ACTIVE SHOOTER TABLETOP DISCUSSIONBASED EXERCISE Presenters Name Office

ACTIVE SHOOTER TABLETOP DISCUSSION-BASED EXERCISE Presenter’s Name Office or Department Name 10/29/2020

NOTES ON USING THIS TTX TEMPLATE • This TTX template is to be used in conjunction with the Active Shooter Drill film (Total Run Time: 00: 17: 25). • Please refer to comments at each Slide Notes (bottom) if applicable. Delete upon completion of editing the TTX. • This TTX can be modified to fit your organization/department and can be used with your organization/department Power. Point template. Feel free to replace pictures relevant to your geographical area and institution. Please ensure that UCSF Medical Center + UCSF Benioff Children’s Hospital is given professional credit. • Any questions and/or concerns, please contact Jordan Cathey, Emergency Exercises + Trainings Manager at jordan. cathey@ucsf. edu

AGENDA • 00: 00 – 00: 00 P. M. Welcome & Introduction • 00: 00 – 00: 00 P. M. Tabletop: Scenario 01 + 02 • 00: 00 – 00: 00 P. M. wash • 00: 00 P. M. Adjourn Hot

FACILITY DETAILS § Please set phones and pagers to vibrate § Please exit the room if you need to take a call § Restrooms

WHAT IS A TABLETOP (TTX)? § A tabletop exercise is a facilitated analysis of an emergency situation in an informal, stress-free environment. It is designed to elicit constructive discussion as participants examine and resolve problems based on existing operational plans and identify where those plans need to be refined.

PURPOSE § To prepare for a coordinated response to an active shooter within the functional areas of Safety and Security, Communication, Resources and Assets, Staff Responsibilities and Patient Clinical and Support Activities.

OBJECTIVES § Ensure effective communications to staff; patients; visitors; UCSF community; local authorities; and the public. § Ensure proper resources and assets are readily available. § Safety and Security of the facility and of all staff, patients, and visitors will be established. § Staff will be knowledgeable about their roles and responsibilities along with clear reporting structure. § Amplify exemplary patient clinical and support activities.

WHY EXERCISE? § In a state of emergency, people don't want to go places they haven't gone before, or use devices they've never seen.

EXPOSURE/EXPERIENCE § Importance to be exposed to this scenario to test out possible procedures and to problem solve appropriately during an actual emergency incident/event.

TABLETOP PARTICIPANTS § Insert

ASSUMPTIONS + ARTIFICIALITIES § The scenario is plausible and events occur as they are presented § All participants understand the any section specific active shooter plans, procedures, and protocols § There are no “hidden agendas” or any trick questions § All participants receive information at the same time § Participants should assume that all jurisdictions are implementing their plans, procedures, and protocols

ROLES – PLAYERS § Players: Respond to the situations as presented based on experience and knowledge as well as the current plans and procedures within their community or agencies

ROLES – THE FACILITATOR § The Facilitator: Provide situation updates and moderate group discussions. Also provide additional information or resolve questions as required.

ROLES – THE EVALUATOR(S) § The Evaluator(s): Exercise participants who observe and document those actions and decisions of the players that are directly related to the exercise objectives.

TABLETOP GROUND RULES § The Evaluator(s) will be evaluating the system and NOT the Player § The Facilitator is responsible for facilitating the discussion and does not have all the answers § Mistakes are going to happen and is part of the learning process of a successful tabletop § Varying viewpoints even disagreements are expected. This exercise is intended to be an open low stress environment § The exercise setting is the ideal opportunity to consider different approaches and suggest improvements to current resources, plans, and training § Responses should be based on current plans and capabilities and insights derived from any trainings § You are never alone, decisions can be made mutually. Teamwork!

INTRODUCTION

BACKGROUND § 12: 00 PM § Business as usual for UCSF Medical Center § No relevant weather conditions: Forecast calls for 65 degrees

THREE PHASES § Phase I: The Incident § Phase II: The Response § Phase III: The Recovery

PHASE I – THE INCIDENT

PHASE I – THE INCIDENT § 12: 00 P. M. • Male, mid 40’s, angry and intent to shooting his wife and child in the Mission Bay Emergency Department

PHASE I – THE INCIDENT QUESTIONS 1. What should staff do to protect themselves and other in regards to an active shooter incident? 2. What communications (phone, vocal), if any, should be made? 3. If not confronted by the "Active Shooter" should you continually try and find a way out or stay in place? 4. If directly confronted by the “Active Shooter” what would you do to protect yourself and possibly others?

PHASE II – THE RESPONSE

PHASE II – THE RESPONSE § 12: 15 P. M. • Law Enforcement arrives and injures the "Active Shooter, " sweeps the floor for any secondary shooter. • Law Enforcement gives instructions to staff (i. e. , hands-up) and deems the area as a crime scene.

PHASE II – THE RESPONSE QUESTIONS 1. Identify who is in charge: Law Enforcement? 2. Identify who is in charge: Your Department? 3. What is the role of the person in charge of your department? 4. What should be done to the "Active Shooter" once they are in custody and is injured? 5. Once the area is deemed a “Crime Scene” how should the area be evacuated? 6. How should your/patients personal belongings be handled? 7. Where is your primary assembly point? Secondary assembly point?

PHASE III – THE RECOVERY

PHASE III – THE RECOVERY § 12: 20 P. M. • AMR arrives and transports patient • Staff are evacuated at the primary assembly point • Casualties: 6 including Security Officer (1), Nurses (3), and Wife and Child (2); Injuries: Numerous including the Active Shooter. No damage reported to the facility

PHASE III – THE RECOVERY QUESTIONS 1. Can you describe what the “Active Shooter” looks like? What were they wearing? Describe them. 2. When/How should interviews be conducted? Group, one-on-one? 3. When/Where should HICS and Spiritual Care be activated to assist staff? 4. How are patients to be triaged? How are they tracked? 5. What should be done to manage family/visitors of patients? 6. What should be done for traffic control? The media? Worried Well?

SCENARIO 02 § 1: 00 P. M. • UCSF Medical Center staff, Male, mid 40’s, angry and intent to shooting his coworkers and patients; has completely lost it.

SCENARIO 02 QUESTIONS 1. What makes this scenario different from the first knowing that it is one of your coworkers? 2. Would Run, Hide, and/or Fight be different? Would you want to negotiate if you knew the staff person that is the Active Shooter? 3. How would you determine signs of potential violence from staff and when would you report it and to who? 4. How does the person reporting this behavior to staff protected as well as other staff? 5. How is potentially violent staff confronted before anything is to occur? 6. How and when would Spiritual Care be initiated? 7. How can the rumor mill be contained?

HOT WASH § Discussion of major issues: what worked, challenges, and suggestions for improvement

THANK YOU Please fill out your Evaluation – your input is invaluable.