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Active shooter in the emergency department: A scenario-based training approach for healthcare workers

Joseph G. Kotora, DO, Terry Clancy, PhD, NREMT-P, Lauren Manzon, BA, Varun Malik, BS, Robert J. Louden, PhD, Mark A. Merlin, DO, EMT-P, FACEP


Background: An active shooter in the emergency department (ED) presents a significant danger to employees, patients, and visitors. Very little education on this topic exists for healthcare workers. Using didactic and scenario-based training methods, the authors constructed a comprehensive training experience to better prepare healthcare workers for an active shooter.
Methods: Thirty-two residents, nurses, and medical students participated in a disaster drill onboard a US military base. All were blinded to the scenarios.The study was approved by the institutional review board, and written consent was obtained from all participants. Each participant completed a 10-item pretest developed from the Department of Homeland Security’s IS:907 Active Shooter course. Participants were exposed to a single active shooter scenario followed by a didactic lecture on hostage recovery and crisis negotiation. Participants were then exposed to a scenario involving multiple shooters. Many of the participants were held hostage for several hours. The training concluded with a post-test and debrief. Paired Student’s t-test determined statistical significance between the pretest and post-test questionnaire scores.
Results: Paired Student’s t-tests confirmed a statistically significant difference between the pretest and posttest scores for the subjects, as a whole (p < 0.002 [−0.177, −0.041]).There was no difference in scores for nurses (p = 1 [−1.779, 1.779]).The scores for resident physicians (p < 0.01 [−0.192, −0.032]) and medical students (p < 0.01 [−0.334, −0.044]) were found to be significant.
Conclusions: Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.


education, training, internal disaster management, violence, healthcare policy

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