Active Shooter Training in the Emergency Department: A Safety Initiative

Sanchez, Leslie; Young, Virginia; Baker, Mary Zoe

doi:10.1016/j.jen.2018.07.002

Cited by 28 publications

(25 citation statements)

References 1 publication

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“…Given these concerns, existing training for EPs on firearm safety may be inadequate. While there have been effective efforts to develop scenario‐based training for EPs regarding an active‐shooter event, few studies describe educational interventions focusing on EPs’ personal knowledge of safely handling firearms. The sole exception showed improvement in knowledge scores and reported comfort with discussing firearms with patients; however, this pilot study had a small sample size and obtained a limited evaluation of its participants’ baseline familiarity with firearms .…”

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confidence: 99%

Emergency Providers’ Familiarity with Firearms: A National Survey

Ketterer

Poland

Ray

et al. 2020

Academic Emergency Medicine

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Background Emergency providers (EPs) are uniquely placed to advocate for firearm safety and have been shown to be at risk of exposure to firearms in the emergency department (ED). We sought to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED and level of confidence with safely removing firearms from patient care settings. Methods This was a survey study of EPs representing medical centers in 22 states. A 15‐item questionnaire was e‐mailed to all EPs at all included institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions with p‐values and conducted association analyses among survey items. Results Of 2,192 survey recipients, 1,074 (49.0%) completed the survey. A total of 635 (59.1%) reported encountering firearms in the ED or its immediate environment at least once per year, and 582 (54.2%) were not confident in their ability to safely handle a firearm found in a patient's possession. Frequency of handling firearms was significantly higher in states in the top quartile for firearm ownership, with 21.5% of respondents reporting handling firearms daily or weekly, compared to 10.9% in bottom‐quartile states. Level of firearms training also differed significantly: 42.1% of respondents in top‐quartile states reported formal training compared to 33.0% in bottom‐quartile states. Increased regional firearm ownership rates were associated with decreased rates of feeling unsafe at work. Conclusions The majority of surveyed EPs reported little experience with handling firearms. Firearm experience was associated with comfort with managing firearms found in patients’ possession. Regional differences were found regarding personal firearm experience and perceptions of workplace safety, both of which were associated with regional variations in firearm ownership. Despite this, no regional differences were found in encountering firearms in or around the ED. EPs may benefit from training on safely handling firearms.

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confidence: 99%

Emergency Providers’ Familiarity with Firearms: A National Survey

Ketterer

Poland

Ray

et al. 2020

Academic Emergency Medicine

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“…This study significantly adds to the body of literature in active shooter simulation and preparation by demonstrating the unique use of video framework analysis as a systematic tool for the identification and categorization of threats based on frequency and severity. 10,11,22 This analysis facilitated amendments to our draft Code Silver policy and protocol directed at the highest risk LSTs. This is in contrast to previous active shooter simulation exercises that relied on direct participant debriefing, postevent survey, observer evaluation, and or nonstructured video review to identify critical events and themes.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to previous active shooter simulation exercises that relied on direct participant debriefing, postevent survey, observer evaluation, and or nonstructured video review to identify critical events and themes. 10,11,22 There are numerous pitfalls to exclusively relying on these nonstructured modalities for LST identification. Postsimulation survey in a similar exercise only achieved a response rate of 50.5%.…”

Section: Discussionmentioning

confidence: 99%

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

Argintaru

Hicks

et al. 2020

Disaster med. public health prep.

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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.

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“…By the end of multiple sessions, participants exhibit improved abilities to triage and treat trauma and in-hospital patients 49. Another recent simulation involving an active shooter in a hospital showed a 70% improvement in knowledge and preparation for an MCE 50…”

Section: Discussionmentioning

confidence: 99%

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

Melmer¹,

Carlin²,

Castater³

et al. 2019

JMDH

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Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a highvolume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.

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Active Shooter Training in the Emergency Department: A Safety Initiative

Cited by 28 publications

References 1 publication

Emergency Providers’ Familiarity with Firearms: A National Survey

Emergency Providers’ Familiarity with Firearms: A National Survey

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

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

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