From malls to movie theaters, elementary schools to military bases, the possibility of an active shooter situation requires security forces across the country to be prepared and continually conduct exercises with partner agencies.

Navy medical commands are no exception, which is why Naval Medical Center Portsmouth (NMCP) held an active-shooter tabletop exercise (TTEX) facilitated by an external agency March 9.

NMCP is the first of seven Navy treatment facilities - four on the East Coast and three on the west coast - to host the facilitator team that is offering a TTEX from a different viewpoint.

"This was to get an outside source to give us another look on how we're doing when it comes to responding to an active shooter in our program and to hopefully identify areas that we can improve," said Louis Cruz, security officer for NMCP. "For previous tabletop exercises that we have done, we have facilitated them, and there's a little bias when you do your own. You feel better when you have an outside entity looking from the outside in because sometimes you get that tunnel vision."

Independent consultant Bob McKenna, a retired Navy captain with experience as the director of training for Navy Expeditionary Combat Command, offered his take on the importance of routinely holding such exercises.

"In order to have an effective active shooter plan, you have to have a training continuum," McKenna said. "A training continuum is circular -- it includes tabletop exercises, functional exercise and full-scale exercises. I know you are doing these exercises, but it's good every once in a while to take a step back and sit around the table with the leadership to review those plans to make sure that they are effective and you can validate them."

During the course of the three hours, more than three dozen NMCP staff went step-by-step through a scenario that included an unknown man entering the medical center with a shotgun, opening fire and moving on to additional areas. As the scenario progressed, staff took turns explaining the response that falls within their area of expertise.

At several points throughout the morning, McKenna asked the experts some novel questions and shared his thoughts on what else to take into consideration. By the end, the group felt confident they had developed a strategy to make some significant improvements to the plan, as well as areas where they believe the plan is thorough.

"I think we demonstrated the involvement and commitment that our leadership has, and [the training] helped us identify crucial points from all the experts throughout the room," Cruz said. "Areas that went well: the tabletop demonstrated that we are all talking, that we are all utilizing all the same responses and same plans. It showed that there are some radio communications issues that we need to fix, and a little more education for our staff on responding to this type of situation.

"The involvement, since we had all the directors and a lot of the leadership in here, our community sponsors and other agencies, demonstrates that we are all committed to one goal - and that is patient safety," Cruz added.

While recognizing full-scale exercises require limiting hospital services so staff is available to train, Capt. Darin Via, NMCP commanding officer, reflected on the opportunity the tabletop presented.

"While we realize that teams have to be flexible, and there's an opportunity here at least to drilling and understanding scenarios, we identified the gaps and looked for opportunities for improvement," Via said. "This doesn't stop at the tabletop. The lessons learned from today will ensure that we have our instructions, Standard Operating Procedures and guidance correct in our engagement with the our regional partners. We also need to ensure that staff on the wards understands what our preconceived expectations of them are and how will they actually respond in an emergency."

Going forward, McKenna said he will provide NMCP with an after action report and lessons learned, before moving onto the next Navy facility. McKenna and his team will use the experience with NMCP's tabletop as they work with staff at Naval Hospital Camp Lejeune and Naval Hospital Beaufort to develop their active shooter scenario, as well as during their visit to the two hospitals in the spring for their TTEX.

By the end of November, the team expects to have completed the exercises with all seven of the medical facilities.

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/.