition of an armed violent intruder, hospital staff shall initiate designated emergency
notification protocol. The objective is to warn as many persons as possible that an armed violent
intruder may be in close proximity to them.
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Implementation:
The first staff member to identify an armed violent intruder should, when safe and practical, call the
hospital emergency number (____)* and provide the following information:







Nature of the incident
Location of the incident
Number of intruder(s)
Physical description of intruder(s)
Top to bottom (gender, Race, Hair, Facial Hair, Hat, Shirt, Pants, Shoes, etc.)
Quantity / type of weapon(s) involved (pistol – small gun / rifle – long gun / knife, etc.)
Last known location and direction of travel
* Alternative emergency contact number dial 911 or applicable emergency law enforcement contact
number
Operator
 Upon receiving information that an armed violent intruder is present, immediately notify hospital
staff. (Examples: Overhead P.A., paging system, text alert, audible warning device, etc.)
 Overhead page example: “YOUR ATTENTION PLEASE. (CODE _______)** announce last
known location of the armed violent intruder. Note: Repeat announcement three (3) times.
 Be prepared to provide armed violent intruder location updates as received.
 Dial 911 or applicable emergency law enforcement contact number and provide the following:
o
Nature of the emergency (armed Intruder, active Shooter, person with gun / knife, etc.)
o
Location of emergency (address or last known location within facility)
o
Description of intruder (gender, race, hair, facial hair, hat, shirt, pants, shoes)
o
Do NOT disconnect with 911 unless instructed to do so, or your safety dictates otherwise.
 Contact Security and confirm that they are aware of the armed violent intruder
 Contact Administrator on Call (AOC) and confirm that they are aware of the armed violent
intruder.
 Secure immediate work area, utilize Quick Response Guide and Out Principles (Appendix A/B)
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** The Joint Commission recommends the use of Code Silver for an Armed Violent Intruder.
Security Department
 Security Officer (Armed) should respond according to their training protocols.
 Security Officer (Unarmed) should respond according to their training protocols.
 Initiate Restricted Access / Limited Mobility (R.A.L.M.) Principles by securing access points in an
attempt to isolate the incident. (R.A.L.M. Principles, Appendix C)
 Security Officer response recommendations (Appendix D)
All Employees
 Utilize the Quick Response Guide and Out Principles. (Appendix A/B)
 Remain calm and assure those in your presence that the hospital’s emergency plan has been
implemented.
Hospital Incident Command
 Refer to the Mitigation Dynamics, Inc. (MDI) Armed Violent Intruder Response (A.V.I.R.)
ICS – Action Step Series.
Incident Deactivation
 At the direction of law enforcement officials and/or the Incident Commander an “All Clear”
announcement will be made upon the termination of the incident.
Debriefing
 Following the resolution of the incident, a debriefing will be conducted to assess the cause of,
response to and the outcome of the incident. The debrief should include all staff that was involved,
as well as representatives from other agencies that responded. The debrief should be conducted
within 48-72 hours of the incident.
Post Incident Follow Up
 Provide mental health support for all involved patients, family, visitors, physicians and staff who
wish to participate. Note: All staff should attend an EAP post incident evaluation.
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Recognizing Signs of Potential Workplace Violence:

An armed violent intruder may be a current or former employee. Alert your supervisor, security, and
human resources department if you believe an employee exhibits potentially violent behavior. Indicators
of potentially violent behavior may include one or more of the following:
o
o
o
o
o
o
o
Increased use of alcohol and/or illegal drugs
Unexplained increase in absenteeism, and/or vague physical complaints
Depression/withdrawal
Increasingly severe mood swings, and noticeably unstable or emotional responses
Increasingly talks of problems at home (relationship(s))
Increasingly talks about topics related to being a victim of stalking or threats
Increase in unsolicited comments about violence, firearms or other dangerous weapons/violent
crimes
o When in doubt...error on the side of caution and make proper notification
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ARMED VIOLENT INTRUDER
APPENDIX A
QUICK RESPONSE GUIDE
QUICKLY DETERMINE THE MOST REASONABLE WAY TO PROTECT YOUR OWN LIFE.
PATIENTS AND VISITORS ARE LIKELY TO FOLLOW THE LEAD OF EMPLOYEES AND MANAGERS.
1. FIGURE Out
·
·
2. GET Out
Where is the danger?
What type of danger?
5. KEEP Out
·
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·
·
Block Entry
Lock & barricade doors
Create layers of obstacles
DO NOT re-enter the area
until safe to do so or
as directed
·
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·
6. HIDE Out
·
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·
·
3. CALL Out
·
·
·
Have an escape route & plan
Leave your belongings behind
Keep your hands visible
Call for help
Alert others in immediate area
When you arrive at a safe location
call 911 (give location, etc.)
7. TAKE Out
·
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·
·
·
Keep silent & silence cell phone
& pager
Hide out of view
Turn out lights
Block windows & door view
panels
USE AS A LAST RESORT *
Try to incapacitate the intruder
Distract intruderr by any means
Act with aggression
Commit to your actions
4. SPREAD Out
·
·
Avoid gathering in groups
Don’t crowd exits or doorways
8. HELP Out
·
·
·
Assist with others
(patients, wounded)
Assist with evacuations
Help Law Enforcement /EMS
* Personal Choice
RESTRICTED ACCESS / LIMITED MOBILITY
"R.A.L.M. PRINCIPLES"
NOTE: IF AN ARMED VIOLENT INTRUDER IS IN YOUR IMMEDIATE AREA, IMMEDIATELY UTILIZE THE
"OUT PRINCIPLES".
R.A.L.M. PRINCIPLES: A SERIES OF PROACTIVE PRINCIPALLY BASED ACTION STEPS, DESIGNED TO
RESTRICT/LIMIT THE MOBILITY OF AN ARMED VIOLENT INTRUDER(S) WITHIN THE CONFINES OF THE
HOSPITAL PROPERTY (EXTERIOR OR INTERIOR)
RESTRICT ACCESS
·
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·
·
·
LIMIT MOBILITY
·
Attempt to secure primary entrance points to the facility
Anticipate possible path of intruder / secure entrance points
accordingly
Secure access points to your immediate area of operation
Notify others (in proximity) of your actions
Ask for Assistance to quickly complete tasks
·
·
·
·
·
Anticipate possible path of intruder / secure entrance points
accordingly
Close doors (hallway, patient, office, etc)
Create multiple “layers” of objects / barriers
Hinder access, move objects (beds, chairs, tables, etc.) to
create physical barriers
Notify others (in proximity) of your actions
Ask for assistance to quickly complete tasks
HOW TO RESPOND
WHEN LAW ENFORCEMENT ARRIVES ON THE SCENE
1. HOW YOU SHOULD REACT WHEN LAW ENFORCEMENT ARRIVES:
·
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·
·
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Be prepared for police to point a weapon
at you
Remain calm, and follow officers’ instructions
Calmly raise hands and spread fingers
Keep hands visible at all times
Avoid pointing, screaming and/or yelling
·
Avoid making quick movements toward officers
·
DO NOT attempt to hold on to officers for safety
·
DO NOT ask officers for help or direction when evacuating;
just proceed in the direction from which officers are entering
the area
2. INFORMATION YOU SHOULD PROVIDE TO SWITCHBOARD, 911 OPERATOR, SECURITY, OR LAW
ENFORCEMENT:
·
·
·
Location of the intruder
Number of intruders, if more than one
Physical description of intruder(s)
© 2011 Mitigation Dynamics, Inc. All Rights Reserved
·
·
Number and type of weapons held by intruder
Number of potential victims at the location
ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
(Appendix B)
Out Principles
Out Principles are a series of reactive principally based action steps, designed to be utilized by an individual as a
Quick Response Guide to assist with proper decision making when the threat of an armed violent intruder(s)
exists within their immediate area.
The spirit of the Out Principles is to provide an individual with personal tools that will assist them in making an informed
decision when reacting to the immediate threat of an armed violent intruder. Although the principles are flexible, they are
listed sequentially to maximize the potential of prevailing against the intruder. If circumstances exist that allow an
individual to prevent a potential threat from entering the immediate area they are in, than that should be their first priority.
Taking steps to secure doors to key access points surrounding an individual's immediate area will most effectively assist
with limiting the movement and/or progression of an intruder and will likely assist with isolating the intruder and/or
incident; ultimately increasing the level of safety for patients, visitors, physicians, and staff.
The Out Principles are based on extensive first hand experiences involving "real world" critical incident problem solving
and numerous debriefs of such incidents throughout the world. Therefore, the elements contained within the Out
Principles are based on how an armed violent intruder acts and/or reacts to various circumstances they are confronted
with. BOTTOM LINE: If "you" are not the primary "target" and there are various layers or barriers in place that will
slow down or hinder the intruder from reaching your location, the intruder will likely move to a lesser path of resistance.
REMEMBER: The intruder is under duress, they know that security and/or police will be responding soon, therefore
they will want to move quickly and as efficiently as possible to carry out their objective.
Out Principles
FIGURE Out
 What is happening?
 What type of danger exists?
o Is it a disturbance, combative person or an armed violent intruder?
 Is the intruder near (immediate work area) or far (another floor or building)?
 Determine the safest response based on the apparent circumstances
 Evacuate “GET Out” or shelter in place “KEEP Out, HIDE Out”
GET Out
 If an intruder is close to you, make every attempt to leave the area and get to safety
 Have a pre-planned escape route with a minimum of two areas of exit from your work area
 Consider leaving the immediate and/or potential threat area regardless of others (Time is limited…Act!)
 Coordinate exit and/or safety strategies with co-workers
 Mentally “map out” your exit strategy
 Leave your belongings behind
 Help others if possible and /or practical
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CALL Out
 Notify others in your immediate area that an intruder exists
 Call for help from a position of safety, if possible
 Dial emergency response number to alert security and/or police of the intruder’s location
 If you cannot speak, leave the phone line open and allow the dispatcher to listen
Information to provide to law enforcement or hospital operator:
 Location of the intruder
 Number of intruder(s) (if more than one)
 Physical description of intruder(s)
 (gender, race, hair color and length, facial hair, hat, shirt, pants, shoes)
 Quantity and type of weapons possessed by the intruder(s)
 knife, pistol, shotgun, rifle
 Quantity of victims at the location
SPREAD Out
 Avoid gathering in large groups
 Make yourself a smaller “target”
 Don’t crowd exits or doorways
 Avoid doors that take keys or key code, if possible
KEEP Out
 Lock or secure any door that may create a barrier between you and the intruder
 Block the doors or access points with heavy furniture if possible and as time allows
 Move furniture and/or objects to create a barrier and hinder movement
 Objective is to hinder the movement of the intruder
 Attempt to establish multiple “layers” of objects and/or barriers between you and the intruder
HIDE Out
 If evacuation is not possible, find a place to hide where the intruder is less likely to find you
 Try to stay out of the intruder’s view
 Hide behind large cabinets, underneath desks, inside restrooms (in stalls and on top of toilet), etc.
 Try to not trap yourself or restrict your options for movement if possible
 Remain quiet
 Silence your cell phone (vibrate feature may still be too loud)
TAKE Out
 THIS IS A PERSONAL CHOICE/ LAST RESORT
 If your life or someone else’s life is in imminent danger or threat of great bodily harm, consider taking
action against the intruder
 Commit to your actions
 Act as aggressively as possible
 Distract by throwing objects (chairs, books, stapler, lamps, etc.)
 Consider the use of improvised weapons to incapacitate the intruder (pen, scissors)
 You may have a better chance of survival if you fight
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HELP Out
 If you are physically able, assist with helping others in need of assistance
 Provide aid within your scope of training
 Law Enforcement and EMS will be on scene shortly to assist with evacuation and medical needs
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ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
(Appendix C)
Restricted Access / Limited Mobility (R.A.L.M)
R.A.L.M. Principles are a series of proactive principally based action steps designed to restrict the access and limit the
mobility of an armed violent intruder(s) within the confines of the hospital property.
The spirit of the R.A.L.M. Principles is to provide an individual with personal tools that will assist them in making an
informed decision when proactively responding to the threat of an armed violent intruder. Although the principles are
flexible, they are listed sequentially to minimize the effect of a potential threat(s) on the exterior of the hospital first, and
the areas within the hospital secondly; ultimately working from an "outside-in" mindset. If circumstances exist that
allows "us" to prevent a potential threat from entering the hospital, than that should be "our" first priority.
Securing doors to pre-identified key access points will most effectively assist with limiting the movement of an intruder.
In addition, these actions will likely assist with isolating the intruder / incident, ultimately increasing the level of safety for
patients, visitors, physicians and staff.
The R.A.L.M. Principles are based on extensive first hand experiences involving "real world" critical incident problem
solving and numerous debriefs of such incidents throughout the world. Therefore, the elements contained within the
R.A.L.M. Principles are based on how an armed violent intruder acts and/or reacts to various circumstances they are
confronted with. BOTTOM LINE: If "you" are not the primary "target" and there are various layers or barriers in place
that will slow down or hinder the intruder from reaching your location, the intruder will likely move to a lesser path of
resistance. REMEMBER: The intruder is under duress, they know that security and/or police will be responding soon,
therefore they will want to move quickly and as efficiently as possible to carry out their objective.
Restrict Access





Attempt to secure primary entrance points to the hospital
Anticipate possible path of intruder and secure entrance points accordingly
Secure access points to your immediate area of operation
Notify others (in proximity) of your actions
Ask for assistance to quickly complete action steps (this can be anyone capable of assisting)
Limit Mobility






Anticipate possible path of intruder and secure entrance points accordingly
Close doors (hallway, patient, office, etc.)
Create multiple “layers” of objects and/or barriers ("anything goes")
Hinder access by moving objects (beds, chairs, tables, etc.) to create physical barriers
Notify others (in proximity) of your actions
Ask for assistance to quickly complete action steps (this can be anyone capable of assisting)
NOTE: If an armed violent intruder is in your immediate area, utilize the Out Principles (Appendix B).
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ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
(Appendix D)
Security Considerations
Each hospital has many different variables relating to the capabilities of security. While it is important to define the role,
scope, and expectations of the security component as it relates to the hospital response policy; it is not practical to create a
security template that would appropriately address all factors related to each hospital or their relative Armed Violent
Intruder Response (A.V.I.R.) policy. Therefore, the purpose of this appendix is to simply offer considerations for
implementation when creating a policy.
Typically, the Security Officers’ responsibility is prevention before an incident and/or offense occurs, therefore security
staff should be highly visible. By being seen, the security officer may discourage anyone who may consider theft,
property damage, or personal injury to others. A security officer’s job is prevention. To do their job well, a security
officer must: be alert, listen, and observe.
Security Director
 Confirm law enforcement has been notified of incident
 Establish contact with AOC and/or Incident Commander

Be prepared to respond to the Hospital Command Center

Be prepared to fulfill Security Section Chief role (see: A.V.I.R. ICS – Action Step Series)

Be prepared to relinquish command to law enforcement upon request
Security Officer (Armed)
 Immediately respond to the threat location, determine if circumstances dictate that an on-going life threatening
situation exists, evaluate the totality of circumstances, and stop the threat (if applicable).
Security Officer (Not Armed)
 Confirm law enforcement has been notified of incident
 Utilize Out Principles (Appendix B) if in immediate area of threat
 Utilize R.A.L.M. Principles (Appendix C) if not in immediate area of threat
 May be assigned to Incident Command
 May be assigned to assist with the movement of injured to areas for treatment or evacuation
 May be assigned to assist law enforcement

Information gathering

Identification of witnesses
 Will complete a report detailing actions at conclusion of incident