Open Access Open Access  Restricted Access Subscription or Fee Access

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

Abstract


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.


Keywords


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

Full Text:

PDF

References


National Institute for Occupational Safety and Health: Violence occupational hazards in hospitals. NIOSH publication 2002-101. Available at http://www.cdc.gov/niosh/docs/2002-101/. Accessed August 4, 2013.

Millen D: Active threat: The hidden terror within the community. J Healthc Prot Manage. 2013; 29(1): 32-46.

IS-907: Active Shooter: What You Can Do. Available at http://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=is-907. Accessed August 13, 2013.

Card AJ, Harrison H, Ward J, et al.: Using prospective hazard analysis to access an active shooter emergency operations plan. J Healthc Risk Manag. 2012; 31(3): 34-40.

Jasper E, Berg K, Reid M, et al.: Disaster preparedness: What training do our interns receive during medical school? Am J Med Qual. 2013; 28(5): 407-413.

Nilsson H, Jonson CO, Vikström T, et al.: Simulation-assisted burn disaster planning. Burns. 2013; 39(6): 1122-1130.

Eason MP: Sarin exposure: A simulation case scenario. South Med J. 2013; 106(1): 55-62.

Kelen GD, Catlett CL, Kubit JG, et al.: Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med. 2012; 60(6): 790-798.

Associated Press: Shots fired at University of Pittsburgh’s psychiatric clinic; two dead, including gunman. New York Daily News. Available at http://www.nydailynews.com. Accessed September 17, 2013.

McNulty M: Heroic EMT disarms crazed man after cop shot by NYPD gun at Harlem Hospital. New York Post. Available at http://nwpost.com. Accessed September 17, 2013.

Active Shooter: How To Respond. US Department of Homeland Security. Available at http://www.dhs.gov/xlibrary/assets/active_ shooter_booklet.pdf. Accessed August 6, 2013.

Clumpner M (speaker): Active Shooter! [audio podcast]. Available at http://www.emrap.org. Accessed September 17, 2013.

Smith E, Iselin B, McKay W: Toward the sound of shooting; Arlington county,VA, rescue. JEMS. 2009; 34(12): 48-55.

Plotner C: Planning for the worst: One hospital’s process for developing an ‘active shooter on campus’ policy. J Healthc Prot Manage. 2008; 24(2): 61-65.

Jacobs LM, McSwain N, Rotondo M: Improving survival from active shooter events: The Hartford Consensus. Bull Am Coll Surg. 2013; 98(6): 14-16.

SERE 100.1 Level A training. Available at http://jko.jfcom.mil. Accessed November 30, 2013.




DOI: https://doi.org/10.5055/ajdm.2014.0140

Refbacks

  • There are currently no refbacks.