All hospital employees should be taught how to react in the face of a physical threat. The principles behind ALICE are a good starting point.
Unprovoked violence against groups of innocent people is frightening. Sometimes random, sometimes retaliatory, the acts are perpetrated against businesses, churches, schools, theaters and even military installations.
The Occupational Safety and Health Administration requires employers to provide a workplace free from recognized hazards. The risks to veterinary practice employees traditionally have focused on bites and scratches, slips and falls, strains and sprains, and lifting and repetitive ergonomic injuries.
But what have hospitals done to protect against a potentially violent intruder? Think about an irate client frightening office staff and visitors over a billing issue or medical outcome. Or a disgruntled employee or spouse barging in through a back-office door in search of retribution for some perceived wrong.
Fortunately, the vast majority of irate clients and disgruntled employees act in non-violent ways, such as verbally, via social media or through the legal system. Though unfortunate, these situations are what we learn to deal with as employers and medical professionals serving the public. Personal and business relationships that move from people’s private lives into a public setting can be more difficult to manage.
Preparation and Training
Does your practice have a plan for how to handle these situations? Does your team know what to do if a person suddenly becomes physically aggressive or worse?
Federal, state and local agencies have spent considerable resources researching events involving violent intruders. Preparation starts with a basic understanding of what has been learned from prior incidents.
Statistics indicate that 47 percent of intruder attacks are committed by a single person. Furthermore, studies show that if not properly trained, people confronted with the threat of violence often deny the possibility of danger rather than respond in a timely and appropriate manner.
Organizations and educational resources are available to assist you and your employees with preparing for a violent intruder. Your liability insurance agent should be able to provide specific guidance.
The Safehold Veterinary Insurance Program works with a property and liability carrier to provide our clients with discounted access to the ALICE Training Institute, a company that provides organizations of all sizes with online and onsite education. Though ALICE is designed specifically around active-shooter situations, many of the principles and techniques that are taught can be utilized to deal with physically aggressive or violence-prone individuals.
An Overview of ALICE
What follows is an outline of the ALICE Training Institute’s online program and is intended for awareness purposes only. All hospital team members should receive training from a professional organization like ALICE before they implement any of the information discussed here.
The acronym ALICE stands for alert, lock down, inform, counter and evacuate. These are not sequential steps to be followed in all situations. Each team member must decide how to respond based on the circumstances of a specific hostile event. Let’s go over the terms one by one.
Alert refers to the first notification of danger. It is when you become aware of a threat. Three important actions should be taken by each member of your staff:
- Recognize and accept the alert. Remember that many people might deny that a threat actually exists.
- Choose the best course of action. It could be lock down, inform, counter or evacuate.
- Act quickly. Seconds count.
Lock down means to safely lock down in your current location if a violent or potentially violent intruder is in the building and you are not in immediate danger, but if you are not sure whether you can evacuate safely. Passive lockdown actions include hiding, turning out the lights and locking the door, if possible. Unfortunately, passive lockdown activities do not always work.
The ALICE Training Institute recommends enhanced strategies to optimize your chances of remaining safe. They include, but are not limited to, utilizing additional barricade and door-restraint techniques. Refer to a professional training program to learn and practice these techniques.
Inform refers to communicating your observations by any means possible to authorities and, if you can, to anyone potentially in immediate harm’s way. The intruder’s location and whether the person is armed are the most helpful facts you can provide.
When communicating, make sure to use plain language rather than code words, give specific details and avoid specific commands. Remember that solutions are often not one-size-fits-all.
Counterstrategies are physical actions you take to interfere with the intruder’s mental and physical capabilities to inflict harm on others. In certain situations, counterstrategies could be your best and only action. They should be taken only if you believe that you are in immediate danger and that no other viable option exists.
The purpose is to:
- Interrupt the intruder’s thought process.
- Confuse and disorient the intruder.
- Prevent or delay aggressive actions by the intruder.
Evacuate means to take the opportunity to escape, if possible. Quickly put as much distance as possible between the intruder and yourself. Psychological studies show that people are often reluctant to escape and instead lock down. One objective of professional training programs is to teach each person to make a decision that minimizes the risk of injury.
Although fire evacuation routes are typically the preferred way out, keep in mind that these paths might not always be the safest. Two non-traditional options that you should be prepared to utilize based on prevailing conditions and the building’s layout are:
- Break and exit through a ground-floor window. Windows are designed to flex and might be difficult to break. ALICE recommends using a heavy object to strike an upper corner of the pane.
- Drop from a second-floor window. Consult with experts to outline the safest way to exit from the second floor.
Once You’re Outside
Everyone should go to a predesignated meeting place when they exit the building. In addition, recognize that you likely will encounter law enforcement personnel. Remember that police officers might not be able to identify the intruder. You don’t want people to think it’s you.
When you first encounter law enforcement on the scene:
- Remain calm and follow the officers’ instructions.
- Put down items you are carrying, such as bags and jackets.
- Keep both hands visible.
- Avoid making quick movements toward officers.
- Don’t point or scream.
- Don’t ask questions.
Regardless of size, every veterinary practice needs a response plan. Prevention is the goal, but you must be prepared for the worst. Appropriate training will allow each team member to react faster, make better decisions and increase the odds of mitigating injury.
Protect & Defend columnist Dr. Ed Branam is veterinary and animal services program manager for Safehold Special Risk Inc. He serves on the American Veterinary Medical Association’s Legislative Advisory Committee.