Research Based to Maximize Effectiveness of Simulation for Hospital Disaster Plan (HDP) Teams in Indonesia

Abstract

Healthcare facilities are "soft targets." The "Run-Hide-Fight" mantra can be easily assimilated by the average learner in generic "active shooter" educational programs. However, healthcare professionals, confronting an active shooter situation, must reconcile conflicting goals: personal, staff, and their patient's safety. Indecisiveness may lead to catastrophe. Targeted education addressing these concerns can be explored in medical simulations. Methods: A case-based simulation medical program (four hours weekly) is included within an emergency medical clerkship involving multidisciplinary students and faculty. At the start of their rotation, students receive "active shooter" educational material including the hospital protocol. While managing a typical ED simulated patient (varying levels of criticality), an "active shooter" component is added. Students must reconcile "Run-Hide-Fight" within the context of patient care. Debriefings follow. Results: Sessions are held twice monthly in a no-threat environment with approval and assistance from university police trained in "active shooter" education. Within a span of ninety minutes, students manage a case into which one active shooter scenario is added. Depending on shooter location and patient condition, students must decide to run (with what and whom) or hide (barricade techniques) and fight (improvisational weapons). Debriefing emphasizes no right answer. Each situation is unique. Lifesaving strategies and tactics emphasize the improvised barricades and weapons that are uniquely found in a patient's room. Over 100 students have gone through this program since its inception. Conclusion: Incorporating active shooter scenarios in medical simulations is accomplished in a no-threat, no-consequence environment. Regular training of healthcare and public health students through simulation of typical and atypical scenarios in healthcare facilities provides experience and sharpens mental "muscle memory"allowing them to make wise decisions quickly during an actual active shooter incident.