Planning for the Unthinkable

Kelsey CreehanFeatured News

By Scott Frederick, D.D.S., Peak Dental Services Clinical Director
From the Fall 2019 Journal of the Colorado Dental Association

Nov. 27, 2015, 11:38 a.m.

Reports of an active shooter start coming through at the Planned Parenthood in Colorado Springs on Centennial Boulevard. Police are responding and the entire corner of Filmore and Centennial are on lock down. Colorado Dental Group sits inside the shopping center of Centennial and Filmore and is 2,000 feet away. Being a practice owner and the primary doctor there, my phone started ringing persistently from family and friends asking for the status and if we were okay. I was lucky. We closed the office that day to give the staff a long holiday break for Thanksgiving. Our office was empty, but right outside became the command post for the El Paso County Sheriff, Colorado Springs Police Department and a host of national media. That day, a police officer and two civilians perished, and five officers and four civilians were injured.

Unfortunately, this is becoming a common occurrence across the nation. According to the FBI, there were 27 incidents across 16 different states in 2018, which produced 213 casualties1. People do not want to think the unthinkable will happen; however, this is something that needs to be discussed and practiced with your team. A disgruntled employee or patient could make your office a victim to unthinkable violence. Office team members need to be informed and the office needs to have a plan in place that can be executed flawlessly if this nightmare turns to reality.

An active shooter is described by Homeland Security as “an individual actively engaged in killing or attempting to kill people in a populated area.” An active shooter will typically use firearms and there can be no rhyme or reason as to how they select their victims. These situations are chaotic and very unpredictable. Law enforcement needs to be immediately dispatched so they can control the situation and diminish the number of victims. Most active shooter situations are over 10-15 minutes before law enforcement arrives2. Individuals need to be prepared and ready to deal with an active shooter scenario.

Tips to diffuse an angry patient and avoid a potential office emergency

  1. Take the patient away from public space. Ask the patient to go into a consult room or private office.
  2. Do not speak until the patient is finished.
  3. Once the patient stops talking, empathize with the patient and try to understand why they are upset.
  4. Take all the information down and explain that you will investigate the problem. Review all facts fairly and then follow-up with the patient in a timely matter.
  5. If all of the above fails and the patient becomes violent, contact local law enforcement immediately.

Setting a plan for your dental office is extremely important. Once the plan is set, conduct a staff meeting to disseminate the plan. This may be uncomfortable but not having a plan is a luxury we can no longer afford. Ultimately, we need to determine what to do to save our own lives. Patients in the office will likely follow the lead from team members and especially managers and doctors. Homeland Security recommends the following progression of events if they are available:

Run: Always be aware of your nearby exits and try to exit the building. Evacuate quickly whether other people decide to follow you or not. Help others escape if possible and prevent others from entering where the shooter may be. Call 911 when safe and keep your hands visible to all people so that you are not mistaken as the shooter.

Hide: If evacuation is not possible, find a suitable hiding place where the shooter will have a hard time finding you and where you can be protected by obstacles (i.e. a locked office door). This includes protection from shots fired in your direction. Barricade doors and block the shooter from entering your area—use upturned furniture or barricade doors with whatever you can find. Try not to limit your movement and try to have an escape route. Silence your cell phone and remain as quiet as possible.

Fight: As a last resort, only when your life is in immediate danger, attempt to disrupt or incapacitate the attacker. Act as aggressive as possible, throw items and use any type of improvised weapon. Make sure to commit to your actions and do not stop until the shooter is completely incapacitated.

When calling 911 the following information should be given to the operator: location of the shooter, number of shooters, physical description of the shooter, types of weapons the shooter possesses and number of potential victims at the location.

Once law enforcement is on the scene, remain calm and listen for their commands and instructions. Immediately raise your hands and spread your fingers, dropping any items you may be holding. Avoid screaming, yelling and pointing, which will only lead to more confusion. Do not stop or talk to officers as this may distract them; instead evacuate calmly and head in the direction that the officers approached. Remember to always keep your hands visible. 

Train your staff for these awful situations by having an Emergency Action Plan (EAP) in place. This will help your staff to efficiently respond and reduce loss of life or potential injuries. An effective EAP includes a method for fires and other natural disasters as well. Have all exits well marked and know how to approach them throughout the building. Have an evacuation plan in place that also has a central meeting location so there can be accountability for all staff members. Have an emergency notification system so everyone will know an emergency is happening. Use a code word that signifies an emergency is occurring so that patients don’t panic. This will help reduce the chaos during a progressing emergency. Our office uses the word “Dog Bone” to signify an emergency. Use the word with the location to signify where the emergency is taking place. This will help get people into the proper position to begin executing the EAP. For more information about creating an EAP contact the U.S. Department of Labor ( and the Occupational Health and Safety Administration ( For more information on how to respond and prevent an active shooter scenario, review

Being prepared and having plans in place is the first course of action to maintaining safety and preventing a future disaster. Hopefully the plans will never have to be used, however, if the unthinkable happens you will be ready.


  1. U.S. Department of Justice, Federal Bureau of Investigation, Active Shooter Incidents in the United States in 2018,
  2. U.S. Department of Homeland Security, Active Shooter How to Respond pamphlet,

After graduation from USC School of Dentistry, Dr. Scott Frederick served as an active duty officer with the U.S. Army in the 101st Airborne (air assault) division. Dr. Frederick has been a part owner of Colorado Dental Group since 2011. He currently serves as clinical director of Peak Dental Services. Contact him at 719-646-6006.