Argintaru Niran, Li Winny, Hicks Christopher, White Kari, McGowan Melissa, Gray Sara, Petrosoniak Andrew
Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada.
St. Michael's Hospital, University of Toronto, Canada.
Disaster Med Public Health Prep. 2021 Apr;15(2):223-231. doi: 10.1017/dmp.2019.161. Epub 2020 Mar 9.
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.
医院枪击事件（银色代码）对工作人员、患者和访客构成极大风险。医院在培训员工和制定应对这些高风险事件的预案方面面临独特挑战。现场模拟是一种创新技术，可评估机构对紧急情况的应对能力。本研究重点介绍了在加拿大一家一级创伤中心进行的主动射击者现场模拟的设计，以测试银色代码主动射击者预案的响应情况。我们进一步应用改进的框架分析，通过对执法人员、医院安保人员、后勤人员和医务人员的响应进行人种学观察，从模拟中提取潜在安全威胁（LSTs）。基于视频的框架分析识别出110个潜在安全威胁，并为其分配了危险评分，突出了3个没有有效控制措施或不易被发现的高风险潜在安全威胁。这些包括患者转运期间缺乏安保、临床区域外态势感知不足以及跨专业团队成员之间关键任务协调不佳。现场模拟是一种新颖的方法，可支持其他机构设计和实施类似事件。人种学观察和基于视频的分析结果形成了一个结构化框架，以解决安全、后勤和医疗响应方面的考虑因素。
