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An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis

Published online by Cambridge University Press:  09 March 2020

Niran Argintaru ,
Winny Li Open the ORCID record for Winny Li [Opens in a new window] ,
Christopher Hicks ,
Kari White ,
Melissa McGowan ,
Sara Gray  and
Andrew Petrosoniak
Niran Argintaru
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada
Winny Li
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada
Christopher Hicks
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada St. Michael’s Hospital, University of Toronto, Canada
Kari White
Affiliation:
St. Michael’s Hospital, University of Toronto, Canada
Melissa McGowan
Affiliation:
St. Michael’s Hospital, University of Toronto, Canada
Sara Gray
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada St. Michael’s Hospital, University of Toronto, Canada Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
Andrew Petrosoniak*
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada St. Michael’s Hospital, University of Toronto, Canada
*
Correspondence and reprint requests to Andrew Petrosoniak, St. Michael’s Hospital, Department of Emergency Medicine, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada (e-mail: petro82@gmail.com).
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Abstract

Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel.

The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

Keywords

active shooterpatient safetysimulationtraining
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 15 , Issue 2 , April 2021 , pp. 223 - 231
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

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