An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

Abstract

With an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2018;page 1 of 8).

Prevenção de pneumonia associada à ventilação mecânica: estudo de intervenção - Prevention of pneumonia associated with mechanical ventilation: intervention study

“…Estes resultados demonstraram que, quando realizados de maneira clara, objetiva e com estratégias atrativas, os treinamentos tendem a apresentar melhores resultados. 13 Tanto o número de casos de pneumonia geral quanto de pneumonia associada à ventilação mecânica apresentou quedas no mês seguinte à realização do treinamento. Entretanto, não foi possível associar este resultado à intervenção realizada.…”

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

“…In situ simulation, represents a resource-efficient and effective technique to detect LSTs, and it may be superior to simulation within a laboratory setting. 11,12,19 In this study, we identified 110 LSTs during a 2-h active shooter scenario. Using a hazard matrix, we categorized 15 LSTs that represent high-risk threats.…”

“…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.…”

“…We used a modified framework analysis to examine synchronized video and audio recording in detail. 11 Two authors (N.A., W.L.) independently performed multiple reviews of the recordings to familiarize themselves with the ASSIST exercise.…”

“…However, none propose a clear methodology to analyze training simulations and inform modification to active shooter protocols and assist in policy implementation. 2,3,[8][9][10][11] While there is no clear consensus for the evaluation of protocols for rare, high-risk events in health-care facilities, interprofessional in situ simulation coupled with framework analysis represents a promising approach. In situ simulation is defined as simulation conducted within the actual clinical environment, 12 and it is particularly effective for the identification of latent safety threats (LSTs), defined as "system-based threats to patient safety that can materialize at any time and are previously unrecognized by health-care providers."…”