Thirteen years after Columbine, what have we learned about school shootings?

 Are we any further ahead at preventing school shootings today than we were in 1999?

Our prayers are with the victims, survivors, and rescuers...

Newtown CT joined the ranks of the those communities devistated by a school shooting event  on December 14, 2012 when a 20-year-old carries out shooting event at an elementary school. The lone attacker is reportedly to have fatally shot his mother as she slept, stealing two pistols and one rifle, prior to going to the Sandy Hook Elementary School.


According to media reports, he forced entry, easily defeating school security systems, by shooting out a window and proceeded to shoot two school administrative staff and children in a first grade class. All the children were between six and seven-years-old. Authorities are reporting a total of 20 children and 7 adults murdered.

It’s sad to say it and hard to hear it. It's even harder to understand. Sadly, it is a topic we've visited many times in this blog and podcast. We've discussed active shooter events and civilian soft targets as much as we've talked about chemical and biological weapons.

We most recently spoke on this topic after the Aurora Colorado movie theater shootings. Our opinions are the same today as they were after that tragedy. The liberal left and conservative right have it all wrong when it comes to finding causes and preventing similar active shooter events. (listen to MJ 238 Aurora CO Movie Shootings - Why we’ve got it all wrong) Stricter gun control will not solve this issue. More people with guns will not prevent future attacks.

Commonalities in active shooter events

• Civilian soft target remain the location of choice. Hospitals also remain at risk with once such active shooter event taking place almost simultaneously at a hospital in Birmingham, Alabama. The Sandy Hook School did have some level of security but it was circumvented. Why was it so easy to breach?

• Gunshot wounds inflicted at close range. The rate of fire and physical confines produce a rapid attack with high fatality rate. There is little opportunity for protective action because of the speed of the event (possibly also because of the age of majority of the victims and the situation they are in).

• Ancillary event - some other related occurrence, prior to main event, that would herald the main attack - shooting his mother, in this case. Use of explosives in other situations to draw attention away form the intended target or as a secondary event to create further casualties.

• History - in many of the cases the alleged perpetrator has had a mental illness diagnosis

Shooting events at high profile soft targets are difficult to prevent and have significant, long-lasting effects. They also have numerous commonalities that can be used to aid planning efforts.

"Locations of critical infrastructure such as hospitals, will need to be protected from attack as will other civilian locations. Hotels, coffee shops, and shopping centers lack the deterrents necessary to prevent attacks. The psychological impact of an attack on any of these soft targets will nearly as devastating as the loss of life."

How ready are we for active shooter events? A question asked too many times over the last seven years.

Active shooter situation may be the most difficult to domestic terrorism situation to deal with. Many of the active shooter situations take place in a work environment or in a public venue with little or no warning. Firearms of all varieties have been noted in active shooter case studies from the United States. According to the Department of Homeland Security:

"An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims..."

These events are unpredictable in nature and timing, but the outcomes and be generically predicted.  If we follow the basic principles of Life Safety, Incident Stabilization, and Property Conservation, we'll be able to keep personnel safety and response priorities in balance.

Key to remember that soft targets continue to be chosen by active shooters and present significant threats. Preplanning and inter-agency cooperation is paramount to reducing the loss of life.

Active shooter situations in a soft target location - a mall, school, hospital/health care environment, or sporting events are disastrous. The answer may be someplace between the left and right...

Screen savers and call bells offer hand hygiene reminders

Two studies look at infection control prompts

Non-pharmaceutical interventions for preventing and controlling infection often take a back seat to vaccination programs. This is especially true during flu season. While vaccination is a vital cornerstone of preventing disease spread, limited access to vaccine and reluctance of staff to get vaccinated can cripple your vaccination program. Non-pharmaceutical interventions are easily taught and integrated within your daily routine. The typical non-pharmaceutical interventions include hand hygiene, respiratory etiquette, and appropriate social distancing, and should be readily available at all times. Hand hygiene is historically considered the most important of these interventions for controlling the spread of disease.

How do we increase voluntary compliance with such an important intervention?

Two studies published in the American Journal of Infection Control looked specifically at ways to improve hand hygiene compliance.

Sample screen saver message

Computer screen saver hand hygiene information curbs a negative trend in hand hygiene behavior.
Can your screen saver change hand hygiene habits? Apparently so, according to the authors of this study. They concluded that by placing gain-framed messages highlighting the benefits of hand hygiene on computer screen savers that compliance was increased.

Evidenced based or not, this seems like a good idea. Screen savers are a venue for delivering a message to your target audience. Rather than displaying some random graphic or blank screen, use the screen saver to reinforce important information on relevant topics.

Positive deviance: Using a nurse call system to evaluate hand hygiene practices evaluated the use of staff alerting system (referred to in the study as a nurse call system) to improve compliance with hand hygiene when entering and leaving a patient care area.
This study monitored the use of alcohol based hand sanitizers using electronic counters. They found that the use of hand sanitizer increased after linking the call system and sanitizer use data - using the call system as a reminder to use hand sanitizer - with higher utilization rates remaining for 2 years. They also noted a trend toward lower device-related infections, including urinary catheter-associated infections.

The study concluded: “The PD [positive deviance] approach to hand hygiene produced increased compliance, as measured by increased consumption of alcohol hand sanitizer, an improved ratio of alcohol hand rub uses to nurse visits, and a reduced rate of device-related infections, with results sustained over 2 years.”

Federal Medical Stations

Providing special needs care in less than 48 hours

What do you get when you add 24 hours and 40,000 square feet of
 medical equipment? You get a Federal Medical Station or FMS.

The FMS is part of the Centers for Disease Control and Preventions Strategic National Stockpile program and is designed to fill a gap that exists between disaster shelters and temporary hospitals. According to the CDC Works For You 24/7 Blog, Federal Medical Stations are non-emergency medical installations used during disaster situations to care for people with special medical needs and  chronic health conditions. They also include services for those with mental health issues. The CDC notes that FMS can be operational within 48 hours and their operational period is open-ended.

 It’s vitally important that basic medical needs are met during disaster situations and meeting those needs becomes an extraordinary challenge when hospitals are compromised or destroyed. While the FMS’s are not hospitals, they provide an invaluable resource and example for the disaster and emergency management community. Federal Medical Stations become a force multiplier by providing routine medical care for those with routine medical conditions, including the provision of routine medications, by sheltering those people, and keeping them out of an already stressed healthcare system during disaster. The FMS has the extra dimension of meeting mental health needs.

The FMS system relies on the asset management and logistics of the Strategic National Stockpile (SNS) for deployment. The SNS is a combination of warehoused supplies and vendor managed inventories of critical medications and equipment that can be shipped in bulk to areas in need. Each city or jurisdiction should have a plan in place (and tested) to receive assets from the SNS.

Photo Credit: CDC - Federal Medical Station

Creation of civilian, locally-based medical stations (in addition to disaster shelters) would be a major improvement to local and regional preparedness. Systems like the FMS should be reproduced by local jurisdictions to meet the expected needs of a community during crisis. We’re not suggesting reinvention of the entire system or duplication of existing programs. A smaller scale version of the FMS that is readily available to local governments with minimal lag-time would improve local response to crisis and disaster situations.