Situation Manual
Time Allotted / 220 MinutesSickbay Security – Exercise Play
Exercise Briefing
During the exercise it will be important to remember and comply with the following statements:
· You should only use Internet Explorer as your internet browser for today’s exercise.
· The focus of this exercise is your hospital’s INITIAL RESPONSE to an active shooter incident. The exercise time line begins several hours prior to the shooting then ends 12 hours after the shooting has occurred. The Medical Mayhem – An Active Shooter Consequence Management Exercise picks up where this exercise ends.
· It is important NOT to jump ahead in the exercise scenario. In other words don’t focus on what might happen, focus on the Common Operating Picture that is presented during the exercise to make informed decisions.
· In any exercise a number of assumptions and artificialities may be necessary to complete play in the time allotted. During this exercise, the following apply:
1. The scenario is plausible, and events occur as they are presented.
2. There is no “hidden agenda”, nor any trick questions.
· Exercise Basics:
1. This exercise contains a total of 13 scenario and inject pages.
2. The exercise is self-paced and it should take approximately three hours to complete. However, based on the time spent on each scenario and inject the exercise may be completed in under three hours or it may take much longer than three hours to complete the exercise.
3. There is a scheduled 15 minute break approximately half way through the exercise.
4. All videos embedded within this exercise can be enlarged to FULL SCREEN by simply clicking on the full screen icon in the lower right hand corner of the video.
5. Thoroughly review all scenarios and injects as they are presented during the exercise.
· At the end of the exercise you will need to complete an evaluation (Hotwash) on how your team performed during the exercise. The Hotwash will consist of your team providing comments on three areas in which it performed well (Strengths) and three areas your team will need to improve upon (Areas for Improvement) to enhance its preparedness, response and recovery capabilities. Found below are Hotwash examples:
Strengths – During the exercise our team consulted our disaster plans and procedures and found them to be complete.
Areas for Improvement – During the exercise our team consulted our disaster plans and procedures and found portions of the plans and procedures that need to be revised.
· After the exercise each registered participant who took part in the exercise will receive an e-mail to log into the ONX System to complete their Individual Hotwash to access their Certificate of Participation.
· If you need assistance anytime during the exercise please call the Help Desk at:
Phone Number – 605-475-4700
Account Number – 1076890 #
Time Allotted / 20 Minutes
Sickbay Security – Primer / No Image
Prior to beginning your participation in the exercise please take the time to view the “Decision Making During an Active Threat” video found below.
CLICK ON VIDEO TO PLAY
Just In Time Disaster Training Video Library – Decision Making During an Active Threat – Code Silver
(Note: The Decision Making During an Active Threat video is part of the Just In Time Disaster Training Video Library. Access and save the web site for the video for future use as part of your hospital’s Active Shooter Training.)
Time Allotted / 20 Minutes
Sickbay Security – Scenario – # 001 / Image of Hospital ED
Friday / 2:19PM
It is a normal Friday afternoon for the staff of the Emergency Department (ED). Individuals with a variety of minor injuries along with their family members and friends are patiently waiting to be admitted and treated.
An ambulance arrives transporting a critically injured 43 year old woman, the survivor of a severe car accident. Within moments of the ambulance’s arrival, the hospital’s medical staff is aggressively treating the woman’s life threatening injuries.
Twenty minutes later, the woman’s husband arrives at the ED extremely emotional and distraught demanding to know his wife’s condition. ED staff members attempt to calm the man telling him that his wife is being cared for and the attending physician will be out shortly to speak with him.
Within 40 minutes of arriving at the hospital the woman dies of the injuries she sustained in the car accident.
The ED physician, Dr Thomas, meets with the wife’s husband to inform him that she has died. Upon being told of his wife’s death, the husband explodes in a rage of anger blaming Dr Thomas and the hospital for killing his wife.
The husband then storms out of the hospital shouting that he will make the hospital pay for killing his wife.
Time Allotted / 10 Minutes
Sickbay Security – Inject – # 002 / Image of Notification
The ED staff is accustomed to working with individuals, patients and family members that are distraught and are often agitated or belligerent.
Will your ED staff notify other hospital staff, administration or outside agencies regarding the actions of the husband? / Yes / No
If the above answer is yes. – Identify who will be notified and how the notifications will be made.
If the above answer is no. – Briefly explain why the threatening actions of the husband will not be reported to others.
Time Allotted / 15 Minutes
Sickbay Security – Inject – # 003 / Image of Hospital Safety
Based on the fact that there is a potential threat to the hospital and its staff, will actions be taken to mitigate the possibility of the husband returning to the hospital and following through with his threat? / Yes / No
If the above answer is yes. – Briefly explain the actions that will be put in place to mitigate the current threat.
(Example: Initiate a hospital wide alert.)
If the above answer is no. – Briefly explain why no protective measures will be taken.
Time Allotted / 15 Minutes
Sickbay Security – Scenario – # 004 / Image of Shooter
Friday / 4:37PM
ED operations have continued to function as normal since the earlier outburst. Staff is dealing with a significant patient load. The ED Waiting Area is full and there is currently a two hour wait time to be seen.
With the ED staff focused on evaluating and treating patients no one notices the husband of the car accident victim as he calmly walks into the Waiting Area.
Suddenly the husband begins to shout that he is going to make Dr Thomas and the hospital pay for killing his wife.
He brandishes a handgun and begins shooting his way through the Waiting Area in search of Dr Thomas.
CLICK ON VIDEO TO PLAY
Video Library – General # 1 – Video # 31 – Active Shooter – Hospital
Time Allotted / 10 Minutes
Sickbay Security – Inject – # 005 / Image of ED Response
Hospital staff, patients, visitors and others are shocked to hear gun shots echoing through the ED. Some people begin to take cover while others are unsure as to what to do.
Describe in detail the immediate protective actions that will be taken by ED staff based upon the current circumstances.
(Note: By immediate protective actions, describe what will need to happen in the first five minutes to ensure the safety of individuals.)
(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on the Hospital Active Shooter Safety / Response. This video is too long to view during today’s exercise. Hospital Active Shooter Safety / Response) – OPTIONAL
Time Allotted / 20 Minutes
Sickbay Security – Inject – # 006 / Image of Wounded Individuals
As the man continues shooting, multiple hospital staff, patients, visitors and by-standers are shot. He has been seen reloading his gun several times.
Within four minutes of a call being made to 9-1-1 law enforcement officers begin to arrive at the hospital.
Describe in detail how hospital staff will interface with arriving law enforcement during the initial response to the shooting.
Identify any resources such as floor plans, master keys, proximity badges, etc. that will be provided to law enforcement upon their arrival.
Time Allotted / 20 Minutes
Sickbay Security – Inject – # 007 / Image of Panic
As law enforcement continues to arrive, knowledge of the shooting incident spreads throughout the hospital. Hospital staff, patients and visitors in other wings of the hospital begin to panic.
Describe in detail the actions that will be implemented to ensure the safety of individuals that are currently at the hospital.
(Example: Hospital security and others will implement the hospital’s lockdown procedures.)
Time Allotted / 20 Minutes
Sickbay Security – Inject – # 008 / Image of Law Enforcement
Friday / 4:59PM
As law enforcement initiates its tactical response they come across multiple individuals who have been wounded or killed by the shooter. Law enforcement finds the shooter barricaded in one of the examination rooms and begins to negotiate his surrender.
While law enforcement negotiates with the shooter the hospital will need to focus its efforts on a number of internal issues.
(Note: At this point the Hospital Incident Command System has not been implemented.)
Identify and describe the various internal issues that the hospital will have to deal with, along with identifying the hospital position that will be responsible for taking action regarding the issue.
(Note: Remember that it is 4:59PM and the shooting began approximately 20 minutes ago.)
(Example: Issue: Due to the shooting the ED is unavailable and the hospital will need to implement its Hospital Diversion Plan. / Responsibility: ED Director.)
Time Allotted / 30 Minutes
Sickbay Security – Inject – # 009 / Image of HICS
As law enforcement continues to negotiate with the shooter, will the hospital shift the management of its response from the ED staff to the Hospital Incident Command System (HICS)?
(Note: For future reference you may want to access the Just In Time Disaster Training Library for additional information on the Hospital Incident Command System. This video is too long to view during today’s exercise. Hospital Incident Command System) – OPTIONAL / Yes / No
If the above answer is yes. – Identify the title of the individual that will be responsible for making this decision.
Briefly describe the process for notifying and mobilizing the necessary staff that will be needed to establish HICS.
(Note: By now it is early Friday evening.)
If the above answer is no. – Briefly explain why the hospital will not implement HICS at this time.
Time Allotted / 15 Minutes
Sickbay Security – Scenario – # 010 / Image of Injured By-Standers
Friday / 6:37PM
After a standoff lasting almost two hours the man fatally shoots himself.
In the wake of the shooting rampage 9 hospital staff members, 3 bystanders along with 2 patients have been killed with another 14 individuals injured.
(Note: If your hospital has a small number of employees, for exercise purposes assume that no more than 10% of your hospital’s staff were killed or injured.)
Time Allotted / 10 Minutes
Sickbay Security – Inject – # 011 / Image of Hospital Command Center
The decision has been made to fully implement the hospital’s Emergency Operations Plan (EOP) and establish HICS. Staff members that are assigned to the various ICS positions have been arriving at the hospital’s Incident Command Center for the past 15 minutes.
Identify the individuals that will fulfill the various ICS positions and briefly describe the responsibility of each position.
(Example: Public Information Officer: June Carter – Will serve as the point of contact for all media inquiries, prepare appropriate media advisories and press releases as well as monitor news outlets including social media.)
Time Allotted / 20 Minutes
Sickbay Security – Inject – # 012 / Image of Incident Action Plan
Friday / 7:43PM
The majority of the incident command staff has arrived at the command center. One of the first actions that will need to occur will be to prepare a prioritized checklist known as an Incident Action Plan (IAP) focusing on the IMMEDIATE RESPONSE issues now confronting the hospital.
CLICK ON VIDEO TO PLAY
Video Library – General # 1 – Video # 5 – Incident Action Plan
Develop an IAP focusing on the actions to be taken over the next 12 hours. In preparing the IAP list the objectives; identify all resources that will be needed to accomplish each listed objective; and list the expected timeline to complete each identified objective.
(Example: Objective: Assign a liaison to each of the agencies responding to the incident. / Required Resource: Assigned staff should have a working knowledge of the hospital’s EOP along with an understanding of the agency to which they are assigned. / Timeline: 1 Hour.)
Time Allotted / 30 Minutes
Situation Manual – Tabletop Exercise 16 Disaster Resistant Communities Group – www.drc-group.com