NFPA Releases Standard for Active Shooter/Hostile Event Response Program That May Affect Hospitals

At Issue:
The National Fire Protection Association has published NFPA 3000: Standards for an Active Shooter/Hostile Event Response (ASHER) Program. The new standard provides communities with a tool to develop a coordinated response to community active shooter and hostile events.While the majority of the standard applies to communities in general and not specific types of facilities, there are provisions that hospital and health system leaders and security departments should understand.

Our Take:
Hospitals and health systems should consider participating in community efforts to develop an ASHER program since they are major stakeholders in this type of program. The AHA's American Society for Healthcare Engineering (ASHE) does not anticipate that the Centers for Medicare & Medicaid Services (CMS) will adopt this standard as a condition of participation (CoP), but local communities may use this standard as a method for developing a program.

About the New Standard:

A 46-person multidisciplinary committee, which included representatives from the Federal Emergency Management Agency, Department of Homeland Security, Department of Justice, Federal Bureau of Investigation, International Association for Healthcare Security and Safety, AHA and ASHE, developed the new standard.

The standard seeks to coordinate communications and response efforts during a situation. On several previous occasions, one of the delaying factors reported by first responders and hospitals is that communications between the many responding agencies became difficult to maintain. The NFPA standard places special emphasis on pre-establishing those communications.

The standard provides requirements for any facility within a community that is at high risk. Determining this risk is made by the entity that is responsible for implementation of this standard (e.g. city government). We recommend that hospitals be part of the risk determination discussion as the decision is being made.

Specific facility requirements for high-risk buildings include:

• Individual facility plans must be developed for ASHER. The standard outlines the process for developing the individual facility plan, and is aligned with the requirements for all hazard planning that are part of the Medicare CoPs.

• Notification of building occupants is required. The standard does not dictate the form of that communication and leaves it to the organization to determine the best method. This will allow hospitals to decide if notification is required campus wide, for a single building, or for a single isolated area or team.
  
• The standard requires an annual exercise of the plan. It does not specifically require the entire plan to be exercised, so, at a minimum, key components of the plan should be exercised. Utilizing the all hazards approach of the CMS emergency preparedness CoP exercising portions of the plan should be acceptable as exercising the ASHER plan.
  
• Individual facilities will need to plan on exercising a security sweep of their hospital during or immediately following an event. The intent is to look for any secondary devices that may have been placed with the intent to do harm.
  
• This standard, as well as NFPA 101, the International Building Code and the Americans with Disabilities Act all prohibit the use of manufactured door barricades.
  
• This standard, as well as NFPA 101, the International Building Code and the Americans with Disabilities Act all prohibit the use of manufactured door barricades.
  

What You Can Do:

All hospitals should consider engaging with their community members who will be planning the response to an active shooter/hostile event. During those discussions, it will be important for the hospital representatives to communicate clearly the organization's capabilities and limits so that plans can be made to care for victims. In addition:

• Hospitals should consider sharing the plans they already have in place to respond to an incident so that responders outside the hospital can better coordinate with them.
  
• Hospitals should make communities with ASHER plans aware of the patient privacy laws during a hostile event. You can share this information with stakeholders.
  
• Hospitals should consider educating all staff on the concept of run, hide, fight as recommended in the annex information of NFPA 3000.Although difficult to implement in health care, it is important that all health care staff be as safe as possible during these situations. Staff following these instructions can help save many more lives in such hostile, emergency situations.
  
• Review additional resources on active shooter preparedness for health care facilities, including information from ASHE, The Joint Commission, and a guide from the Healthcare and Public Health Sector Coordinating Council.

AHA's Hospitals Against Violence (HAV) initiative on Friday, June 8 will launch the second annual #HAVhope Day of Awareness to focus national attention on ending violence in our workplaces and communities. This effort focuses on social media platforms using the hashtag #HAVhope. For more information and resources, please visit www.aha.org/HAVhope.

Further Questions:

Please contact Chad Beebe, ASHE deputy executive director, at cbeebe@aha.org or at (312) 422-3824.

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