“This year, the U.S. has already had more than 30 mass shootings.” That quote alone would comfortably capture attention no matter what time of year it was reported. And yet that is how we started the first month of 2023. In fact, this very statement alluding to targeted violence was reported by NPR’s Ari Shapiro in January of 2023, just 25 days into the new year.
The NPR story centered around the impact violence is having on mental health and identified that these shootings were a significant cause of stress for the general public. Even when we are not directly impacted from the reported violence, we still feel significant anxiety and begin to worry about our own safety, particularly in the workplace where most of these incidents occur.
No longer are these attacks generally interpreted as isolated incidents taking place only in specific industries or businesses. They have become common in the American psyche and the moniker, “workplace violence” is well understood. In fact, the US Department of Labor cites acts of violence and other injuries as the third-leading cause of fatal workplace injuries in the US.
For those of us who have not been directly impacted by the violence, we can also increasingly feel distressed, and our continued hypervigilance is eroding our sense of normalcy. Those who are directly affected by these tragedies, especially those who experience the most loss, have increased potential for PTSD, depression, and lasting traumas associated with tremendous grief.
Anecdotal evidence suggests that most people want to do something to counter this violence but continue to be frustrated at the inability to affect and see changes. Whether it’s the same debate for or against gun control, both sides are tired of the stalemate. Though it’s becoming clearer that society is no longer satisfied with the status quo and are demanding accountability in the workplace. This accountability is being handed down through the courts.
Courts demand accountability with billions in fines.
From government and military agencies to individual corporate officers, courts are demanding tighter scrutiny by employers, and oversight regarding how personnel complaints and concerns of violence are handled in the workplace. This increasing pressure for accountability is forcing organizations of all sizes to confront its own responsibility in preventing violence and protecting its employees.
The American Bar Association cites a shift in recent court decisions and predicts the trend will be that more will be held liable for failing to prevent acts of violence. Particularly as incidents become more frequent and more widely reported, the argument that an incident was unforeseeable is no longer good enough.
The following jury awards, court rulings, and pending lawsuits align with this trend. Juries are demanding prevention and preparedness even from government agencies who have traditionally enjoyed a level of impunity. Liability and accountability are being sought, and in some cases, delivered in unprecedented monetary sums.
The Justice Department was found negligent and will pay $130 million to the victims of the Parkland high school shootings because the FBI failed to properly investigate tips about the assailant it had received prior to the shooting. The lawsuit argued that the crime was preventable. The FBI acknowledged that they had not followed its own protocols and failed to pursue information provided from their tipline and social media postings from the assailant.
The US Air Force was ordered to pay more than $230 million to victims of those killed in Sutherland Springs by a former Air Force Airman (employee) who was discharged in 2014. The court ruled that the Air Force was liable because it failed to report (six times) the Airman’s previous assault and domestic violence convictions and other related information to the FBI. As that may have prevented him from buying the rifle used to in the attack.
MGM resorts agree to pay $800 million settlement to shooting victims. 58 people were killed in the attack where the assailant shot at victims from his hotel room overlooking an open-air concert in Las Vegas. The MGM casino was accused of negligence, wrongful death and liability, failing to protect people at the concert venue, and failing to stop the shooter from amassing weapons and ammunition in his room over several days.
Cable company Charter Spectrum was ordered to pay over $1 billion to the family of the victim who was murdered in her home by a Spectrum technician that had previously performed a service call to the residence. Despite the company arguing that the employee’s act of violence was unforeseeable, the court cited Spectrum’s lack of due diligence by hiring the employee without reviewing his work history and ignored behavioral red flags during his employment. The jury had initially awarded the victim more than $7 billion in damages, but was lowered to $1.1 billion by the presiding judge.
A $50 million lawsuit launched against Walmart by an employee who survived a workplace shooting perpetrated by a Walmart manager, alleges that the company knew of the assailant’s violent behavior and failed to protect the workers. The employee is faulting Walmart and accusing the company of not taking investigative action despite numerous complaints about his behavior. This case is still pending as of March 2023.
Victims of the Uvalde school shooting have filed a $27 billion class-action lawsuit against the police, the city, and school officials for the attack. 19 children and two teachers were among the victims. The lawsuit claims their deaths could have been preventable if not for the collective negligence and failure of the law enforcement officials at the scene. A separate group of survivors have also filed an additional $6 billion suit against Daniel Defense, a company that manufactures the firearm used. This case is still pending as of March 2023.
In all of the cases above, courts are finding convincing arguments surrounding the prevention of these attacks. That is, these targeted attacks were foreseeable and could have been prevented. The courts determined that the responsible parties were negligent, failed to act, and did not satisfy their duty to protect their employees and the community.
But is workplace violence and targeted attacks preventable?
A recent publication by the US Secret Service’s National Threat Assessment Center, analysis of 173 attacks in the US from 2016 to 2020, offered an unambiguous response. To quote from its executive summary, “…targeted violence is preventable when communities are equipped with the appropriate tools, training, and resources…” Because most locations of attacks were businesses, one of the key implications of this report is squarely directed at businesses; to establish a workplace violence prevention plan to better “identify, assess, and intervene with current employees, former employees, and customers who may pose a risk of violence.”
As reported by the American Bar Association, the perception of whether targeted violence and incidents involving violence in the workplace are foreseeable has begun to shift. In other words, exposure to litigation and significant penalties can now more readily include everyone from business owners of where the incident occurred, to security firms and law enforcement, and even parents of the assailant.
As was the case where parents of a Michigan school shooting suspect was charged with involuntary manslaughter for missed opportunities in preventing the tragedy despite knowing that their son had access to a weapon, and that he was deeply troubled. Indeed, the legal bar of foreseeability and preventability has been lowered.
Crime is trending upward.
According to a recent 60 Minutes interview, FBI Director Christopher Wray acknowledged that there was a 29% increase in murder in the US in 2020, almost 5,000 more people were killed than in 2019. Violent crimes such as murder and aggravated assault saw record increases, by another 4 percent in 2021. And in his testimony before the Senate Judiciary Committee in August 2022, the FBI Director stated that the top concern from law enforcement leadership around the country is the increasing violence in their communities.
Exacerbating this trend are the difficult challenges still present in communities where trust remains low for law enforcement and demands to defund the police continue.
Some cities around the country are seeing how lawlessness hampers economic growth and recovery. Starbucks cited increased violence and the need to protect employees and customers when it shuttered 16 stores, with six of them in Seattle alone. Amazon is taking similar approaches by moving employees, or simply not renewing leases in some of its downtown locations, impacting approximately 2,000 employees.
As recent as 2017, the Canadian province of Ontario enacted comprehensive requirements for companies to assess the risk of workplace violence in their facilities and present a full emergency plan to the government’s joint health and safety committee. At PRS, we highlighted the specific requirements of the new legislation at the time and our article can be found here.
How can we help you?
As violence increases, the cost of negligence increases as well. No longer are businesses and companies shielded from traditional beliefs that used to protect organizations from third party negligence. Juries are sending clear messages on who they consider the liable party. Legislatures are also aggressively seeking ways to address the violence, by mandating training and ensuring that emergency plans are developed for each and every workplace.
In other words, we are all on notice to ensure that our organizations develop plans for workplace violence prevention, conduct threat and security assessments, and update emergency response plans.
For nearly 10 years, PRS has been active in assisting our clients to comply with latest requirements of workplace violence prevention laws and associated best practices. We are uniquely qualified and have certified professionals on our team to help you prepare and protect your people. Call on us to help you get started on a workplace violence prevention plan or a security risk assessment.
The term Situational Awareness is quickly being relegated to jargon and used so often that its meaning is becoming too vague for many of us to fully understand and appreciate. At the risk of diluting more of its impact, the intention of this post is to help improve organizational capacity for Situational Awareness. Before that can be achieved, however, we must first offer (yet another) brief definition.
What is it exactly?
At its core, Situational Awareness is observation plus perception, underpinned by understanding. And that level of understanding is informed by how familiar we are with our surroundings and there environmental and cultural norms.
By understanding how we can increase our observations, we can then help to reduce the risk of injury to ourselves by more accurately recognizing potential threats to our security.
Our level of awareness depends on how observant we are, and in varying degrees, help us make sense of the situation around us. As humans, we benefit from multiple senses working together to inform our perception of where we are, and what might be happening.
And that perception can be inherently subjective because it is supported by our personal experiences, professional training, and cultural values.
A brief thought experiment:
Suppose we woke up suddenly in an unfamiliar setting feeling completely groggy. It is still dark and through the window we notice it getting brighter. In short order, our senses work together to increase awareness of our current situation. Our eyes scan the room for not just casual features, but whether anyone or anything present can be a threat to our safety.
We notice the smell of bacon and conclude there is a kitchen nearby or perhaps it’s breakfast time. We feel a chill in the air, hear the wind howling outside, and assume there’s a winter storm. Absent the sound of traffic, the notable quiet helps us imagine ourselves far from the city.
After a few minutes, we begin to settle our minds, stand, and observe our surroundings a bit more deliberately. We now notice our personal luggage by the door, a ski brochure next to the TV stand with ads in a foreign language, and the power outlets on the walls are shaped differently.
It’s all coming back. It has been a few years, but still familiar. We take a deep breath, smile, and realize we are finally back at this mountain resort, safe, and recovering from the long travel … and a few sleeping pills.
Let’s break this down.
In this scenario, our observation of new surroundings (E.g., initial scan of the room) is then coupled with our perception (E.g., the smell of bacon, feeling chilly, and noticing the quiet) to inform what becomes our ultimate understanding/judgment that we are in a familiar environment.
That conclusion required making sense of observable clues and analyzing the information based on how we were feeling, at that moment.
How observant are we?
After the attacks of 9/11, New York City created the “[if you] See Something, Say Something” campaign, which has since been adopted by the US Department of Homeland Security (DHS).
DHS’s efforts to promote general awareness nationwide included videos (still found on YouTube) that challenged viewers’ level of attention and perception.
These videos usually contained a fast-paced scene where multiple actions happen simultaneously. Modeled after the classic “invisible gorilla” experiment, viewers are asked to keep their attention on one area of the action and were then tested to see if they noticed changes happening in other areas during the same scene.
While overall feedback of the videos was mixed, anecdotal successes for the campaign have been attributed by many safety experts who cite increases in bystander reporting. That is, more people are starting to say something after they see something thus generating more situational awareness.
But how can we improve this skill?
Honing our capacity for Situational Awareness can be likened to a journey. As with most journeys, it is dynamic, and the landscape changes constantly. Practice and repetition help to sharpen our mental filters, making us more capable of recognizing things that don’t quite fit. Deliberate observation is necessary.
Most of us do this daily without much effort.
In the virtual world, when scanning our emails, for example, we have a sense of awareness of spam, phishing attempts, and potential cybercrime.
From confirming a sender’s full URL or taking note of grammatical and cultural tones, we are increasingly adept at Cybersecurity and identifying digital threats – and which attachments NOT to download.
It is no different in the physical space.
When driving, we would likely reduce our speed when we notice a police officer nearby, and we’d probably avoid parking in a poorly lit area of a garage. We might move away from rowdy and boisterous crowds, etc… And we’ve come to do these things almost instinctively because we have grown more observant through exposure, experience, and training. Just like what we do daily in cyberspace.
To put it another way, we have increased our familiarity with these types of scenarios and can now respond more effectively to decrease the risk to our own safety.
From the commuter train to the corner office, our daily journey is dynamic and offers abundant opportunities to help sharpen our Situational Awareness.
The more times we experience something, such as going to a concert or navigating through a busy airport, we become ever more familiar with what is supposed to be routine, and “normal.”
So how can we improve on these skills and get to our conclusions more efficiently? And can we get there in a timely manner? The answer can be a resounding “yes!” and here’s how we can begin to increase our capabilities.
But first, a case study in situational awareness: Despite popular media often describing catastrophic events being thwarted by those with almost super-human abilities and world-class training, the reality is that a vast majority of incidents are not prevented by a Jason Bourne, but rather, regular people who are just more aware of their surroundings.
The following testimonial from a senior member of the PRS team offers an ideal opportunity to analyze a scenario most of us are familiar with. Reading through the narrative, we can easily picture ourselves at the scene and analyze what we would do in this situation.
In the following narrative, let’s consider two questions.
1) What would we have done?
2) How can we help prevent/mitigate this situation?
“I took the attached picture mid-day on Saturday, July 30th, 2022, at SeaTac airport. The airport was quite busy at the time with travelers’ comings and goings. This vehicle was situated curbside from baggage claim. As I walked up to take my position on the curb to await my ride, I immediately noticed no one was in or with the vehicle. I surveyed the area and did not notice any individual(s) who appeared to be keeping an eye on the vehicle. I waited a couple of minutes to see if someone may approach the vehicle figuring there is a chance they ran inside to help an elderly family member or friend or perhaps had to use the restroom.”
“ As 3-4 minutes went by and no one arrived or appeared to be minding the vehicle, I snapped this photo. I looked up Port of Seattle Police to report what I felt was a suspicious vehicle. As I located only a number to text or a non-emergency line, I decided to go the route of texting, thinking perhaps it may be a line more urgently monitored. Just as I was about to hit send on that text a younger-looking female approached the vehicle, albeit somewhat suspiciously as she appeared to have a hesitancy to stay with the vehicle. In short order, however, she decided to enter the vehicle and sit on the passenger side. At that point, I felt it was no longer necessary to report the incident as a suspicious vehicle and within another 30-45 seconds a few others appeared, jumped in the vehicle, and departed.”
“While all ended well in this scenario, the spider senses went up because of the training I have had over the years to identify situations such as this and handle them accordingly. I realize time is of the essence in reporting potentially suspicious items or equipment, in this case, I did not visibly see anything in the vehicle itself. Could an item have been in the trunk that had a nefarious purpose? Perhaps. My senses told me otherwise though once the initial female arrived and stayed with the vehicle.”
As to the first question, “What would we have done?”, given the circumstances there’s not much more that could be done at that time. Attempts were already being made to contact airport authorities and was only discontinued when the owner(s) of the vehicle returned.
Playing the “What if?” game.
We all do it, and we should. Our brains are naturally wired to seek out solutions and understand how we can best survive. Taking the above scenario a bit further, however, if we supposed that more minutes went by and the vehicle increasingly looked like it was abandoned, then we would be forced to act.
What if, there was something in the trunk?
We’d likely move farther away from the vehicle and then attempt to recruit others nearby (I.e., call out to airport employees and others, etc..) to help keep the area clear until law enforcement officials can respond and properly secure the scene and begin mitigating strategies on the car (E.g., explosives detection, etc…). Indeed, our individual efforts would have to be amplified for us to clear the area.
How can Situational Awareness be amplified (force-multiplied)?
In the US military, the use of a small number of specialists to train a larger force is designed to create a force-multiplying effect. Extra sets of eyes and ears will always help.
Simply put, a force multiplier can be anything or anyone that increases the effectiveness of that force.
In our airport scenario, the force-multiplying elements are human bystanders, airport employees, and fellow travelers who are willing to help. However, that presupposes they have been trained and will cooperate in ways that do not complicate the scene, and cause even more confusion. It’s not an ideal situation, but it might be the next best thing given the apparent absence of other security professionals.
The benefits of having even just one security agent.
Regarding Situational Awareness, a more effective force-multiplier is a professional security agent. Organizations that employ physical security agents have an inherent advantage of trusted professionals who are trained to keep a watchful presence and respond to incidents.
Beyond training and knowing proper response protocols, these agents also have the benefit of regular interaction with company personnel, the facility, and its surrounding area – all factors working to increase their understanding of what is normal and what might be otherwise concerning.
Physical security agents can also serve as a resource for employees (and bystanders) to report incidents and suspected wrongdoing without fear of judgment or retaliation.
Professional security agents are force-multipliers benefiting the entire organization, as well as neighboring facilities and indeed, the community. From assisting hybrid employees unfamiliar with the office to spotting hazards (E.g., broken and malfunctioning equipment, etc.…) and preventing trespassers with nefarious intent, professional security agents’ advantages are immeasurable to an organization and its assets.
Their high level of Situational Awareness is honed through consistent observation of their environment. In fact, an organization’s overt security presence also signals to would-be attackers that they are not an easy target for crime.
At PRS, we help protect organizations by preparing their personnel. Contact us should you want to learn more about our services.
The world we find ourselves living in today is filled with turmoil, conflict, and disruption. Early indicators show that Y2022 is proving to be disruptive on many levels. Current global conditions have created geopolitical divisiveness coming from such countries as Russia, China, Iran, Syria, and Canada. Global security concerns present other countries facing immediate danger of civil war, protesting, civil unrest, food insecurity, critical infrastructure/energy, economic, pandemic/infectious disease outbreaks, cyber/IT, and terrorism-related challenges.
Furthermore, the current Russian-Ukraine crisis in Eastern Europe has created the possibility of economic stagflation, increased energy/oil prices, and supply chain management challenges. Russia’s waging war on Ukraine has created a humanitarian crisis not seen since World War 2. Russia’s full-court press for a land-grab situation to mine additional resources (fossil fuels and other minerals) is naturally a disaster to the Ukrainians who wish to remain an independent nation of peaceful people. Ukraine remains steadfast in its resolve to fight back against a much larger, more powerful nation-state in Russia, which is building parallels in their government and global actions reminiscent of the Soviet Union’s Cold War years of the past.
With the US mid-term elections approaching this November, there exists increased anxiety along with disruption to household incomes. Considering the global pandemic, organizations have been faced with the Great Resignation, with workers being highly selective on work-life balance while safeguarding their personal and mental health and managing their self-care. Recent events have further caused labor staffing challenges for most businesses, creating bottlenecks and supply chain interruptions with organizations and their products available to consumers as well increased wages and other associated costs. This has forced organizations to be ever mindful of their personnel and their impacts on the overall organization’s health, welfare, and vitality. This has caused disruption to the organization’s overall strategic mission, goals, and objectives. Managing risks in this situation includes organizational morale, employee empowerment, corporate budget impacts, and operational/financial risks involved in evacuating or displacing staff or employee family members.
Premier Risk Solutions has borne first-hand witness to the situation on the ground in Ukraine that is impacting locales as well as, by extension, family members who are living and working outside of the country but concerned for the well-being of their family. While the clients we have supported within Ukraine do not have full-time employees within the country, their employees have family members there, and/or the client has vendor partners in-country they work with. These situations have caused disruption to the business as the personnel are unable to focus on their work or in some cases do any work at all, further causing supply chain delays to the company. Companies are forced to decide on what level of support they can or are willing to provide to personnel who are not direct employees. Our clients who we’ve worked with directly on this issue to evacuate impacted personnel are treating them as one-off situations but have provided support for evacuation when and where appropriate based on a dynamic risk assessment of the situation. Premier Risk Solutions and our agents are also constantly evaluating opportunities through our own fluid risk assessment for avenues of egress for evacuation as it is evolving on a day-by-day basis.
The threat continuum is ever-evolving and is constantly changing based upon a multitude of security challenges. The need for organizations to create an enterprise risk security management, holistic approach to safeguarding their personnel, brand, assets, and vendor supply chain is paramount in meeting today’s challenges. Organizations are well served by conducting – at minimum – annual risk assessments while conducting normal business activities during this time of uncertainty. Should your organization require a consultation please reach out to Premier Risk Solutions for a free consultation.
How can we prevent major violent incidents from occurring? Being proactive is the best means of doing so, as we all know. With budgets constantly being challenged for resources from within the organization, corporate security department heads need to determine where their budgetary funds are best utilized in providing value to and enabling the business. Enter TipNow Pro out of Silicon Valley in California, where founder Cyril Rayan has developed a tool that acts as an extension of your existing program to deliver a proactive means of identifying threatening situations or items through anonymous reporting as well as integrated video analytics.
Cyril developed the technology after the Virginia Tech college campus active shooter incident at a time when he himself was a professor. In its current iteration of the tool, it utilizes both human capital and integrated video analytics to report on threats. It is the very definition of “see something, say something”. The human capital component through anonymous self-reporting in live streaming, SMS texting, voice tips, and mobile app tips, allows for the pre-defined administrators from the client company to receive notifications in “real-time” for assessment of appropriate action to be taken.
The integrated video analytics component allows for the identification of weapons, license plates, and intrusion in an automated manner. As a two-way system, it’s both people and technology working in tandem that allow further agility within the corporate security department in being proactive in augmenting their current security posture.
Premier Risk Solutions sat down with the founder of TipNow, Cyril Rayan, and had a brief discussion on his technology and how it can enable business, providing the value that so many department heads seek. He discusses some of the content written here but also shares a case study example of how the technology benefited a client in the best way possible. Have a listen! Please contact us should you have any questions.
As the world is evolving into more uncertain times in society, having a means of centered communications in a way a company can aid in proving a duty of care to their employees and contingent staff is of paramount importance. That is the reason for the existence of a GSOC. The integrated adoption of technologies with a combination of human capital to monitor and respond to alerts, developing intelligence, emergency phone calls, asset tracking, travel advisories, or other related systems notifications allow for quick response capabilities in triaging the situation. Being agile, consistent, reliable, and adopting new tasks are pivotal to support business operational needs.
In Premier Risk Solutions’ protective operations, we work with our partners at NSSG Global in Bucharest, Romania to provide remote support capabilities. With 24/7 dedicated GSOC operators, integrated network video, alarm & access control systems, telephonic response & escalation, along with protective intelligence analysts there is a holistic approach and execution to support field operations. As part of the service, we have rolled out an app that can be found in the Apple or Android stores that is called NSSG Support. We want to take an opportunity to showcase this further in this blog.
The purpose of the app is for personnel in the field – both business travelers/principals and our agents supporting them – to be able to not only provide safety check-ins but share pictures from your gallery and even snapshot one with your current location, chat with our GSOC operators with any questions or issues, as well as provide an urgent SOS signal to our GSOC operators to escalate imminently for garnering assistance to the individual.
The screenshot enclosed is directly pulled from the app, where “Send SOS” is located at the top. With “Tracking” turned on, we can get an accuracy of the individual’s location inside of 30ft and in some cases closer. You can also see in the enclosed screenshots where an individual can chat directly with the GSOC or an agent supporting the individual can also do the very same providing updates or requests for assistance. We do have our agent resources located on a map that is run in the GSOC to know who the closest assets are for deployment in an emergency. The “Send SOS” signal goes to one dedicated device with a phone number, with email notifications additionally permissible for redundant receipts.
Groupings can be set up for any number of individuals within an organization. There can be an unlimited number of groupings. Each grouping can have an email disseminated to the assigned representative from the company for any/all relevant activity desired. Should a company desire more regular reporting, the GSOC on the back end can administratively export chats, tracking info, etc collected data to share with our client.
Setting up a new user account typically takes approximately five (5) minutes time for our GSOC managers to get operational. Collaborating with your company representative, we can scale quickly to meet more volume needs as well. Knowing where your staff are and getting them expedient, qualified assistance is of the utmost importance. Should your company like a demo of the tool to learn more, we are happy to schedule a time to do so.
The main theme here is the attention to detail, quality assurance, and custom/tailored approach Premier Risk Solutions takes to ensure we reflect your brand reputation and integrity. Remaining agile to service your evolving needs, being responsive to your requests, and being consistent and reliable in our service delivery are hallmarks we strive for in each engagement. In all things we do, we provide comfort to your principals while balancing privacy and confidentiality with safety and security. We will be highly collaborative in our boutique offerings. Please contact us should you like to discuss your unique situation.
Following the protective services offerings PRS has been engaged in with our clients since the company began in early 2014, we began in late Q3 2021 exploring how we can further enhance our service offerings to our clients in the areas of:
We are proud to announce that we are operational in each of these areas! Our partnership with NSSG Global allows for our dedicated services in Protective Intelligence and Global Security Operations Center (GSOC) to support our ongoing and new prospective clients for their protective operations.
In Protective Intelligence, a high-level snapshot of capabilities include:
Flexible and Agile to Scale to your needs
24/7 Dedicated Analysts
Custom, tailored research, analysis, and reporting of threats to staff and properties
Guide executive protection team members and client personnel in planning, protecting and responding to operations
In Global Security Operations Center (GSOC) support services, a high-level snapshot of capabilities include:
Flexible and Agile to Scale to your needs
24/7 Dedicated, Highly Trained Operators
Command, Control & Communication Flow
GPS Tracking Capabilities
Integrated Network Video, Access Control & Alarm System Monitoring
The Protective Intelligence Analysts and Global Security Operations Center (GSOC) personnel are all co-located out of Bucharest, Romania in a secure location with the latest available high-speed broadband and network abilities. Being co-located allows for as near “real-time” information flow to PRS support operations and our clients. The personnel at the center are adaptable to tools preferred or required by our clients, which depending on the tool may require additional license fees beyond our standard package offerings.
Our Medic personnel is resourced from our local healthcare partners in the market of need throughout the U.S. They can either be full-time, dedicated staff members to a client or temporary needs for specific events or activities like board meetings or larger special events like a sales kickoff or tradeshow. The medic training packages offered include:
Short 1-4 hour refresher/tac-med skills driven
One Day, up to 12 students with 2 instructors, skills & scenario based training outside (class is POST, DHS & EMSA approved)
Two Day, up to 12 students with 2 instructors, Tactical Medical Operator (TMO) training (class is POST, DHS & EMSA approved)
Five Day, up to 20 students with 2 instructors and 4 skill/proctor instructors, Tactical Medical Technician (TMT) training (some medical training pre-requisites; class is NAEMT, POST and EMSA approved), with TECC certification included
Program Development Consulting: Advising on best practices for medical preparedness, preventions, early interventions, gear selection, travel medicine programs, and emergency medical response.
The medic training can be delivered to our client in-house and/or contingent staff (vendors), along with providing to our own team members.
Drug Diversion Interviews in Healthcare: Gateway to the Truth
The Emotional Connection Interview
By: Kevin Vanover and Rich Cinfio
The intent of this article is not to provide an in-depth review of drug diversion in healthcare; rather, it is to shift the primary focus to what we believe is the most critical component of the investigation process: The Interview. The interview is all too often overlooked, misunderstood and mishandled by well-intentioned leaders who may not be fully prepared to perform this responsibility at the level needed. There are inherent obstacles when trying to determine the truth under very stressful circumstances. Drug diversion interviews are by their very nature high-stress with much at stake. To overcome these challenges, the interviewer needs to possess a significant level of training and experience. The latter poses its own set of challenges when the interviewer is unaccustomed to utilizing conversation on a daily basis to determine the truth. To help better understand the importance of a sound interview approach, it is helpful to possess a general awareness of drug diversion nuances in healthcare.
Drug Diversion in Healthcare
Internal diversion of controlled medications by hospital employees erodes the care plan and safety of patients, hurts the service image of the care provider and supports the employee’s unhealthy and unlawful lifestyle. Further compounding this is the possibility of state-imposed fines, Joint Commission sanctions and patient initiated civil litigation. Typically, clinical care providers, such as physicians, nurses and pharmacists, have the most access to controlled medications. Despite existing systems to deter such activity, some caregivers possess the motivation and opportunity to circumvent safeguarding protocols to use medications for their own purposes. One motivation is drug addiction. The American Association of College for Nursing estimates there are 3.8 million registered nurses in the United States. Various studies place drug addiction rates among nurses at 8 to 15%. This is not to assume, however, that all drug addicted nurses divert medication. The frequency of diversion is also a factor to consider. John Burke, President of the International Health Facility Diversion Association, using extrapolated data from medical facilities in Ohio, estimates that 37,000 drug diversions occur nationwide annually at an estimated loss approaching $200 million.
What is clear, is the consequences of drug diversion are significant and harms everyone involved. In many instances the patient is denied pain relief and the risk of exposure to blood-borne pathogens from the cross contamination of supplies can elevate. Other concerns include inaccurate billing for medications never received and criminal and state regulatory board investigations resulting in sanctions.
Common Methods Used to Divert Medications
Some common methods for diverting medication include “wasting product”, which occurs after a patient refuses the medication or the dose pulled is inconsistent with the amount ordered, and the remaining dose is then used for the healthcare workers (HCW) own purpose. “Substitution” of medication occurs when the HCW diverts the intended medication and administers a common uncontrolled medication in its place. Another way to divert medication is the concept of “One for you and one for me”. This occurs when the HCW pulls two doses of medication – often two pills – scans the dose in the system and gives one dose to the patient while keeping one for their own use.
There are many systems commonly used to support prevention and detection of diversion activities. In addition to having a sound early recognition system to detect anomalies and other patterns of possible diversion, common defense strategies include strict transportation and storage guidelines, the tracking of retrieved or “pulled” medication from storage systems, such as “Pyxis machines”, and documenting when and to whom the medication is provided.
Suspected Diversion: Initial Response Options
Despite existing systems and protocols to prevent and detect diversion, it does occur on an all too frequent basis. Responses can vary and typically consist of:
Monitoring the behavior to determine if additional steps need to be taken.
Remedial education and training if established protocols are not being followed.
A review of practices and behavior exhibited by critical stakeholders involved in the dispersion of medication processes.
Convening an internal review group consisting of experts representing various medication touchpoints to examine and assess existing facts.
Reporting to state regulatory agencies. Typically, each state has a regulatory oversite board that falls under various branches of the state government.
While there are numerous response strategies available when diversion is suspected, it is our belief that all must strike the proper balance between protecting the patient, provider and employee. Fairness, balance, compassion and sensitivity is highly important when ensuring the determination of truth and the inherent accuracy of facts. Taking an aggressive posture that wrongly accuses the employee will leave them feeling abandoned by the organization with trust irrevocably broken. At the same time, determining the truth is a significant safety and risk- management concern for all involved parties.
Despite the existence of numerous response strategies, interviewing the employee is often the only available course of action that yields the greatest results and determines the truth. The question then becomes how to fairly balance everyone’s interest while protecting the needs and safety of the patient? It is our belief the interview and statements provided by the employee most often sheds direct light on what occurred and in a fair manner; thus, eliminating the need for speculation and an unsettled outcome. A truthful admission has many benefits including:
A legitimate explanation that clears up a misunderstanding.
Identifying training gaps that need to be rectified; very helpful when the employee is new.
Providing clarification on next-steps to help guide the recovery process.
Preventing future diversion attempts in a timely manner.
Shedding light on protocol adjustments in the event the interview does not yield a clear direction.
Gathers facts that can be used to prevent future activity by strengthening oversight.
Serves as a mitigation strategy for patient safety, risk management and liability exposure.
A fair process done in a compassionate way messages to the organization and patients that the organization has a strong, yet balanced approach while focusing on a zero-tolerance standard.
It has been our experience, however, that this most valuable tool, in our professional opinion second only to direct observation of theft (which rarely occurs), is often mishandled resulting in a cloud of confusion, frustration and mistrust. Common interview pitfalls include:
Rushing to conclusions.
Supervisor and others dismissing or downplaying the facts: rationalization and denial.
Inherent bias when leaders make decisions based on personal relationships with staff.
Interviewing before all available facts are known.
Poor or non-existent documentation.
Using harsh language and tone of voice.
Conducting a “police interrogation” first.
Attempts to outsmart and outwit the healthcare worker or bluffing with false information: “The Colombo approach”. The mistaken belief that a factual “gotcha” moment will result in an admission.
In addition to failing to establish an emotional bond with the employee, one of the more common mistakes is having too many people involved in the interview process. There is the mistaken belief that some bit of information will be missed, or an employee’s right will be violated so every entity who touches the diversion process needs to be in the room. With so many group representatives involved, the interview takes on the appearance of an inquisition. This all but guarantees an unsuccessful outcome because the interview focuses on what occurred thus failing to answer the more important question – why it occurred. It is the “why” that provides the gateway to determining the truth. Simply stated, having too many people in the room more often than not severely limits the interview and prevents a connection. This was one of many reasons why criminal investigators, who perform sensitive and stressful interviews, transitioned away from this model decades ago
A Different Approach: The Emotional Connection Interview & Determining the Why
Unrealized by many, interviews are highly complicated, involve many facets and require the interviewer to make an instant emotional connection with the interviewee. A connection that fosters trust, reduces fear and provides the best opportunity for establishing the truth. The interviewer needs to actively listen for a small kernel of information that requires a seamless and instant pivot towards a new direction; the ability to ease the employee’s concerns, fear and eliminate untruthful defenses while genuinely investing in their future recovery. There are five primary facets to the emotional connection interview: Preparation, Environment, Opening, Narrative and Closing. The following is a brief summary for each:
Preparing for the Interview
Preparations in advance of the interview include:
Reviewing and understanding all facts associated with the incident.
Examining the employee’s work history.
Determining what is known that could drive the employee to engage in this behavior.
Preparing the interviewer’s mindset – determining how best to approach the interview.
A proper interview environment is critical. In general:
Conduct the interview at a neutral and confidential location that is free of distractions.
Silence cell phones.
There should be no more than two factfinders in the room.
Only one person should ask questions.
Initially, only take written notes when necessary. Note taking is a distraction and prompts defensiveness.
Prepare a few questions in advance and avoid a script.
Explain to the HCW that the interviewer is here to understand why this happened. Explain that we know what happened, but we don’t know why. The why is important for many reasons including setting the context for what occurred – the salient driving issues – which help set the foundation for discussion.
Summarize that you are representing everyone involved including them. Recognize and discuss the pressures the employee must be feeling.
Explain that the organization has a robust analytical system that provides the pharmacy team with anomalies associated with the distribution of medication and these cases are investigated daily just looking for answers.
Allow the HCW to explain the processes they use when performing their medication responsibilities for narcotics and non-narcotic medications.
Assure the HCW that this process has the ultimate goal of making sure that the HCW is healthy and to have better work-life balance.
Practice active listening by letting them talk.
Listen for defensive themes designed to mislead the interviewer. Themes many times include statements that attempt to imply the theft did not occur or they are not responsible. Examples include, “I know you won’t believe this but…”; “To tell you the truth…” or “I swear on…”
Explore opportunities to reaffirm that “good people make mistakes”.
Compare many life events to the interviewee with the ultimate goal of minimizing what has occurred.
Speak to the root-causes for the behavior not the behavior itself.
Empathize with them as they explain the why. You are asking them to open up and to be vulnerable. Be prepared to be vulnerable yourself.
Vary tone of voice to encourage conversation and to display compassion.
Once there has been sufficient conversation to adequately address all facts and concerns, then the interview can enter into the closing phase.
Explain to the HCW that this investigation has to be reported to the state regulatory board and local law enforcement for separate investigations. Emphasize that their cooperation with the additional investigations is optimum to reaching the end goal of a healthy lifestyle.
Actively share in their relief by telling the truth; be encouraging and non-judgmental.
Let the HCW know that they will be supported through the Employee Assistance Program to include the drug screen process prior to leaving the site on the day of the interview. Think of it this way: The ultimate goal is to determine the truth and to bring closure for all involved. Done right, the employee may reach out and thank you in the future for impacting their life in a positive way, sharing with you the recovery process.
The investigation of suspected diversion can be a complicated, emotionally charged and stressful endeavor. A properly trained interviewer has the ability to obtain the truth, streamline the process, lessen stress for everyone involved and enhance future safety.
Kevin has served law enforcement and healthcare security for over 20 years. He is a recognized security expert who specializes in complex investigations with a special focus on drug diversion. Previous experiences include serving as a law enforcement officer in the State of Ohio, including a special assignment to a drug task-force, and was subsequently promoted to Lieutenant in-charge of felony investigations. Kevin is currently employed by a large healthcare system in the Greater Cincinnati Area where he serves as a Protective Services Investigator, supporting drug diversion investigations for multiple locations within the system. Kevin is well educated and highly experienced in best practices related to diversion within a healthcare setting. His work has gained the professional respect of local, state and federal authorities as well as regulatory board personnel due to his case work in addition to his presentation of case work within the board setting.