“Active Assailants in Healthcare: The Pros, Cons and Ethics of Run, Hide, Fight Training ”
Host: Lisa Terry
Guests: Stephanie Doty, MSN, MBA, RN, CHSP, CPHRM, Doug Kohlsdorf, CPP, Karen Garvey, MPA/HCN, BSN, DFASHRM, CHPHRM, CPPS, Michael Dunning, CHPA.
To watch the podcast discussion of this video, click here.
On this episode, Lisa Terry is joined by Stephanie Doty, MSN, MBA, RN, CHSP, CPHRM, Doug Kohlsdorf, CPP, Karen Garvey, MPA/HCN, BSN, DFASHRM, CHPHRM, CPPS, Michael Dunning, CHPA.
In this podcast episode of "Confidence in Conflict," host Lisa Terry is joined by four esteemed colleagues – Stephanie Doty, Doug Kohlsdorf, Karen Garvey, and Michael Dunning – to discuss the topic of active assailants in healthcare. The focus is on the pros, cons, and ethics of run, hide, fight training in the context of healthcare setting.
The episode raises critical questions about the applicability of run, hide, fight training in healthcare settings and emphasizes the need for a nuanced approach to active assailant response, considering the complexities unique to healthcare environments.
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Lisa Terry: Welcome to our Confidence in Conflict podcast. I'm Lisa Terry, your host. And today I am joined by four of my very esteemed colleagues, Stephanie Doty, Doug Kohlsdorf, Karen Garvey and Michael Dunning. And we're going to discuss a subject that is very important to all of us, the active assailant in health care, the pros, the cons and the ethics of run, hide, fight training.
And thank you all for joining us today. So before we get started, I would like to ask our panelists to tell us who they are in a bit about their career journey. Stephanie, would you be so kind as to start us off?
Stephanie Doty: Sure. Happy to. Thanks, Lisa. So I'm Stephanie Doty and assistant vice president for risk management and loss Prevention at Common Spirit Health.
We're the largest faith based, private, not for profit health care system in the United States. We're in about 22 states have approximately 145 acute care facilities, about a thousand clinics and ten or 15 long term care facilities. I've been a nurse for 43 years. In my current role, I'm responsible for understanding what's driving our insurance losses across common spirit and putting in strategies to help reduce or reduce those losses.
And of course, the losses are driven by employee harm as well as patient harm. In addition, I chair our System Workplace Violence Prevention Council, and the purpose of the Council is to develop a program across common spirit to again reduce workplace violence incidents within our facilities and ensure we have a standard approach to addressing those issues. So thanks, Lisa.
Lisa Terry: Thank you. I'll move over to Doug.
Doug Kohlsdorf: Thank you, Lisa. My name is Doug Kohlsdorf. I've been in security risk management for over 40 years. Started my career in law enforcement and in the Air Force, where I was a security policeman. I've recently been in health care for the last 12 years and have recently moved into a consulting role in health care.
Lisa Terry: Awesome. Thank you. Next, we have Karen.
Karen Garvey: Hi, my name is Karen Garvey, and I serve as the vice president of Safety and Clinical Risk Management at Parkland Health in Dallas, Texas, which is a standalone safety net facility providing care to our most vulnerable populations within Dallas County. We have been cited by Becker for the last three years as being the busiest ED in the nation.
We're also that facility where President Kennedy came after that unfortunate incident in November several years ago. I am a nurse working in the workplace violence arena along with my regulatory and patient safety areas for well over 15 years and continue to do a lot of work on this, both at the state level and national level as well. Thank you for allowing me to be here.
Lisa Terry: Thank you, Karen. And last but not least, we have Mike.
Michael Dunning: All right. Thank you, Lisa. I'm Mike Dunning and the associate vice president of Public Safety and Emergency Management for Simon Health. SIMON Health is a relatively new health system based out of Louisville, Kentucky. We're about to hit our two year mark. We consist of 18 acute care hospitals and about 94 long term acute care facilities across the United States.
My role is to help develop and put together a system wide approach to public safety and emergency management. I've been in health care for about 20 years. Prior to that, I was in the United States Air Force where my jobs were executive protection and security and law enforcement.
Lisa Terry: Awesome. Thank you. So, Doug, for the context of our discussion, I was wondering if you would give us an overview of what run, hide, fight training is and its origin.
Doug Kohlsdorf: Sure. So I think it's important in this work to understand the evolution of how we got to where we're at today in Run, Hide, Fight. And I think it starts with Columbine. We remember the Columbine incident in Denver in which there was active shooters in the building during that, and they were on the phone with the 911 dispatchers and they could hear the shooting going on.
Up to that point, law enforcement's response was it was either a barricaded suspect or a hostage situation. So they would secure the perimeter. They would call in negotiators, they would, you know, secure the area, get people out, that they could get out and then move from there. And in that incident after in the in the after actions, they realized that when there was active shooting going on, that they needed to do something different.
And so law Enforcement institute at the Protocols of active shooter protocols in which when there was active violence or active shooting going on killing, they would the first ones on scene would go into the building and neutralize the the shooter, the threat. So what came out of that is that became socialized in our country. Private entities started saying, well, what do we do about active shooters?
What can we do in the organization? And from that, and especially in schools, from that came the run hide fight protocols, talking about here's what and somebody who's not in law enforcement, not responsible for that armed response can do to protect themselves. And that would be to run to hide from the shooting or to act as a last resort to fight in that.
And I think what we're going to talk about today is the next evolution of that run, hide, fight, especially in health care. And that is what how do we implement that? Is it is it practical to implement those steps at the very least? And oftentimes people think of that in a linear process, run, hide, fight. And how do we implement that if it if we can even implement that?
And is it practical in a health care setting?
Lisa Tery: Thank you. Very comprehensive response, Doug. I want to share some findings with you that came from the National Library of Medicine's Active Shooter Response study, which was actually released this past February. And they looked at past events in the health care environment and there's a few findings that I thought were very interesting.
Most active shooter incidents were pre-planned. 90% of the time, the shooter was a young male. Hospital
And as Doug mentioned, there's some of the pros of the current run, hide fight training include that those three words are easy to recall in an emergency. The training has been used for decades to teach civilians their options if confronted with an active shooter. It is endorsed by the US Department of Homeland Security and according to an FBI training video employing the run hide fight tactics, as well as knowing the basics of rendering first aid to others, Individuals are more prepared, more empowered and able to survive an attack.
Now, some of the concerns that we've heard expressed is that the run hide fight model not only is linear, but it encourages a soft response to violence and it preconditions individuals to escape or hide as the preferred means of survival rather than confronting the attacker with immediate counter-violence. Potential victims are taught that risks associated with fighting the attacker are much greater than those from right away.
So violence, again, as Doug told us, should only be used as a last resort. After all, the other options have been tried and failed. It's been asserted recently that this model may be outdated and no longer fit as a general response. Now we in health care know that crafting violence for an active assailant response is not a one size fits all solution, and fighting back may not work.
For instance, a USC Charlotte College student charged a gunman during a 2019 attack and he died a week later. A Colorado high school student met that same fate. However, nurses assigned several patients in different locations may struggle with how to utilize this training effectively. So with that, Stephanie, would you please share with us a summary of the shooting which occurred in a small health care facility that you reviewed?
Stephanie Doty: Sure, happy to, Lisa. So as Lisa said, a couple of years ago, we actually had an active shooter event in one of our smaller hospitals. It's about a 200 bed hospital located in a fairly small community. The shooting event matched so much of the characteristics that Lisa just talked about. It was a it was targeted. It was a young male.
He entered the facility specifically to kill a visitor. He knew the visitor. The two of them knew each other. The assailant entered a patient's room. The victim was visiting his fiancée. The assailant confronted the other visitor, shot him, and then exited the building. The patient activated her call light. Of course, the staff heard the shots. They notified the operator who paged overhead that there was an active shooter in the building and staff acted appropriately based on how we've trained them.
And as Lisa talked about, we used the run, hide, fight video and we train our staff that in the instance of an active shooter, that they are to run, to exit the building, to hide if they cannot, or to confront the shooter. And in fact, many staff did leave the building. The perpetrator, the assailant was was found by police about 2 hours later, 15 or so miles away from the hospital.
And he was successfully arrested without any further violence. But, you know, it raises a lot of questions that Lisa touched on this as it relates to health care. You know, when you're using the run hide fight model in a non-health care setting, it perhaps makes sense. But in a health care setting, you create an internal conflict where health care providers.
Right, because we are trained to care for people. And in fact, if we're if we're training our staff that they should run, then they're leaving their patients behind. And that creates, I think, a conflict with internal conflict. It creates some moral distress for the health care provider. Do I save myself or do I stay and potentially become another victim of this assailant? And so I think that that's a unique challenge in the health care setting. And and I do know as a nurse, certainly it would be something I would struggle with. Do I put myself in harm's way or do I leave and and leave my patients behind knowing that they're going to to need some care.
In the particular instance that happened in our facility, nobody else was harmed. It was very targeted. The shooter left the building, did not confront anybody else. No patients were harmed as a result of this. But again, it creates a real challenge, I think, for our health care providers, really across the health care industry. You know, as Lisa talked to, is this the right model to be using in a health care setting?
And does everybody have to run? You know, is it just in the location where the shooter is? And do we know where the shooter is? I think those are all the various things that we need to think through when we use this model in a health care setting.
Lisa Terry: Awesome. Thank you. So, Doug, after listening to Stephanie's summary, what are some of the considerations that you might have from the lens of a security leader?
Doug Kohlsdorf: Sure. So, yeah, listening to Stephanie, she's right on on that internal conflict with the caretakers when it comes to that. And it's easy from a security perspective, you know, in any security for a professional would look at you and say if you said, hey, I'm being threatened, they would say, well, get away from it, which is the run portion.
If they were saying, you know, if you said, well, I'm being threatened and I can't get away from it, they would say, put a barrier between you and whatever is threatening you. And that would be the hide part, you know, your way hide from it. And, you know, and if it's if violence is imminent, then you you would resist or fight whatever that verb is, you know, that would be that would be pretty much security 101. I think the challenge in health care and I spoke to this a little bit earlier about is it practical in health care? Can we do those things? So as an example, if somebody is on dialysis, you can't just unhook them and say, let's go. Right. Or if they're in surgery or if they're in the ICU. And so it's not a one size fits all in health care where we can just say, okay, first thing you do is you run away from it.
And in many of our facilities, they are large enough that we even have to ask ourselves the question, are we going to run in to it as opposed to running away from it? So it becomes a real challenge. And I think one of the things that we have to understand and we have to articulate to our staff is what are the options that we have that they have, and and we need to provide the training for them.
I think as an organization, we have to give practical training to our staff that says, here's what you can do and here's what the circumstances are. We need to be able to provide reasonable security on a daily basis. And so as we look at this, I know several colleagues that I've talked to they're moving away from and I know Mike's going to speak to this. They're moving away from that run, and I think actually, Karen, I think your organization is that way, too. Is they're moving to hide or barricade where you're at, secure yourself where you're at. And that takes a lot from a security program perspective because you now have to look at things like how can we lock the doors and can we isolate somebody who's actively violent? How do we do that? So it's a little more intense on the security, the physical barriers and the technology piece that we're using. And culturally, as opposed to just saying empty out the building and everybody get away. And that was to Stephanie's point, is that is that really practical? And we also have to be able to communicate quickly and we have to be able to partner with first responders from that security perspective.
So I think, again, from the program perspective, we have to ask ourselves as security professionals, what's our program, the security program designed to do. So in many instances, we have armed security officers in our health care, you know, in these health care environments, are they designed to intervene and be the part become part of that first responding force that is going the other you know, they're going towards it to neutralize what is actually the program designed to do.
And are we capable of doing that? And I know we'll have more discussion on that. But an example that I've seen many times is I would go into hospitals or facilities and ask about their program and they'd say, well, we would lock all the doors. well, how can you do that? And you know, well, how fast can you do that?
As an example? So we know statistically that these active assailants, these take, you know, I don't know exactly what the number is, but 3 to 7 minutes or something like that, under ten certainly. And they tell me that they can lock all the doors in the facility in an hour and a half or the janitor can lock, you know, the maintenance people can lock the doors.
Well, how do you we get a hold of them or things like that. So do we have the capability to do the things we're saying to do as opposed to just saying, run, hide, fight, and we'll write these things into our protocols, in our procedures. But do we can we actually do those things? Do we have that capability and are we willing?
I think another key piece here is are we willing to perform the actions? And when I say we, I mean our staff. And that speaks directly to what Stephanie was talking about. If we tell clinical staff in an ICU, evacuate, run away in that linear discussion, and we give that ICU no way to secure themselves the physical security program in that room. And we say your options are to run away or to hide and then resist if necessary. We have to ask ourselves the question, are they actually going to run? Are they actually going to leave the ICU? I would venture to say probably not. So it's a really important as security professionals that we talk to our staff, talk to our doctors, talk to our nurses and see how they're going to react.
It's really surprising when I talk to the clinicians or even security professionals out in the field and ask them, have you communicated? Have you talked with? And they say, No, I have no clue what they're saying. That's really surprising because they're the ones who are going to be doing whatever it is we're asking them to do. So that's, you know, that's not comprehensive.
But in a nutshell, that's what I would say are some of the big challenges with that linear thought of run, hide, fight. And again, I think that several health care organizations are starting to come to that realization that we need to beef up the barricade or the hide piece of it.
Lisa Terry: Thank you. That is very comprehensive there, Doug.
And I think that's almost like a novel concept that we would ask the individuals that we are serving, what they're willing to do and what, you know, what would really work for you. So, Karen, as another clinical leader in a large health care organization, would you share your experience? And also I'm really interested to hear how you perceive the importance of trauma informed care and being trauma responsive to our staff as we plan for these events?
Karen Garvey: Sure. I think that the first thing, though, is to kind of jump off of what Doug and Stephanie had said. We don't use run, hide, fight in our organization. We actually use avoid, deny and defend. And so it's avoiding the situation as best as possible, moving away from it when you are, I guess, confronting it, denying the best that you can with barriers and things like that, which would be similar to that, the hiding component, but at least putting barriers in front of them.
And then the defend is certainly when they are encountering that individual face to face is defending that themselves. But we have done active shooter drills within our own organization, utilizing that mentality. But when you really think about it, working in health care, as others have said, it really is in conflict with what we have been incarcerated to do from from being a clinician.
If you look at the Hippocratic Oath related to the medical, the medical profession, it's first do no harm. And so if you are running away from a patient who is laying on an O.R. table or hooked to a dialysis machine, that's the antithesis of what we've been we've been told to do. And you can't just strip away in a moment, you know, in a training session years and years of what has been incorporated into the into the medical professions.
So, you know, there is a lot of there is some controversy that's going on, you know, at different levels. And even if you look at the the code of ethics from the American Medical Association that came out in the the mid 1800s, it was about that professionals would put themselves in harm's way and certainly to defend the situation, even if it that that was about jeopardizing themselves, that those statements have actually been removed today.
So they're no longer asking people to put themselves in harm's way. But we also know that as a profession and being a service oriented industry, that people will do that. So some of that, some of what they're actually looking for is looking to secure the situation so that the patient and the health care professional is actually secure, preserving the life of both the individual professional as well as the patient, and then fighting as needed.
So because typically health care professionals have been asked to, you know, in dire situations in war or in disaster situations is if they prefer themselves, then they've got to turn around and defend the situation. And that that that is still what people would pretty much do today. But, you know, OSHA general duty clause for employers is they've got to identify the hazards and they need to provide the environments where employees should be protected.
So but you used you asked about that, the trauma informed care perspective. And so when you look at trauma informed care overall, it really is you know, we tend to see people as they are at face value. It's almost like a universal precaution in that we have to assume that people have been traumatized in their life and how they encounter situations is based on that trigger of that trauma.
70% of folks have been have had some type of trauma in their life. And so they will react by that trigger. So if
And so we've learned this certainly with some of our patient populations as we've gone to investigate some of the more violent cases and, you know, even I have used a case study where, you know, an individual was so violent towards our staff in one in one location, then continually over and over again. Meanwhile, you know, maybe our staff is also traumatized from other things that they've experienced in their life, too.
So we have to we have to monitor that component. But I'm going to stick with the patient here for a minute. So as we've looked at the objective information of police reports, event reports in our workplace violence event reporting system, the complaints and grievances that may come through the injury logs that may come through for worker's compensation, some of that the documentation in the medical record about how this patient is, you know the words that and then unkind choice words that they may put that we've taught staff to actually put in quotes in the documentation.
We're looking at it from one objective perspective. As we have pulled in our trauma psychologists to examine the trauma, the trauma history of the individual. We've identified that while we may be inducing more trauma to the patient, that's causing them to escalate. So in this particular situation, this individual was traumatized from a very young age by his mother.
Well, he's coming into a hospital. And who is he seeing? He's seeing a bunch of clinicians and then being a nurse. Well, his mother was a nurse, so we've only continued to induce that trauma. But we didn't know that either until we actually looked into the situation a little bit more. Also we're managing to look at our employee population to, knowing that employees have had to deal with issues in their in their own lives.
How does the traumatic situation escalating of that patient also retraumatize our workforce? So these are things that we are continuing to work on as we move forward.
Lisa Terry: I love that. Thank you very much. So, Mike, you've been quiet and I know you've been listening to everyone. And as a seasoned health care security leader, would you be willing to share with us your own training philosophy regarding active assailant events?
Michael Dunning: So I want to go back to a simplistic look at this. Words matter, especially when those words trigger actions on our part. The whole point of training is to condition us to act in a certain way when confronted with a situation. If you look at fires, for example, when there's a fire, there's a fire alarm. We respond by evacuating.
Unfortunately, run, hide, fight has become synonymous with what we do, and it's almost irrelevant what you teach in training, because if you're not going to back that training up with constant training, consistent training, if you do it just once a year, everyone reverts back to those three trigger words. So let's look at the first word run. When you have an active shooter, when you have an active shooter, code activation, look at what happens.
People run. Where do they run? They run outside. Is that really what we want them to do? Is that really what is the safe bet or the safe process for them to do? And let's look at the challenges we have being in health care. If you look at the construction material used in our hallways, if you look at the way hallways are developed, though, the way the buildings are constructed, sound reverberates and it reflects.
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And if you hear a gunshot, it's very hard in a lot of facilities to know where did that gunshot come from. And yet the very first word we teach them is run. I'll tell you a quick story. There was a there's a small hospital. It's in the southeast. It was late at night. A car pulled up into the parking lot of the emergency department.
A second car pulled up next to it and they started exchanging gunfire. Now, it was not inside the hospital. They were not going inside the hospital. They just pulled in front of the emergency department. Someone in the emergency department who heard the shots and called active shooter when active shooter was called. What happened? Everybody ran into the parking lot.
So we're not using this training. We're not using these words, I think to the best that we could be using them. If you take the word run and put it next to the word avoid, I think avoid gives us a better description. It gives us a better trigger of what we should be thinking about when we do this.
Not run blindly. It should be a void. And I think everyone in Doug especially has a very great point in that we have to start looking at our facilities individually to find out what is the best approach for us being able to confront an active shooter. Sometimes that approach, especially looking at nursing and clinical staff and whether or not they're going to leave their patient may be the best approach is to barricade.
Maybe the best approach is to shut off avenues of approach to where we are relatively safe behind those locked and barricaded doors. So I think looking at this investigate dating events that have occurred, talking with tons of people who train, tons of people who've been involved in these, I think it's time that we really take a deeper look at how we're using run, hide, fight and start using better descriptive words.
And instead of training once and done, you know, or one time a year, we're good. This needs to be something that's done constantly and we need to be referring to it constantly. And I'm not saying do full blown drills all the time because that's not the right way either. But it should be something that we talk about in huddles.It should be something that we plan on when we build, when we do new construction. But it should be something that in that comes into our culture. And by the way, you know, being in a new health system, I will tell you the two hardest things in the world to change someone's mindset and the culture. So those are our two biggest challenges.
When we start looking at new techniques or new ways to train. Sorry, I could ramble on forever on this, but thank you.
Lisa Terry: Great. So with that being said, great ideas, but I'd like to hear from everyone. Where do we go from here? I mean, having this conversation is a wonderful first step, and the four of us have discussed this in the past.
But I guess where do we go from here? Anyone?
Michael Dunning: I think conversations. I think conversations like this are a great first step. We need to start broadening these conversations. It can't just be security professionals in law enforcement. We have to have the conversations with clinical. We have to have the conversations with administration. We have to educate people on what it is we're talking about and why we need to make changes or why we need to beef this training up.
I think that would be the next step. Broadening who we communicate with.
Doug Kohlsdorf: Yeah, I agree with that. That's exactly what I was going to say. I think the other thing that I would add is we need to be very critical at our approaches, honest, honestly, critical with ourselves and look at capabilities. Look at what are we asking people to do and can we do it? I think that that's a that's a huge issue.
You know, oftentimes something will happen and, you know, we do an after action review or we people will do a after action review. And we all talk about how great it went. And, you know, and we write that down as one of our our exercises for our, you know, our inspections. But we really need to be critical on honesty and critical with ourselves.
Stephanie Doty: I think one thing that we need to think through as a health care industry is appreciating the internal conflict that caregivers are going to have with that run, hide fight model. And I think what we have to, if we're going to continue to use that model, I think we have to make sure staff know that if they choose not to run, it's okay.
If they choose to run, it's okay and that we will support them in their individual decision. To my mind, it's an individual decision that I'm going to make at the point that I have to make it on whether or not I'm going to leave or not leave. And I think, you know, we've talked a lot about is there a different model and should we instead teach folks to hide and to secure, get into some kind of secure area where in fact, they're out of the vision of the active assailant?
I think that's a great I think that's a great idea. And I think as a health care professional, I think that creates less internal conflict, less moral distress with that type of a of a suggestion. But again, ultimately, I have to make that decision for myself at the moment I'm confronted with it.
Michael Dunning: You know, I completely agree with that.
I will add one more thing to that, if I may. We need to teach them how to make that decision, what tools they need in their brain to be able to decide, do I run or do I not run? Because if you just say, hey, the decisions yours, you do what you want, they're still not prepared to make a good decision.
Instead, we need to train them about what to listen for, what to look for, what route of travel you're going to take. If you're going to hide, what does that mean? In a sad fact, I've been to several active shooter drills, and when you start talking about the hide part, we still have people who hide under desks and forget to lock the doors. Right. So they don't barricade. They don't deny that entry point. They just try and hide without the knowledge of how to hide.
Karen Garvey: Yeah. And I think in addition, in each of you have mentioned, it is the training component. And in my career, the training has all been this quote unquote nonproductive time, which has, you know, sometimes is frowned upon and some things that you have to do.
But there really is not the adequate resources in the time to be able to be devoted to it. And I think that that this is part of our job. This is part of the requirement. So moving it from that mindset of being, it's just nonproductive time. I've got to go and I've got to do this and get it done and check that box.
But really implementing it as part of our general day to day curriculum.
Lisa Terry: Just absolutely. Excellent. Go ahead. I'm sorry, Doug.
Doug Kohlsdorf: Well, I just wanted to I just wanted to go back to the comments about the run hindsight and individual decision. I agree with those comments, and I think, too, to punctuate that as an organization from an organizational level, we have to give them, to Mike's point, the tools, we can't just say, do what you want.
We don't say that with anything else, right? We say when the fire alarm goes off, you do this, this and this. So it's really important to understand what your your board's what your senior leaders are saying. This is what we want done. And it goes back to that conversation, having that, you know, having the honest conversation with them, saying, what is it?
How do you want us to react and giving them their options is really important. So it kind of circles back to that communication. But just saying do what you want is to Mike's point, we just can't you just can't do that. It has to reflect the organizational, the organization's senior leader’s desires. I mean, that's who we you know, we serve at their will, so.
Lisa Terry: I think one thing that really came to mind is, for instance, we talk about safe rooms, and I dare say there is not one safe room in a hospital that would that you could actually say this is a safe room for an armed situation, armed attack. So really making sure that we share these are relatively this is a relatively safe space.
And how do you, as Mike said, lock the door, you know, one of those things, what would you add to barricade? How can we make that so that certain things wouldn't penetrate that door or that room? But there's just so much to this. I think we could all probably talk for days. Is there any last words, anything you'd like to say?
This was absolutely wonderful.
Stephanie Doty: You know, the only thing I would add is a bit of a word of caution. Watching a video was one thing. Doing a live active shooter drill is a whole nother kettle of fish. And that can actually cause more harm than good. And so I think I would just caution anybody who is considering doing that to reconsider that approach. I think running through scenarios in individual’s minds and running it through that way is safer, if you will, than actually doing an active shooter drill, a real live, active shooter drill.
Michael Dunning: You know, that's a very good point because there have been studies looking at doing active shooter drills and the impact on not only staff, but patients.
And, you know, you can only go so far to tell everyone this is a drill and they still respond as if it's real. One of the things that I found works very well is you take this in little pieces, little segments, and watching a video, if that's your end all be all training. I'm sorry. That is just that's not anywhere near enough.
We've got to go to huddles. We've got to go to department meetings. This has to become a conversation that we have, not just once a year, not just once a quarter. This should be something that we bring up and say, what do we do If ? You know, that's a great way to start a meeting? What do we do if we heard a shot? What would we do? Take 5 minutes and go through that scenario. Then have your meeting. And that way, every time you get together, you have like you consider that your safety briefing or your safety moment for your meeting. I think if we know, if we don't put this into our everyday conversation, then we're not addressing this as we should.
Lisa Terry: Any last words from you, Karen? I can see thoughts running through your head there.
Karen Garvey: Well, and I'm hearing everybody and I want to I think just restate something that I had said earlier. So we have done more localized drills, you know, in our own space of how do we barricade in a conference room or something like that, but have not done.
And just as Mike had said, not done full blown because of the panic, inducing panic, when it may not when it's not like you can do a fire drill where you can get people outside. That's a whole different story. So it was more localized where we've done them in our own our own area.
Lisa Terry: Very good. I can't thank you enough.
This is wonderful. This was, again, another good first step. And I really look forward to continuing this conversation as we move forward. I love leading practices and I think each of you have some of those to share. So thank you. And I look forward to talking with you again soon.
Michael Dunning: Thank you, everyone.
Doug Kohlsdorf: Thank you.
Karen Garvey: Thank you.
Stephanie Doty: Thank you.
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