PC Keith Palmer. Met Police
LONDON PC Keith Palmer, the police officer killed in Wednesday’s terror attack in Westminster, was unarmed. Palmer was stabbed as he rushed to confront the knife-wielding attacker, moments before armed colleagues shot and killed the suspect. MP and former Conservative leader Iain Duncan Smith has now questioned why there was not an armed presence at the gates where the incident took place, and said it was a “little bit of a surprise that there was not.”
So why was PC Palmer unarmed?
What police carry
Most police officers in the UK do not carry a firearm, as senior officers want forces to retain a “respect and consent” policy which could be undermined by the widespread use of weapons. However, PC Palmer was a member of the Parliamentary and Diplomatic Protection Command (PaDP), a special operations branch of the London Metropolitan Police Service responsible for protecting UK embassies, diplomats, and the parliamentary estate.
The unit is an armed command, meaning that most of its officers are “authorised firearms officers” (AFOs). Firearms commonly carried by officers include the Glock 17 pistol and the Heckler & Koch MP5 submachine gun. But not all PaDP officers carry weapons on duty. The Metropolitan Police’s Acting deputy commissioner Mark Rowley said in a statement on Wednesday:
“Our parliamentary protection team are a combination of armed and unarmed officers doing different roles, and sadly the officer who lost his life today was unarmed.
“He was supported by armed colleagues who shot and killed the attacker. [The attacker] tried to enter parliament and was stopped at the gate.”
The Defence Secretary, Home Secretary, Foreign Secretary, and Northern Ireland Secretary are all assigned Specialist Protection Command (SO1) close protection officers, who carry firearms. Rowley did not specify why Palmer was not carrying a gun, or why there was not an armed presence at the gates which the attacker attempted to breach.
Armed response units responded swiftly
Stefan Wermuth / Reuters
As well as the armed PaDP officers who were already present at the scene of the attack, a number of Metropolitan Police counter-terrorism armed response units flooded the area around Westminster on Wednesday. The response by emergency services was widely praised for its speed and preparedness. BBC home affairs correspondent Dominic Casciani said: “The fact that the Metropolitan Police’s counter-terrorism armed response swung into action so quickly indicates how much work has been done since the killing of Lee Rigby in 2013.”
At present, there are around 2,200 armed police officers within the Metropolitan Police, with another 600 currently being trained. Most armed units are deployed in response to specific events or to carry out specific firearms operations rather than for routine patrols.
Stepping up police patrols
Stefan Wermuth / Reuters
Extra armed police officers have been deployed across London in the wake of the attack. The Metropolitan Police, British Transport Police, and the City of London Police all confirmed on Wednesday that more officers are currently on patrol. Rowley said in a statement: “On a precautionary basis across the country we are stepping up police patrols unarmed and armed and the public will see far more of their local police forces over the forthcoming days, particularly in crowded places and iconic locations.”
Prime Minister Theresa May told the House of Commons on Thursday morning that security around the parliamentary estate would be reviewed as a matter of routine. She said: “In terms of security here in Westminster, we should be clear first of all that an attacker attempted to break into parliament and was shot dead within twenty yards of the gate.
“If his intention was to gain access to this building, we should be clear that he did not succeed. The police heroically did their job.
“But as is routine, the police together with the house authorities are reviewing the security of the parliamentary estate, co-ordinated with the cabinet office, who have responsibility for the security measures in place around the government’s secure zone.”
Defence Minister Michael Fallon also confirmed that all security at the Houses of Parliament will be reviewed, including whether police on the front gates should be armed or not. He paid tribute to PC Palmer, who he said had “made the ultimate sacrifice” to keep others safe by stopping the attacker breaching the gates at Parliament.
- ^ little bit of a surprise that there was not (www.independent.ie)
- ^ PC Palmer was a member of the Parliamentary and Diplomatic Protection Command (uk.businessinsider.com)
- ^ The unit is an armed command (web.archive.org)
- ^ said in a statement on Wednesday (news.met.police.uk)
- ^ BBC political editor Laura Kuenssberg reported (twitter.com)
- ^ Dominic Casciani said (www.bbc.co.uk)
- ^ 2,200 armed police officers within the Metropolitan Police (www.theguardian.com)
- ^ Defence Minister Michael Fallon also confirmed (www.itv.com)
AUGUSTA The proposed $29.2 million school budget, up by about $280,000 over the superintendent s initial budget proposal, goes to the school board for a vote Wednesday. Superintendent James Anastasio s initially proposed school budget totaled $28.9 million, which was about $740,000 less than the current year s budget.
However, in budget workshops since the budget was presented, school board members put items cut in Anastasio s proposal back into the budget, increasing it to just under $29.2 million. Positions cut but then returned to the budget by the board in the latest proposal total about $280,000 and include a school nurse at Cony High School at $71,000, a security guard at Cony at $27,000, and other positions, according to Kim Martin, chairwoman of the school board.
The board was very leery of cutting any direct service positions for our students, so the board added some positions back in, Martin said.
Also in the time since Anastasio first proposed a budget, the school department received a projection from the state of how much funding Augusta will get for its schools, although that figure could very well change as the state Legislature works on the state budget. The recently released state funding projects Augusta would get $12.8 million, an increase of $135,000 over what Anastasio included in the initial budget. So the increase in projected state funding covers some, but not all of the expenses added back into the budget by board members, leaving about $145,000 in additional funding which would come from local taxpayers.
Even before that change, the school budget, although it is lower than the current year s $29.6 million budget, would have required $600,000 more funding from local taxpayers next year. That s because the proposed budget takes less from the fund balance, or surplus, account than the current year s, leaving more of the funding burden to be covered by property taxes. With the restored cuts, the budget would now, if passed as proposed, require an additional $740,000 from taxpayers. The board is scheduled to vote on the budget at their 6 p.m. meeting Wednesday in council chambers at Augusta City Center.
Once the school budget is approved by the school board, it goes to the City Council to be included in the overall city and school budget. Councilors can, and often do, ask that the school board make changes to the budget before councilors vote on whether to approve the total city and school budget. The school budget must also be validated by voters in a citywide referendum scheduled for June 13. The school board is also scheduled to vote Wednesday on another proposal that would go to voters in June. The proposal is to seek residents permission for the board, if Augusta receives more state funding for education than the amount included in the budget, to use some or all of the additional funds. The board could use the money to add programming and its associated expenses back into the budget, and/or use the additional state funds to decrease the amount of money that would come from local property taxpayers. Martin said a new state law allows school systems, if they get more money from the state than anticipated in their budgets, to use additional amounts to help fund that year s budget. Martin said previously when that happened, the additional money couldn t be used if the local budget had already been passed, so the additional state money went into the fund balance account.
Keith Edwards 621-5647
This is the first in a yearlong series of articles in which H&HN Senior Writer Marty Stempniak will focus on crucial lessons from hospitals that have responded to the epidemic of violence plaguing our nation. It will examine mass casualty events like those that occurred in Orlando, Fla., and Dallas, as well as the seemingly intractable day-to-day cycle of violence the afflicts too many American neighborhoods.
The purpose of the series is to provide insights on how to sensibly prepare your organization for events we all hope will never happen but could erupt anywhere without warning. It also will consider how hospitals can work with others to stem the tide of violence in their communities and their facilities.
The series is inspired by and supports Hospitals Against Violence, an initiative undertaken in the fall by the American Hospital Association at the behest of its board members.
Watch for future articles in H&HN and in our e-newsletter at HHNmag.com/hav. And for more on how hospitals are working to prevent and treat violence in their communities, be sure to check out the AHA resource page.
For Elisabeth Brown, R.N., June 11 began like any other busy Saturday night in an urban emergency department. But in the wee hours of Sunday morning, she got an alarming text from her husband. At least 20 individuals had been shot at a nearby nightclub and, he warned, Orlando Regional Medical Center was about to get very busy. Three blocks away, 29-year-old security guard Omar Mateen had opened fire at Pulse, a dance club with a primarily gay clientele. It wasn t long before victims started trickling into Central Florida s only Level I trauma center.
Our first patient came in and then we got to work. That s what we do in the emergency department: We get to work, Brown told attendees at the Institute for Healthcare Improvement annual conference in Orlando in December, six months after the incident. And then another patient came in. And then another patient came in. And another patient came in, and they just kept coming, and they had wounds like I had never seen before, and I started to get really scared, and I looked in the other nurses eyes and they were scared, too. In what turned out to be worst mass shooting in U.S. history, 50 people died, including the gunman. All told, 44 victims were rushed to ORMC. Nine died, but clinicians at the hospital performed more than 50 surgeries on 35 patients. Everyone who made it to the operating room survived.
Amid the turmoil, ORMC s leaders were calm and collected. Just three months earlier, Orlando Health had conducted a communitywide mass casualty drill to prepare for such a situation. Without that practice, Mark Jones, senior vice president of the system and president of ORMC, believes many more people could have died.
There is no question that the work that was done that day helped to save lives, he told the rapt audience at the IHI forum. Hospitals, we would really, really urge you to practice incident command. Drill often. Do the tabletop exercises as often as you can. And, Jones emphasized, don t hold those drills only when it s convenient. You always think that, you know what, the hospital is too busy, he said. We would urge you to drill when you re busy. Drill at night. Practice on the weekends. Because what comes out of that are lessons and learnings and gaps that are identified that allow you to address them and prepare.
A call to action
Less than a month after the Pulse tragedy, a sniper opened fire during a protest in downtown Dallas, killing five police officers and wounding nine others. Ten days later, a different gunman shot six police officers in Baton Rouge, La., killing three before he was gunned down by a SWAT officer. All told, there were 385 mass shootings defined as four or more individuals shot or killed in a single event in the U.S. last year, according to the Gun Violence Archive. More than 1,500 individuals were injured and 458 died, a 24 percent uptick from mass shooting homicides the previous year.
Framing the Issue
- The number of mass shootings are on the upswing.
- Such violent events are prompting a re-evaluation of how well-prepared the hospital field is for handling mass casualty events.
- The American Hospital Association has launched a year-long initiative, called Hospitals Against Violence, to help the field better prepare for mass casualty events, as well as with incidents that occur inside a facility.
- Those who have responded to attacks in Orlando, Dallas and San Bernardino offer valuable lessons for their peers on preparation and practice.
Such violent events are prompting a re-evaluation of how well-prepared the hospital field is for handling mass casualty events. The American Hospital Association began talking internally with its board of trustees comprising hospital leaders from across the country about how the field can respond to these tragedies beyond mending the broken bodies in the ED, says Melinda Reid Hatton, senior vice president of the association, who is spearheading the effort.
It was certainly an accumulation of things, but I think the tipping point came as a result of the tragedies and carnage in both Orlando and Dallas, she says. We asked whether or not we in the hospital community should be doing more to combat violence, both in the community that inevitably ends up on the doorsteps of the hospital, and also violence in our facilities that is inflicted on our colleagues and staff.
Following that call from its board, the AHA last fall launched Hospitals Against Violence, an initiative focusing on what it calls one of the major public health and safety issues throughout the country. This year, the organization and its 5,000 hospital members will build coalitions with community institutions, share best practices, and conduct research to gain deeper insights into the impact that violence has on both hospitals and the patients they serve. Health care leaders are eager to find ways to thwart violence, and the association is making sure to include all facets of an organization from its diversity in management group to nurse leadership, engineering and human resources in the initiative.
This is very much a coalition of the willing at the AHA, and we have a very big and very diverse group that has signed up to work on this, Hatton says. We re really trying to make sure that we involve the whole AHA family because this is something that affects everyone in our hospitals.
Plan and practice, practice, practice
Leaders with both ORMC and Dallas-based Parkland Memorial Hospital, which treated victims of the July 7 sniper attack on police officers, have shared their stories across the country in the months following the incidents. They say they re alarmed that their peers elsewhere aren t taking the need to address the potential for mass casualty incidents in their own communities more urgently.
You would be surprised by how many have the mentality of it won t happen here, or people who truly underestimate the threat of what is capable of happening in their own community or, for that matter, at their facility, says Dan Birbeck, a captain with the Dallas County Hospital District Police Department. Some of the places that we go to are more robust and prepared and get the big picture of preparedness, but there are others that are way behind the curve. Preparedness was never a question for Massachusetts General Hospital and other hospitals that responded to the Boston Marathon bombing in April 2013. They d been working together for years to brace for the possibility of such an event.
But luck also played a part, says Paul Biddinger, M.D., chief of emergency preparedness and head of Mass General s Center for Disaster Medicine. The two homemade bombs planted by the Tsarnaev brothers detonated in a centralized location, near the finish line at Copley Square, making it much easier to disperse patients evenly to the numerous trauma centers across the city. Moreoever, the explosions occurred just before shift change at 3 p.m., meaning there were twice as many staff members on hand to tend to the hundreds injured. That s where matters of chance ended. In the decade-plus following the 9/11 terrorist attacks, Boston hospitals had developed a coordinated response plan, just in case, Biddinger says. Each year, medical leaders reviewed literature from others who had experienced similar incidents. And, in 2008 and 2009, the Harvard School of Public Health and the Centers for Disease Control and Prevention hosted symposia featuring speakers from London, Madrid, Mumbai and other cities that had been targeted by terrorists. Marathon organizers and health care leaders had long treated the annual race as a planned mass casualty event, Biddinger says, enabling emergency management services, hospitals, fire and police leaders, and other key players to coalesce and determine how such events might be managed.
One key lesson, Biddinger says, is the importance of establishing a plan about how to distribute patients among institutions. Many cities rely too heavily on just one hospital, and even the largest institutions can become overrun by droves of patients showing up quickly. And all hospitals must have a mass casualty protocol in place, Biddinger says, that specifically automates all the actions that have to happen following an attack, and how to make space in an already packed ED when dozens of victims start trickling in.
Very few hospitals in America have a true mass casualty protocol, he says. Most hospitals have systems by which they can call surgeons, extra emergency physicians, you name it, but rarely are a whole series of actions embedded deeply across the institution, including their admitting office, their laboratories, their radiology.”
Mass General was already slammed before the Marathon bombing, with 97 patients in its 49-bed ED. However, because of pre-existing plans to rapidly transport patients from the ED to inpatient floors and open up operating rooms by delaying certain pending cases, the hospital took in 31 patients in about an hour, with room for others if it had been needed. In total, more than 260 people injured in the bombing were dispersed evenly among hospitals in the city, and none of those died.
Over and above the obvious
Organizations like the Joint Commission and Centers for Medicare & Medicaid Services require that hospitals create emergency operations plans and exercises. But it s essential that leaders go beyond those regulatory requirements, says John Hick, M.D., an emergency medicine expert with Hennepin County Medical Center in Minneapolis, who s written numerous articles on the topic and took part in that hospital s response to the 2012 Accent Signage shooting in the city. Hick highlights three key areas hospitals should strengthen when planning for violent mass casualty incidents, which aren t necessarily spelled out in the usual hospital preparedness plans. Those include:
- Heightened security in the event that an attack continues inside the hospital, and the need for access controls on a hospital campus.
- Accepting victims of penetrating trauma from blast or bullet injuries requires a higher level of surgical planning, specifically, the ability to ramp up surgical services and having suffient doctors enough doctors and supplies on hand.
- You must be prepared with a robust blood bank response to make sure that victims of mass casualty events get transfused in a timely manner.
To target those preparedness gaps that are unique to your own facility, Hick says you must push your hospital to the limit in practice drills and engage employees in discussions about what needs to be strengthened. There are also tools available to help analyze any vulnerabilities.
Leaving room for innovation
While it is crucial to establish policies prior to a violent incident, experts also stress the importance of flexibility if a plan fails to address a certain scenario. That was the case for clinicians at Loma Linda University Health, who responded to a December 2015 shooting at a public health training event and Christmas party in San Bernardino, Calif., that left 14 people dead and two injured. The perpetrators, a husband and wife, were killed in a shootout with police. Although the preparedness plan did not specify it, triage tents were set up outside the hospital to help treat less acute patients, which provided space in the ED for victims of the attack, says Connie Cunningham, R.N., executive director of emergency and trauma services. What works today doesn t always work tomorrow, she says. When you practice, you hope that you ve remembered everything, but when you actually have the people coming in, you need the latitude to be able to shift gears and do things a different way. Chadwick Smith, M.D., a trauma surgeon and team leader in the OR at Orlando Health, says that drills and training may not completely prepare you for responding to a mass trauma incident, but it places you in the right position. Like a play, it gets you to your point on stage, he says. You have a good starting point and you have supplies in order, you have people who have gone through the motions of at least practicing where patients are going to go, and who s going to do what. It doesn t totally prepare you, but it gets you to a good starting point.
The night of the Pulse attack, Smith was tasked with triaging victims, making sure that those in the worst shape received care first. In one instance, he had to make the tough call of ceasing CPR on one unresponsive patient and move to another who did not have an attending surgeon.
Smith says the culture of teamwork at his hospital proved critical to their success, with empowered doctors and nurses confident in making tough choices, without asking for permission. Enabling them to make decisions on the fly is imperative, and embracing a culture of team member empowerment is key, he says.