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

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.

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

“…While disaster planning has become core content within some training curricula, the majority of health professionals remain ill prepared to deal with large scale disasters and will not encounter these critical scenarios in practice [13,14]. Simulation is one method that has been identified to improve readiness and preparedness in times of disaster through deliberate practice and exposure to rare situations [15][16][17][18]. Simulation-based learning has historically focused on individual and team training of practicing HCPs [19][20][21][22][23][24][25], although it has evolved to include just-in-time in situ training within the actual clinical environment [26][27][28] including simulation for systems integration (SIS), targeting the testing and integration of systems and processes (e.g., workflows, care pathways) that are uniquely important to disaster preparedness [29][30][31][32].…”

The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK

“…The COVID-19 outbreak is a textbook case for the use of simulation and an opportunity for simulation to play to its strengths. This was seen in previous crisis events inside and outside of healthcare [11][12][13][14]. The demands of clinical care are sensitive to errors, and the stakes are high if errors occur.…”

Lessons learned in preparing for and responding to the early stages of the COVID-19 pandemic: one simulation’s program experience adapting to the new normal

“…Taking the initiative to respond and our situated lessons learned Our organization's senior leadership recognized UHT-SP as a key change agent in Unity Health Toronto's response to the multiple pandemic demands. For instance, our team has previously conducted several successful large-scale simulations aimed at testing clinical micro-system's responsiveness to situations demanding high healthcare resources and patient surges, such as mock Code Silver [19], mock Code Oranges [20], and evaluation of a Family Information Support Centre model. Using the overarching principle of functional task alignment [11]-aligning a simulation's design, delivery, and function with the functional demands of the task at hand-we responded rapidly to the organization's requests across a variety of initiatives.…”