Kotora Joseph G, Clancy Terry, Manzon Lauren, Malik Varun, Louden Robert J, Merlin Mark A
Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
Chief, Education, Certification, & Technology, New Jersey Department of Health, Office of Emergency Medical Services, Trenton, New Jersey.
Am J Disaster Med. 2014 Winter;9(1):39-51. doi: 10.5055/ajdm.2014.0140.
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.
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.
Paired Student's t-tests confirmed a statistically significant difference between the pretest and post-test 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.
Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.
急诊科出现活跃射手会对员工、患者和访客构成重大危险。针对这一主题，医护人员接受的相关培训非常少。作者采用讲授法和基于场景的培训方法，构建了一种全面的培训体验，以便让医护人员更好地应对活跃射手事件。
32名住院医师、护士和医学生参加了在美国军事基地进行的灾难演习。所有人对演习场景均不知情。该研究经机构审查委员会批准，并获得了所有参与者的书面同意。每位参与者完成了一份由国土安全部IS:907活跃射手课程衍生而来的包含10个项目的预测试。参与者先接触了一个活跃射手场景，随后听取了一场关于人质解救和危机谈判的讲授讲座。接着，参与者又接触了一个涉及多名射手的场景。许多参与者被挟持为人质长达数小时。培训最后进行了后测试和汇报总结。配对学生t检验确定了预测试和后测试问卷分数之间的统计学显著性。
配对学生t检验证实，总体而言，受试者的预测试和后测试分数之间存在统计学显著差异（p < 0.002 [-0.177, -0.041]）。护士的分数没有差异（p = 1 [-1.779, 1.779]）。住院医师（p < 0.01 [-0.192, -0.032]）和医学生（p < 0.01 [-0.334, -0.044]）的分数具有显著性。
讲授讲座与基于案例的场景相结合，是教导医护人员如何最佳应对活跃射手事件的有效方法。
