In the Cross- hairs: Active Shooter Event After Actions

In the Cross- hairs: Active Shooter Event After Actions Christopher Hunter, MD, PhD, FACEP, FAEMS Director, Orange County Health Services Department Associate Medical Director, Orange County EMS System Medical Director, Orlando Health Air Care team

Contents The Incident CISM EMS Hospital Staff Summary Suggestions

The Incident An active shooter followed by a hostage scenario

The A8ack

Patient Distribution Scene (41) 39 in club 2 collection point Transported (57) 46 ORMC 15 by police 11 FHO Walk- in/pov (9) 3 ORMC 2 DPH 1 WPH 3 FHE

The Aftermath The deadliest shooting in modern United States history The worst attack on LGBT community in documented history The deadliest terror attack in the United States since September 11, 2001 First use of Facebook safety check in United States history

The Aftermath

Critical Incident Stress Management Structured, interventional protocol for dealing with traumatic events Developed by military for combat o Debriefing o Diffusing o Grief and Loss Session o Crisis Management Briefing o Critical Incident Adjustment support o Pre-crisis Education

Critical Incident Stress Management Debriefing: proactive intervention involving a group meeting/discussion about the critical incident. Designed to mitigate the impact assist in recovery from the stress associated with the event. Facilitated by a specially trained team which includes professional and peer support personnel. Should be conducted between 24 and 72 hours after the incident Defusing: shorter, less formal version of a debriefing. Best conducted within one to four hours after a critical incident. Like a debriefing - it is a confidential and voluntary opportunity to learn about stress, share reactions to an incident and vent emotions. The main purpose is to stabilize people affected by the incident so that they can return to their normal routines without unusual stress

Critical Incident Stress Management Grief and Loss Session: structured group or individual session following a death and assists people in understanding their own grief reactions as well as creating a healthy atmosphere of openness and dialogue around the circumstances of the death Crisis Management Briefing: large, homogeneous group intervention used before, during and after crisis to present facts, facilitate a brief, controlled discussion, Q & A and info on stress survival skills and/or other available support services Critical Incident Adjustment Support: multi-faceted humanitarian assistance to individual, families or groups for coping with the aftermath of an incident and overcoming the ongoing impact of a death or injury Pre-Crisis Education: provides a foundation for CISM services. Includes incident awareness, crisis response strategies and develops stress management coping skills that can prevent major problems should an incident occur. Could be an employee handbook, e-book and/or workshops and training seminars.

Critical Incident Stress Management Why is it important? Who is going to do it? o Internal o External (Comfort K9s, IAFF, FBI, etc.) Timing o Immediate ability to answer the next call o Short term debriefing o Long term - support Unanticipated Concerns o Those that weren t called to action (guilt, jealousy, frustration) o Background support staff (janitorial, dispatch, administrative staff) o Unrelated psychiatric patients (generalized community anxiety)

After Action: EMS Orlando Fire Department Held three Critical Incident Stress Debriefings, one for each shift, jointly with RMA Union brought in IAFF Peer Support Team o Arrived June 13 th o Followed up throughout first month o Trained members of OFD s peer support team Formed Partner ship with University of Central Florida Restores o Clinical Research center focused on PTSD Prepare for 6 month and one year anniversary dates Met with FDNY, Boston Fire, OCFR, OFD officials

After Action: EMS Rural Metro Ambulance/American Medical Response Crews met with management team immediately following event for evaluation Off-duty crews called All crews attended critical incident stress debriefing on June 13 th Many attended OFD CISDs as well Crews were allowed to participate in press conferences and appreciation ceremonies

After Action: EMS Orange County Fire Rescue Maintains a wellness coordinator and 20 trained peer support team members Set up center at ME Office with 4 clinicians and 5 peer support members by late morning Held mandatory debriefing on 6/13 for all on-scene staff Worked with individuals Offered support to administrative and non-first response staff three weeks later

After Action: Hospital Orlando Health Employee Assistance Program Began offering counseling by 8am on June 12 th o One on one and groups o Sessions held during night and day shifts Served >1,200 staff members Administration o Leadership rounded several times daily to approach staff for wellness Graduate Medical Education o Emergency Department residency debrief with counselors held June 14th

After Action: Medical Examiner Response to mass fatality Among only non-law enforcement officers to enter the club Offered grief counseling Held debriefing on June 15th o Support animals Held Appreciation meeting on June 16 th o Governor o Mayor

After Action: Office of the Medical Director/ESF- 8 Staffed Family Reunification Center Provided support for HAZMAT clean-up and evidence collection Offered grief counseling Held internal CISD Treated as other first responders for appreciation ceremonies

After Action: Communications Public Information Officers Held joint-agency debrief Utilized support animals Offered Counseling through Orange County

After Action: Community Over 950 served at community center Increased access to crisis assistance and mental health programs across the county Cooperate Generosity o Walt Disney World o Anderson Cooper o Rascal Flats o Local restaurants o Healthcare centers from around the world

Community Support

Summary The attack had far-reaching consequences on the emergency response community from law enforcement and EMS, to hospitals and support staff After action plans consisted of critical incident stress management and psychological support Outside agencies from county, state, federal, and non-profit organizations descended on Orlando and provided massive support

Suggestions Get to know your local and national resources Make sure you have plans in place to support unanticipated needs Most managers indicated they wished they spent more on-on-one time with those affected Be prepared for long-term issues