Managing Health and Safety in our Practices

Officer Tom: It could just be the right place, the wrong day, and just a bad situation. And that’s all it takes and someone could do something as crazy as walking into an office and just start shooting people for no reason.

Dr. Bethany Fishbein: Hi! I am Bethany Fishbein, CEO of the Power Practice and host of the Power Hour Optometry podcast. And our topic today is being ready for an emergency. And I have to say that I don’t think that there’s any topic that I’ve done yet that’s given me the anxiety that preparing for this one has as I’m writing a list of things that I want to speak to the guest about. It’s kind of a laundry list of all the things that could happen in the practice that you hope never will. But if they do, it is better to be informed. And I’m hoping that this is something that everyone can use and learn a little bit about. Maybe share with staff so that everybody in the office has a sense of what if. What do I do if this happens? So I want to welcome my guest. He is a nine-year police officer in the New Jersey municipality. His chief asked that we do not give his last name or his precinct so we’re going with Officer Tom today, but I will vouch for him. He’s legit. Prior to his years in the police force, he worked in Loss Prevention, and before that, he managed a bar. So he’s got all kinds of experience with customers in the public in many different areas. So Officer Tom, thank you so much for being here and sharing some of your experiences with us. Have you been on a podcast before?

Officer Tom: No. No, this is my first experience. Well, I’ve listened to quite a few so I hope I’m at par.

Dr.Bethany Fishbein: Yeah, I think you definitely will be. And this actually started to formulate in my mind after the school shooting in Uvalde, Texas. I was on a conference call with the manager of an office who’s like 20 or 30 minutes from there and said that they were bringing someone in to train their staff on what to do if. And somebody else said, “Oh! Yeah, we’ve just had somebody from the First Aid Squad come in to do training.” and I was like, “Oh my gosh!”. And so I kind of ordered these in order of things that I’m most comfortable with to things that I am least comfortable with. So we’ll start slow and work our way up.

Officer Tom: Okay.

Dr.Bethany Fishbein: Alright. So we’re doctors’ offices. Let’s talk about emergency medical situations. People have had situations where someone passes out, someone has a diabetic emergency, someone goes into labor, or somebody has a severe injury. What are the things that a practice or a small business should have in kind of an Emergency Preparedness Kit in the office?

Officer Tom: So really, your expectations have to be reasonable. As far as what your degree of training is based on the situation that you encounter. You know, I’m not expecting you to be stitching up, you know, large lacerations if you’re just an eye doctor. That’s just going to be your basic eye tests and things like that. But definitely be prepared to have a first aid kit on hand. And you know, you can look on Amazon, and most of them, just look at a general first aid kit. They’ll have gauze and you know, quick (clamp) and things like that tourniquets. It’s kind of good to have some of that stuff and I know that. I see your reaction. I know that sounds a little dramatic but you’d be amazed at what situations that you can encounter. Now these tourniquets, you know, and you just touching up on an active shooter situation, which I know is something that we’re going to delve into a little bit later on. But having a tourniquet on hand is quickly becoming one of the most easy to apply life-saving mechanisms that you can use not only on another person but yourself. If God forbid you’re ever in that situation. But if you just go on Google and you just look at the kind of some of the basic first aid kits that first responders have like for police officers, for example, we don’t have a lot. But it helps us really just manage the situation until someone like an EMT or a Medic can arrive on the scene because they’re really going to be the experts in that situation who are going to take over and the most important thing is really just keeping that patient stable until you get them into the hands of a higher trained healthcare provider. And more importantly to a higher facility that is able to provide a higher level of care than your own. As far as like a woman going into labor or something like that, I can’t really elaborate it. Ironically, we actually just had a baby delivered by one of our officers a few weeks ago. And I was actually very disappointed because one of my goals as a police officer was always to save someone’s life and to deliver a baby. And I was actually working the night it happened. Unfortunately, I had to stay available and I wasn’t able to go on the scene to be a part of that. But our officer did successfully assist in delivering a baby but again, really even their presence on the scene was just to keep her stable, keep her breathing, and make sure that they were addressing her medical needs for that moment until the EMTs were able to arrive and Medics and they were able to actually deliver the baby on the scene.

Dr.Bethany Fishbein: You definitely didn’t use a tourniquet for that, right?

Officer Tom: No. It was not needed for that situation but just to keep the person calm. Keep the breathing maintained. Try not to encourage them to push. That’s what I would recommend at least until someone with a higher level of medical training gets on the scene.

Dr.Bethany Fishbein: Solid advice. So I mean, I think too, even if you don’t or your staff doesn’t know how to use all this stuff in that kit, it helps. Because there could be somebody in the office who does know and can grab those supplies and that would be helpful. So we get questioned a lot about AEDs. It’s currently not required in most small businesses the size of our offices to have an AED but people are starting to think that that’s a good thing to do. Does that make a difference?

Officer Tom: Yeah, absolutely. I would highly recommend having an AED in your office regardless of the situation. It’s again a very key life-saving tool. They’re pretty self-explanatory if you get one. They are Automated External Defibrillators. You literally it’s a step-by-step guide. They’ve made it very simple. You literally open them up. There’s two patches pre-attached to the unit. It literally shows on the patches. You stick one up high and one down low on the chest. It doesn’t really matter which position it goes. As long as you just have one up high and one down low. You’d go front and back. Pretty much as long as you get it somewhere where the electrical line that the charge it will send will cross through the heart, it’ll work effectively. But once you get the patches applied, you just push the button and it really just talks you through. But I mean, realistically, you never know what will happen. I think one thing that you mentioned and that’s really something I’m going to advocate throughout this is training beforehand. And really, that’s the key in all these what-if situations is pre-planning. Hopefully, that’s what this podcast will lead to to a lot of the people and the offices that are hearing this. But if you don’t have people that have some level of basic CPR training or first aid training, it might be something that you might want to mix into your next office meeting. You know like throwing just a quick YouTube video of CPR. Really the big thing with CPR nowadays is just chest compressions. They really kind of did away. I had CPR training. I used to be a lifeguard in high school. And when I had CPR training back then it was 10 times more complicated than what it is now. And really all they do is tell you now if someone passes out and you don’t think that they’re breathing or you don’t think that they have a pulse. Even if you don’t know if they have a pulse or not, they really advocate just doing good clean chest compressions on the person. Because a lot of studies have come out that have shown that the blood will actually hold oxygen for a lot longer than they originally realized. So as long as you’re keeping a good circulation into the brain with whatever limited amount of oxygen is still left in that blood, it’ll keep people alive for a lot longer and reduce the amount of effects and damage to that person’s brain when they do go into heart failure and things like that. So really, just simply learning how to do chest compressions can really save someone’s life. And an AED will be amply helpful in that situation as well as being able to apply that. If you ever have a situation where someone passes out in your office, have someone immediately pick up the phone and call 911. Because even if someone doesn’t have knowledge in that thing, all dispatchers, first responder dispatchers have the training to be able to talk them through that step by step. And it’s also important as well to get EMTs, police, and first responding units going to that place that do have that training.

Dr.Bethany Fishbein: As you’re talking, one thing that I’m thinking about is like I know in New Jersey, where I’m from, for an optometry license, we’re required to keep an updated CPR and First Aid training. And I think that’s the case in a lot of states. But it’s the doctor in the exam room that has it and sometimes that’s the only one. So some people have done first aid training for their staff. I think it’s certainly not a bad idea. But it’s also worth having a conversation or even a drill on what to do. How are you going to reach the doctor if that happens? We’ve been in offices where they’re like, “Oh, I wouldn’t want to interrupt.” Meantime somebody’s having an emergency out in the front of the office. So I think that those things are worth at least discussing and practicing and having a plan for.

Officer Tom: One thing that I would kind of recommend is if you are considering may be getting all of your staff some level of first aid or CPR training, reach out to your local fire departments or even police departments and see what they are able to provide you. As they may have someone and do it free of cost as a community outreach program. They may have something in place where not only they may come in and give your staff training and everything like that. A lot of townships actually have grants where they have free medical supplies that they’ll be able to give you and not only give you but give you training for it as well. First responders, we’re community service, you know.  Just like you guys deal with customer service with your patients and everything like that. The community is our customers and we have to give you guys customer service. And a lot of times it’s just a means of tapping into that resource of your first responders and what we have to offer to you guys. So for anyone that is considering it, reach out to your local fire departments or police departments and see what they have to offer for you.

Dr.Bethany Fishbein: Yeah, that’s awesome. Good advice. One other question before we leave medical kind of emergencies. Somebody had asked I think yesterday or maybe it was this morning. It’s been a long day. About whether people are starting to have Narcan in their offices. Is that something that should go in the first aid kit? And is that a thing?

Officer Tom: So what I advocate Narcan use by or what I would say is any equipment that you get, just understand that you’re going to open yourself to some sort of liability. When you’re, I’m going to use the term injecting but it’s not an injection it’s a nasal spray. It’s an atomized nasal spray that goes into a person’s nose, but regardless, it’s a substance that you’re introducing into their bodies. If you do so wrongly, you’re opening yourself up to some degree of liability. So understand, like as a first responder, when I use Narcan, there are certain things that I have to identify that lead me to believe that what I’m witnessing is an overdose as a result of some sort of opioid. And if I wrongly apply that Narcan to that person and it results in some sort of injury, I’m opening myself up to liability. But so you just understand that. Yeah, Narcan is a wonderful substance and from my understanding of everything in the training that I’ve had is the benefits greatly outweigh the risks of whatever damage may result from inappropriately applying it. But what I would say is if you do get Narcan in your office, make sure that you accompany it with some sort of training that will teach you as far as how to identify an opioid-based overdose which is only what it should be applied for. But when you apply Narcan, one last caveat, the important thing is that you’re supposed to give respiratory breathing as well. That’s not something that I would recommend going mouth to mouth on anyone. So understand that if you apply it, you technically should be accompanying that with rescue breathing through a bag valve mask as well. which that would be included with your typical first responder or first aid kit like I mentioned earlier.

Dr. Bethany Fishbein: Alright. So moving up the ladder I guess, one of the other situations that people encounter in their offices is theft. And when I added theft to the list, I was thinking about shoplifting. You added some other kinds of theft which we’ll talk about. But let’s talk about shoplifting first. And this happens way too frequently where somebody sees somebody in the office. And sometimes you don’t find out until after, right? Where somebody notices, “Oh! Half that display of frames is missing. ” You go back to your video and you see it. But what happens if you see somebody in the office taking some of the merchandise and sliding it into their shirt or into a bag or into a pocket? What is the staff supposed to do?

Officer Tom: So, as you’ve mentioned earlier in the podcast, I previously used to work at a box store in Loss Prevention before I became a police officer. I did it for 2 years. We were probably one of the few stores that were left that work in the mall. And out of all the stores in the mall, I think there is only one or two other box stores that still had a Loss Prevention team. Really all the companies began to divert away from intervention in that situation. And that is really, especially with today’s day and age, you know everyone is really looking for a lawsuit so they may be intentionally stealing, hoping that you’re going to have some sort of intervention and stop them just to get a lawsuit out of them. So what I would advocate, go and intervene. The best, I guess, the interaction that you can simply have is no interaction truthfully. Because the less interaction that your staff is going to have, the longer they are going to be in the store. At the end of the day, you really just want to buy yourself time until the police get there. So, if a staff member is seeing someone stealing what I would do is try to stop them in any way. I would just simply call the police without making it appear to them, to the person who is stealing the things that you’re unto them. Go on your security cameras if you have outside security cameras. Begin rolling them back as quickly as possible. Try and figure out where that person came from before they came into your office. See if you can see what vehicle they came from because at the end of the day, the best case situation is you want that person to just simply take the stuff, walk out the front door, and then have the police catch them, recover your merchandise, and arrest that person and deal with it in that environment. So, the information that I would tell you is the more information that you can get to the police in the shortest amount of time is always going to be your best action in that situation. Now, obviously, the best situation would be to have some sort of deterrent that would prevent the theft in the first place. So you know you mentioned cameras, cameras are wonderful. Make sure your camera clarity is good enough that you can actually identify a person. It is really shocking how many very expensive warehouses and stores that we have in the jurisdiction of where I work. Where you walk in and they’re like, “Oh we had this theft occur.” And you walk in and you can’t even see what type of car the person drove up and let alone who that person was or a license plate. License plates are the biggest help because that’s what’s really going to help us locate that person even if they do manage to get away. So if you could somehow locate their vehicle and get their license plate, that’s really going be the biggest piece of information that we need. Because even if you get a clear picture of their face, we then somehow have to locate that person in the grand scheme of things in the hopes that we can get a positive facial identification of them based on the picture they have.

Dr. Bethany Fishbein: So really the ideal is you kind of let them keep stealing and think about a way to alert the police while they are in your store or in your office.

Officer Tom: Yeah and it sounds ridiculous, “Oh let them steal from me?” It’s really sad but that’s the best way to hopefully recover the merchandise they are stealing without opening yourself up to liability.

Dr. Bethany Fishbein: And is true that they have to walk out with it to be considered stealing? So they can be stuffing it in their shirt the whole time and if they are in the office when they are caught or whatever, they can say, “Oh yeah I was just storing them in there so I can try them on later. ” or whatever but they have to walk out, right? They’re going to walk out the door.

Officer Tom: Yes. So what I could tell you, in New Jersey, just simply intent is very hard to prove. There is a lot of criminal statutes in New Jersey where an arrest has been made based on someone’s intent to do something. But intent is just merely someone’s thoughts in their head and it’s very very difficult to have that person convicted. I mean, granted, at the end of the day, you’re not losing any merchandise in that situation. But what I could just tell you from a prosecution standpoint is that more than likely your case is probably gonna get tossed out and that person is going to walk away scot-free. Maybe they’ll downgrade it to a minor slap on the wrist ordinance violation. They’ll pay a petty fine and that’ll be the extent of it. But yeah, truthfully, until they walk through your door, it’s hard to really say that they stole the stuff. What I can tell you is when I worked in Loss Prevention, we had requirements before we can actually intervene. We had to have on video selection of the merchandise that was inevitably stolen. We had to have that merchandise concealed. Now we dealt with like, fitting rooms and things like that. So people would go into fitting rooms, obviously, there’s no cameras in there. So we would have to actually go in check the fitting room before they would go in there confirm that, you know, whatever tags security tags or whatever that they would inevitably rip off the merchandise were in there, to begin with. And then once they left we would find the tags and the security tags and then we can articulate yet that they concealed the item in an area that we couldn’t legally see into but that’s how we would confirm that the concealment occurred in that area. But then they would have to leave the store and we wouldn’t be able to stop them until they actually broke the threshold of our doors. And that’s when we would then stop them. So yeah, sadly, if you have someone that’s just stuffing a bunch of stuff in their shirts or their purses, yeah, until they walk through the door. It’s in the eyes of the law. Like yeah, they have obviously the intent to steal it and they should be prosecuted for it but it’s a case that’s not going to hold enough water to follow through with the prosecution and it’s probably just going to get tossed. So, but at the end of the day, you want to make sure that your merchandise isn’t stolen. So perhaps that’s the best course of action. It’s just making sure before they even walk out the door and run away or jump in a car and are gone that the police can get there as quickly as possible. And if they can intervene, that’s what you want. You want them to intervene. You want them to recover your merchandise or whatever it is before it’s actually gone forever because.

Dr.Bethany Fishbein: It’s probably worth making a plan for that too, right? That is like discussing it as an office, if we see this, somebody’s going to send a message on the internal communication system. Or my college roommates used to work in a retail store and they had a code word and if somebody said the code word, somebody was supposed to go in the back and call the police or something. I mean, you need a way to not have the person in front of the person who’s stealing and be like, “Oh, hey, police, you know.” And yeah, these things are probably worth drilling a little bit. So we should also talk about internal theft. What do you mean when you say it?

Officer Tom: So internal theft, I mean that could happen in a litany of ways. And truthfully when I worked in Loss Prevention, we really dealt with internal and external theft of about 50/50. And I know when I was a manager of a bar, and I know it’s different environments, but it’s really the same thing. Wherever there is an opportunity of theft, whether it’s merchandise or money. Opportunity and necessity will always trigger internal conflicts within people and drive them to do things that would go against their norms.

Dr.Bethany Fishbein: So internal theft, do you mean like one of the employees stealing from you?

Officer Tom: Yes. So this is an employee theft. So really the biggest key and then that goes with all theft is going to be a very strict management system of your merchandise and of your supplies. So that’s going to be strictly just for the merchandise aspect. Well not even just the merchandise aspect of it because it can be very complex. If you, and I know there’s certain brands that we can’t discount, but if there is any kind of opportunity where discounts can be applied to things. There should really be a tracking system for that. And that the tracking system should be separate from the people that are going to be utilizing it. So just to try and clarify that, if you have a staff member, just like the example that you just said, who says, “Okay, I have a customer that’s requesting whatever a discount for eight pairs of this particular glasses.” and they go to a manager for approval for that. And that manager then has to apply that discount. That discount should have some sort of trigger in your system that can be tracked. But that manager that is applying that discount should not be able to see that tracking system. That needs to be done by someone over that. And to kind of give you a perspective of how this is applicable in a real-world situation, right before I left to go into the police academy, we actually opened up a very large investigation for the managers within the store that I was working. And basically, how retail works is in order to keep inventory moving, eventually the shelf space has a valley. So eventually what they’ll do is for merchandise that isn’t moving, they’ll actually zero it out it’s called. But they’ll reduce it to such a discount that it will actually have no more value. And what they’ll either do is they’ll just give it away internally to employees or they’ll just send it out for destruction or donate it to somewhere as a tax write-off or something like that. But it’ll get to a point where the merchandise has no monetary value to the company anymore and they just get it off the shelves to make room for the next stuff. So what ends up happening is managers are the ones responsible and the staff are responsible for going through and applying those discounts to keep the inventory moving. Well, what we ended up finding out through this tracking system that we had in place was that the second highest manager at the store was actually involved in essentially a ring involving 4 other managers down the line below him. Where they were actively taking merchandise that wasn’t even going out onto the floor, reducing it in the system to where it was worth nothing, and taking it and just selling it on Craigslist and eBay and things like that. And it ended up totaling, I believe when it was all said and done, I think we had roughly $35,000 worth of merchandise that this ring of managers. And it was really kind of shocking to me because a lot of them were doing very well for themselves with the company. But like I said again, it’s opportunity. I think what started it all was the head manager that was kind of like in charge of it all. He recently had a child and it’s just monetary issues became a problem because of the child and needed a little extra weight or money. And he saw this opportunity and ended up getting other people involved and it spread and yeah, it turned in, and eventually they all ended up being terminated. But yes, so internal theft anytime that you have employees that are handling merchandise and your money. You always have to be mindful of that.

Dr.Bethany Fishbein: Yeah, it sounds crazy. But that is absolutely something that we’ve seen in our client offices and other offices. That you know somebody is ordering eyeglass frames for the inventory and they just put a couple extra in order each time. And all of a sudden, before you know it, they’ve got a little shop at a flea market out of the back of their car with all of these extras, or people putting a contact lens order in for a friend, or taking a cash transaction. We had someone with a manager who was taking a cash deposit to the bank but depositing a different amount, filling out a new deposit slip, and just taking the difference and these amounts add up. So one of my colleagues once gave me the advice to sit down one day and think about any way you could possibly steal from your own business. And then put those systems and those checks in place to look for those. So it’s a good perspective and it’s something you don’t want to think about. You think the people who are working with you are amazing, and they’re lovely, and they’re wonderful, and they’re mothers and fathers, and people’s kids. But like you said people end up in a situation that leads them to behave unusually and you can really have your business hurt if that doesn’t get caught.

Officer Tom: Yeah. And really just the biggest key that I can emphasize in that is whatever system of checks and balances that you have in place, always make sure that it appears in a way that the people that you’re monitoring can never access the systems. Or even have really they shouldn’t even have knowledge of the systems that are put in place to monitor them.

Dr.Bethany Fishbein: Okay. So let’s switch again and talk about the public a little bit. That sometimes people, and I feel like it’s happening more lately like I don’t know what it is going on in the world. But everybody’s a little bit closer to the edge than usual. And I’ve seen a couple of posts lately from offices saying that somebody came in, they were told something, and it’s usually something small, they didn’t think they were gonna have to pay a $10 copay, and all of a sudden, it escalates and they’re getting aggressive or yelling at or threatening staff. What do you do in that situation where somebody is? Well, I don’t know, even if somebody’s necessarily getting aggressive. I can’t quite imagine the necessity of that in a typical optometry practice. But when somebody’s getting aggressive with staff and just yelling or getting into somebody’s personal space or saying things that are making them feel uncomfortable?

Officer Tom: So, what I can tell you is mental health in this country is in a dire situation. I personally, the stress that COVID has put on everyone’s mental health in this country. It’s just pushing people over the edge left and right. The crisis calls that we go on. I couldn’t even tell you how much they have increased. I would easily say 200% if not more. It seems like, I don’t think there’s a shift that goes by that I don’t deal with some sort of mental health issue. And that’s, I would say 90% of the time, I am going to some sort of mental health call at some point in the shift. And I work five days a week and probably all five of those days, I’m dealing with some sort of mental health issue. And kind of what you talked about is really something that I think is a good thing to keep in perspective. And it’s something that we as officers always try and try not to lose perspective of. And it’s very easy because we deal with every person’s worst day of their life. And no matter how minor it may appear or how drastic it really is we are dealing with the worst day of their life. No matter what it is. Because if it wasn’t the worst day of their life, they wouldn’t be calling us. And this is the God honest truth, the calls that I’ve received where people have called because there was a cricket in their bathtub. People have called because their neighbor was playing music at a birthday party on a Sunday afternoon. You just don’t know the stresses that people are going through in their personal life. So something as simple as I didn’t pay a $10 copay. You don’t know what was going on leading up to that and that could just be the straw that breaks the camel’s back for them. No matter how mundane it may appear, treat that person with some sort of sincerity and compassion. Understand that there could be a litany of issues that they’re dealing with on top of this, you know. They could have just gotten a diagnosis of some sort of cancer or something like that and then suddenly they walk through your door and they’re like, “I have to pay a $10 copay all of a sudden.” or you know. You just never know. So as minor as it may be, try and just keep a perspective of it could be the biggest situation in that person’s life right now. But once it escalates to a point where they’re like really getting over the top and really getting aggressive. First and foremost, what I would recommend is at any point that you feel that you’re in danger or you feel your staff is in danger, someone and when you mentioned earlier about having a code word or something like that, someone needs to call the police and have them come out there. Because no one in your profession or in your offices should be placed in danger because of someone’s aggression. That’s the police’s job. We’re the ones that are supposed to be going into those dangerous situations to keep you guys safe. That isn’t your job. That isn’t your responsibility. Your responsibility is your safety and nothing else. But as far as de-escalation, rarely are things to the point where they can’t come back down to planet Earth. The biggest thing is, is that once things begin to escalate, a manager has to step in. I don’t care who the manager is. I don’t care what their job title is.  Whatever it is, someone of some sort of authority needs to step in, remove whatever employee that initiated the aggression, and whether it was justified by their actions or not. That person needs to be removed from the situation because their presence is only going to continue to exacerbate the situation. The key thing here is perception. It’s going to be perceived authority. Anytime someone is angry, they want someone who’s going to make a different step in to resolve that situation. So as long as a person walks in, identifies themselves, presents themselves, and says, “Hey, I’m so and so. I’m the Optical Manager here.  I’m the Office Manager.” whatever their title might be. Present them with that title because that’s going to get that person perceived authority. Explain to them that you are there to help them, to understand what their problem is, and try and come up with some sort of resolution. It’s always important to talk to them with compassion. Not to escalate the situation. Not to yell at them. Always try and talk in an even tone. They may continue to go off. The best advice that I can tell you is, if someone is really just weighing in with irrational thoughts, just let them get it out. Just listen to what they’re saying. And then once they’re done, relay to them that you heard what they said. And you would be amazed at how quickly that will de-escalate the situation. No matter how irrational the things that they may be saying, just simply be an active listener and say, “I understand you’re upset because now you suddenly have to pay a $10 copay. I’m sorry that that wasn’t explained to you sooner.” And then explain the situation, “But unfortunately, this is what your insurance company is.” or “This is what our office policy is. I know it’s frustrating to you.” and just reiterate that you understand that it’s a difficult situation for them. Acknowledge their emotions at that moment. And that typically is what will de-escalate the vast majority of those situations that you’ll encounter. But if that’s not working, you need to change plans and kind of go a different route, you know. Feel the person out. If what you’re saying isn’t getting the response that you want, you either need to divert and go a different route, whatever that may be, or someone else needs to step in. You kind of have to keep things in perspective as well, that in some situations and cultures, there may be a cultural influence on someone’s behavior. They may have a culture where they are demeaning to women. Where they don’t respect women’s opinions. So if you as a business owner are a woman and you walk in, they may not care that you are the highest authority in your office. They want to talk to a man and you really just have to kind of not take it personally even though it is a personal thing. But just recognize it like, “Alright. You know that’s life.” Unfortunately, not everyone’s going to have the same perspective on situations. And the same thing with gender perspectives as well. There may be a woman that doesn’t want to be talked down by a man, even if he is the owner of that company in the highest authority there. She may just not want to be. She may see anything that he says as demeaning to her. So it may be a situation where even if you are the highest authority in your office, you may want to defer the conversation with someone lesser than you. At the end of the day, the key is de-escalation. No one wants to see themselves in a dangerous situation. At the end of the day, someone who is that agitated is in a dangerous situation.

Dr.Bethany Fishbein: And I think the things that you said are useful, especially removing the initial person from the situation. As I’m thinking about situations that we’ve been in where something like that has happened. That does tend to be the most effective for them as well as the person showing the aggression. But what happens if that person just takes it to the next level, either they’re under the influence of something or they start threatening violence, right? They’re threatening, “I’m going to beat you up. I’m going to come back with whatever.” You call the police, right? But how do you get the situation to just stop before it gets to that level?

Officer Tom: So one thing and you kind of mentioned it earlier, have code words. If you have a situation, have a code word for where if you find yourself in a situation where you need someone to call the police discreetly. Have that in place and let the staff know so that way they know like, “Alright. Now is the time to pick up the phone and call the cops and get them here.” I think the biggest key to this and this is what I said earlier is really pre-planning and training is going to be key. And I think it’s also very important from your staff’s perspective, to really know that you as a manager or any manager that’s stepping into that situation that de-escalation is key. So even if they say things, that the manager that is, say things that may appear or I don’t wanna say demeaning to the staff member but the staff member may be hurt by it. Because suddenly you’re siding with this irrational person that is saying psychotic things. And that person is demeaning to them. You know, I don’t want to say by any means to allow anyone to walk over a staff member but at the end of the day, you’re just what you’re expressing. Now your goal is to keep everyone safe and you don’t want that person to continue to escalate. And when I say remove that staff member, I mean, like get them out of sight. I don’t even think that they should be in earshot for exactly the reasons that I’m saying because you don’t want them overhearing the conversation. And who knows, maybe that staff member really did something that triggered that person and set it off and that was inappropriate from the staff member. Like that’s something that you want to deal with internally and not in a public setting. I mean most of these issues are really going to happen out on the floor in front of the public. And that’s not really the environment that you want to be addressing issues like this. The biggest key that I would say is to try to appease the person as quickly as possible and get them out the door. If it gets to the point where they’re threatening to harm you, make sure that that is relayed to the police officers. But at the end of the day, you want to get them out the door. I would recommend doing it in any way shape or form that you can. Appease them for that moment. Whatever ramifications come out of it, promise to give them discounts, promise to waive you know, the $10 copay. At the end of the day, is your safety worth $10? Absolutely. I think you would say that as far as any one of your staff members would be worth whatever amount of money that you have to keep them safe. Appease them for the moment, get them out the door, and let the cops deal with it. But the big thing is, it’s just having some system in place and having your staff trained to know that when that situation happens, this is what you have to do. You have to call the police. You have to tell them who the person is. Get a vehicle description like I said earlier. If you think that they’re under the influence, you know, be mindful. They can be a dangerous person. Try and keep your distance but at the same time, you just want to appease them and get them out the door. That’s my best advice. Let the cops deal with them. Just get them away from you. Get them away from the staff. Get them out the door and then let us deal with them. Or keep them happy until we show up and then we’ll take care of it from that point.

Dr.Bethany Fishbein: So we get to this situation of what really started all this. Of the kind of the ultimate what if that people are thinking about and depending on what’s in the news that we are more and more terrified of. What if someone does come in with a weapon? Or somebody comes in with a gun? Somebody fires a shot? What the heck do you do then?

Officer Tom: It’s tragic. It’s really become almost a norm. And I know it’s probably insane to even think about it as a doctor’s office. But like I said, as far as the situation of mental health in this country, you just don’t know who you’re dealing with. You don’t know whom you’re caring for and you don’t know what little thing could set them off. And it could just be the right place, the wrong day, and just a bad situation. And that’s all it takes and someone could do something as crazy as walking into an office and just start shooting people for no reason. Or for whatever reason, they have in their head. My best advice is for everyone to have some sort of preplanned escape route for your staff if you have a backdoor. One thing I’ll recommend, there is a brief video, I think it’s a little hokey but it does kind of get the message across. There’s a five-minute YouTube video that I would really implement in all your offices and just let them know like, what’s the rise of things we need to be conscientious of the situation. But there’s a five-minute YouTube video it’s called, “Run, Hide, Fight.” And that’s really my recommendation. If anyone can run and escape the situation, do so and do so as quickly as possible. Draw your escape routes. If you have a back door, if you have offices that have windows that can get out to the outside parking lots, or the rear of the building that will expose them to the shooter, get out as quickly as you can. Call the police and give the police as much information as you possibly can. And just get yourself to a safe location. If you’re unable to. You want to hide. You want to conceal yourself as much as you can. And it’s really scary because a lot of people don’t even realize the capabilities of most of the weapons that are out there. Most assault rifles like you’re hearing so much on the news as far as what these active shooters are using. Simply just hiding behind the door may not be enough. If that’s the best that you have. That’s what you gotta use. But the capabilities of these weapons, they could shoot through pretty much everything that isn’t forged steel or solid concrete. That is most rifles that are calibered with like two to three rounds which is most assault rifles. They can shoot all the way through a car aside from just the engine block and the rims that are all forged steel. So it’s really sad but even we, as police officers, the body armor that I wear on a daily basis, they can’t even stop a rifle round. Truthfully, the list of capabilities of those rifle rounds will actually pass through. If you lined up three police officers, all with their standard vest that they wear, their bulletproof vest. They can actually go through three of them. Typically the ballistic capability, it should stop somewhere in the third officer but it’s going to penetrate the body armor and it’s probably going to hit the back plate. So don’t just hide behind a flimsy drywall or wooden door and think that you’re suddenly safe. The video really talks about it. You want to try and barrier yourself in a room. You want to be quiet. You want to conceal yourself. Try and lock the doors. Something as simple as, if you don’t have, I know a lot of exam rooms. They don’t really have locks on doors but knowing how to kind of makeshift a lock. How to secure like, for example, the door handles that go up and down as opposed to a knob. Closing yourself in a room like that and simply sliding something under the handle so it can’t function properly. That may mean the difference between life and death for that person. But they need to know that that’s what they got to do to secure themselves in a room. And lastly, I mean, if you can’t hide and you’re encountering that person, you have to fight for your life. Pick up whatever you can and try and do what you can to protect yourself. But the day that it happens, it’s going to be hell. And I think the biggest thing is just knowing the escape route. And really it’s just pre-planning and letting your staff know like really just pose the question to them. What are you going to do on the day that that person walks through the door with a gun and just starts shooting? Now how are you going to react? And just let them think about it for the moment. And just think like what would I ever do if I was conducting some sort of optical exam and all of a sudden I heard it. Most people don’t even know what a gunshot sounds like. But what would I do in that situation? And really just let them mull it over and think. Well, the best thing you can do is get out of there. If you even remotely think that what you heard was a gunshot, Don’t investigate. Don’t go and check it out. Call the police. Whether it’s something as silly as someone drops whatever or it being a loud bang and it scared you. Well, let the cops show up and find out and we’ll have a good laugh about it after the fact. But at the end of the day, you’re going to survive.

Dr.Bethany Fishbein: I hate that we had to do this. I hate that the world is such that all of these things that we’ve talked about from beginning to end feel like things that could happen in our offices. I hate that I’m writing notes and paying attention and thinking about things to go back and do with the next staff meeting. But that is the current reality of the world that we’re living in. And I think this is solid advice here. So, Officer Tom, thank you so much for doing this. For taking the time out of your night away from your family to do this with us. Thank you for all you do in the community to keep us safe. I greatly appreciate it. And I hope that we never need to call you to tell you that this has happened but thank you so much.

Officer Tom: You’re welcome. And again, hopefully, these are what-ifs that you guys never have to encounter.

Dr.Bethany Fishbein: I hope so. Thank you again.

Officer Tom: You’re welcome.