(Editor’s Note: This article is a collaboration with Michael S. D’Angelo, CPP, CSC, CHPA, a Board Certified Security Consultant specializing in the security of healthcare facilities. He can be reached at michael@securedirection.net,  www.securedirection.net or 786-444-1109. See his biographical information at the end of the article.)

As America continues to endure mass shootings at school, security and law enforcement experts face a monumental task of securing schools and protecting children. The impact of a large number of fatalities is often intensified by a significant number of students and educators who are not fatally injured during the event. Once the shooting has stopped and the event has ended with law enforcement intervention, the ripple effect can equate to a surge of patients being received by local hospital emergency departments and the associated medical facilities.

Suburban, rural, andurban hospital emergency departments consider preparedness needs for mass schoolshootings

Since there is no control as to where the shootings takeplace, there is little that can be done to determine in advance which specifichospital emergency departments are more likely to receive an influx of patientsfrom school shootings. In recent years, school shootings have transpired in urban,suburban, and rural communities. Typically the more populated the city, thebetter equipped emergency and trauma departments will be in hospitals.

Bed availability, staffing, and current patient load willall dictate the level of care a hospital can provide, and ultimately will bepart of the decision making process that determines what hospital(s) patientswill be transported to by first responders. Police, EMS, and fire services willall share in the role of rapid triage and evacuation of patients from theschool scene to local healthcare facilities. Subsequently, with heightenedthreat levels (actual or perceived) following an active shooter event, hospitalstaff will request a larger than usual police presence during patient receiving-furthertaxing already strained law enforcement resources. Multiple hospitals may sharethe burden when mass casualties are involved in a school shooting.

If the already catastrophic event of a school shooting reachesthe level of a mass casualty incident (MCI), it is very likely hospitalemergency response teams will be activated in order to prepare for receiving asignificantly larger amount of patients. These teams will be prepared for notjust a larger than normal quantity of injured victims, but likely victims thatwill be triaged with serious and even life-threatening injuries.  How this is physically established will againdepend greatly on the capacity and capability of the hospital.

Many smaller or rural hospitals may set up their masscasualty triages outside of the main emergency department. Common healthcaresecurity concerns of access control and visitor management become even more ofa challenge when treatment areas are outdoors. Security of the triage area willbe a joint effort between local law enforcement, hospital security teams, andperhaps even members of the hospital’s emergency response team.

Hospital security andemergency preparedness for mass casualty school shooting incidents

Hospital emergency departments can anticipate a rapid influxof first responders bringing victims with varying levels of injuries andmedical needs.  Emergency rooms mayquickly be overloaded.  School officialsmay accompany student victims until parents or legal guardians arrive on scene.Parents and families will likely overwhelm hospital emergency departments andparking lots searching for their loved ones. 

Phone lines will likely be overloaded.  Media, oftentimes including news helicopters,will quickly flood the scene. Demands for public information and continuous updateswill be made by media that often will extend nationally, and in some casesinternationally, in addition to local news outlets.

These and other dynamics suggest the need for hospitalmedical, security, and emergency preparedness in areas including:

• Perimeter security, parking lot security, andtraffic control
• Heightened access control at points of hospitalingress and egress
• Establishment of command posts and staging areas
• HIPPA and other privacy considerations
• Family support staff and planning
• Psychological support and debriefings forhospital medical personnel and support staff
• Training, tabletop exercises, and drills
• Public information staffing, crisiscommunications plans, social media engagement, and communications training forhospital medical and support staff

School shootings can tax even the most prepared hospital emergencydepartments and facilities. While you can never script any crisis in fullbefore it occurs, there are areas for planning and preparedness that can beincorporated into hospital and school emergency planning for a crisis.

Hospital, firstresponder, and school security training and emergency drilling partnerships canhelp strengthen preparedness for a mass shooting

The challenges of a mass school shooting can be addressed,in part, by a greater cooperation and partnerships that expand beyond just havingschools conducting active shooter exercises and trainings. It is commonly recommendedthat schools include their law enforcement jurisdictions in such planning anddrilling.  However, taking that training andplanning several steps further and including EMS services and local hospitalsthat may receive patients from a school based shooting can lead to betterpreparedness for schools, hospital emergency departments, first responders, andpatients and their families.

Michael S. D’Angelo, CPP, CSC, CHPA is a Board Certified Security Consultant specializing in the security of healthcare facilities. In addition to almost a decade in healthcare security management, D’Angelo is a retired Police Captain from the City of South Miami, Florida where he served for over 20 years. He is often called upon by media outlets for his commentary and serves as an expert witness in cases involving hospital security or healthcare workplace violence.  He can be reached at michael@securedirection.net, www.securedirection.net or 786-444-1109.

Kenneth S. Trump, MPA, is President of National School Safety and Security Services (www.schoolsecurity.org), a Cleveland (Ohio)-based national consulting firm specializing in PK-12 school security and emergency preparedness planning. He is currently a doctoral student at Johns Hopkins University where his research focuses on strategic crisis leadership and school administrator communication with parents about school safety issues. Ken has more than 30 years of experience in working with schools and their community partners on school security assessments, emergency planning evaluations, professional development training, tabletop exercises, and expert witness litigation consulting on school safety cases ranging from school active shooters to wrongful death, rape and other sexual assault, child abduction, gang violence, and other security and crisis matters.  He may be contacted at ken@schoolsecurity.org .  Follow on social media @safeschools and www.facebook.com/schoolsafety