The role of law enforcement, fire-rescue, and emergency medical services in active shooter response is apparent. But how does an Emergency Management Agency make a concrete, direct impact? Palm Beach County looked at recent shootings in its area and figured it out.
The Pulse nightclub shooting in Orlando, Fla., on June 12, 2016, left 49 dead (plus the shooter) and 53 injured. It was the deadliest mass shooting in the United States at that time. Concerned family and friends approaching the scene were initially directed to the Orlando Regional Medical Center (ORMC), where most — but not all – victims had been sent. Hundreds of people arrived. They overwhelmed the hospital. They were then sent to a staging area set up by ORMC for friends and family at a nearby Hampton Inn and Suites. They filled that up. The city’s Office of Emergency Management helped set up a Family Reunification Center (FAC) at a senior center near the nightclub. Family and friends were moved again. In addition to the repeated moves, initial death notifications were far from ideal, forcing family members to wait for a formal process to be executed to receive their news. At one point, friends and family were asked to email photos of their missing loved ones to an email address; a well-meaning and industrious hospital worker attempted to match those photos to the injured and deceased, to assist patient identification. In some cases, the media was able to gain direct access to friends and families in or near the FAC.
The Fort Lauderdale-Hollywood International Airport (FLL) shooting on Jan. 6, 2017, left five dead and at least six others injured. This event made clear that a federal requirement – the Aviation Disaster Families Assistance Act of 1996, which directs the National Transportation Safety Board (NTSB) to coordinate with air carriers and other agencies to address the needs of aviation disaster victims – is not sufficient for the complexities that accompany active shooter events. After evacuating, some survivors/customers waited on the curbs of the airport for hours. Others were kept on fully loaded planes on the airfield, some for over seven hours. About 10,000 people were ultimately transported via buses to Port Everglades for temporary shelter. There were complications in accessing food, water, restrooms, medical supplies, and other provisions. Twenty thousand personal items were left unclaimed and had to be managed.
The Marjory Stoneman Douglas High School shooting in Parkland, Fla., on Feb. 14, 2018, left 17 dead and 17 injured. Families recount terrible stories of trying to find their children. They report visiting multiple hospitals and would be sent to holding rooms within the hospitals; others were sent to a reunification center set up at a Marriott hotel, where they again sat for hours, were repeatedly asked for the same information, and received little or no information. Others were sent to the gym at a community center. Some parents reported overhearing officials discussing the case in the hallways but providing them no information; others reported hearing screams from families who either couldn’t take the lack of information any longer or who finally learned their children had been killed.
Palm Beach County (PBC) Division of Emergency Management (DEM) reviewed these and other active shooter cases from around the country and identified two clear gaps that it could fill: family reunification and patient tracking. PBC DEM Director Bill Johnson explained “these are services emergency management can provide.”
“When we fill these gaps, law enforcement can focus on the shooter, on security, and on the investigation,” he said. “Fire and EMS can focus on helping the victims. It keeps us all focused on the human element, the most important element, in the ways we each do it best.”
New Approach to Family Assistance and Reunification: Focus on the Human Element
PBC DEM already had a Mass Casualty Incident/Mass Fatality Incident (MCI/MFI) Incident Support Plan in place. They had begun their regular process to update and enhance it when the Parkland shooting took place, and then the update became an urgent priority. PBC DEM decided they needed to create a Family Assistance and Survivor Care Center (FASCC) Annex to the MCI/MFI Plan. The FASCC would need to address aspects of family reunification, family assistance, and survivor support. And while the now comprehensive draft FASCC includes all of the key components an emergency manager would expect, such as command and control, client intake and flow, and key stakeholder roles and responsibilities, it also adds some unique components, consistently emphasizing the importance of the human element, such as:
|Clear, Fast Notification||· The public must know clearly and quickly what the FASCC is, where it is, and what it provides so a victim’s family and friends are not running around the county trying to find help during their most stressful time.|
· Make sure your FASCC has a PIO who coordinates with the JIC.
|Calm, Thoughtful Registration||· Registration will set the tone for the entire FASCC experience. Incorporate a brief needs assessment so that you ensure you are providing the customized services each registrant needs.|
· Provide escorts for all registrants to walk them personally from the registration desk to their next stop, usually the Family Waiting Area.
· Make sure that mental health professionals, clergy, and/or interpreters are available.
|Regular Family Briefings||· The FASCC must provide survivors, families, and friends with consistent information at regular intervals, so they know what type of information to expect and when. Make sure they are never sitting around feeling isolated and wondering if they will ever get any news.|
· Tell them when they can expect briefings and what the agenda will be.
|Private Interview Rooms||· Hearing the cheers from those receiving good news can be as difficult as hearing the anguish from those receiving bad news.|
· Make sure you select venues configured with completely private interview rooms; makeshift partitions are not sufficient.
|Transportation and Lodging Services||· Survivors, family, and friends may need safe, secure, and private emergency housing. Some may need help with transportation.|
· Include a Transportation and Lodging Unit in your FASCC plan. Enlist tourism agencies, airlines, and hotels to support its staffing and help coordinate affordable options.
A routine plan update became a major overhaul. “I knew that to do this right, it would take some arm-twisting and would require some of our partners to think in new ways,” said Johnson. “But I also know how important this is. I took lead of this initiative myself in its early stages, ensuring we got off in the right direction. Once we built some momentum, my team took over. I am very proud of how comprehensive this has become and how hard-working the PBC DEM staff and our partners have been. This is the evolution of emergency management.”
New Approach to Patient Tracking: Deliberate, Systematic Preliminary Planning
PBC DEM is in the development phases of its Patient Tracking initiative. It is a complex challenge, but they are making progress. Johnson knew he would need high-level support from a variety of players including the hospitals and medical examiner to really make this happen, so he pitched the idea of implementing a patient tracking program to the county EMS Advisory Council, which reports to the Board of County Commissioners. They agreed to set up a Task Force. The Task Force organized around three working groups: Process Flow, Legal, Funding.
Process Flow Work Group: PBC DEM reminds us that patients may enter the medical system through a variety of ways. Patients may be taken to the hospital by ambulance or by pickup truck, they may self-present to the hospital or self-present to the Family Assistance Center (FAC). Even once patients find the hospital, there are typically multiple entrances – the emergency room, the main entrance, the outpatient areas. To have a patient tracking system that really works, practitioners must map this all out ahead of time. What are all of the possible ways a patient enters the system? Assemble a group of practitioners and develop this process flow for your jurisdiction. Try using PPT, Excel, or Visio. If these aren’t available to you, draw it out on a white board or a piece of paper. Look online for a variety of examples. Your mapping will inform all of the locations that must be ready for patient wristband distribution (or whatever alternate method is determined to identify and track patients), all the places that must be equipped to read those wristbands, and all of the stakeholders who will need different pieces of data from those wristbands.
Legal Task Force: PBC DEM recommends you look into all legal and legislative requirements at the state and local levels that may impact how information is shared during emergencies. Make sure you are continuously monitoring new legislation. For example, many states have adopted versions of Marsy’s Law, which may include protections for victim data; make sure you are aware of whether this applies to you and of your jurisdiction’s interpretation of data protection laws and regulations.
Funding Task Force: Funding sources will be required for purchase, customization, and deployment of the system. Consider a phased approach that allows you to scale the rollout of the patient tracking system over time. Investigate funding options such as regular budget allocation, grants, public-private partnerships, and even a legislative request.
Applicability Beyond Active Shooter Response
PBC’s FASCC and Patient Tracking system will have applications far beyond active shooter response. Still, Johnson, his team, and PBC are taking action now, acting on the lessons learned from these recent events to ensure they are prepared to support their residents and visitors for all hazards, whenever they occur.