Kim Julie J, Howes Daniel, Forristal Chantal, Willmore Andrew
Department of Medicine, Division of Emergency Medicine, Lawson Research Institute, Western University, London, Ontario, Canada.
Department of Emergency Medicine, London Health Sciences Centre, Victoria Hospital Campus, 800 Commissioners Road East, Room E1-125, London, Ontario, N6A 5W9, Canada.
Adv Simul (Lond). 2021 Oct 21;6(1):37. doi: 10.1186/s41077-021-00190-0.
Mass-shooting incidents have been increasing in recent years and Code Silver-the hospital response to a person with a weapon such as an active shooter in many Provinces or States in North America-is quickly shifting from a theoretical safety measure to a realistic scenario for which hospitals must prepare their staff. A Code Silver Exercise (CSE) involving an independent mental practice exercise with written responses to scenarios and questions, followed by a facilitated debrief with all participants, was conceptualized and trialled for feasibility and efficacy. The CSE was piloted as a quality improvement and emergency preparedness initiative in three different settings including in situ within a hospital Emergency Department or Intensive Care Unit, offsite in a large conference room workshop, and online via virtual platform. These sessions took place in 4 different cities in Canada and included 3 academic teaching hospitals. Participants of the in situ and virtual CSE completed pre- and post-simulation surveys which showed improved understanding of Code Silver protocols following participation.The CSE is a reproducible simulation alternative, designed to operationalize a Code Silver policy at a large healthcare institution in a sustainable way. This training model can be administered in multiple settings in-person (in situ or offsite), and virtually, making it versatile and easily accessible for participants. This exercise enables participants to mentally rehearse practical responses to an active shooter in their unique work environments and to discuss ethical and medical-legal implications of their responses during a facilitated debrief with fellow healthcare providers. Implementation of a CSE for training in hospitals may help staff to create a mental schema prior to an active shooter event, and thus indirectly improve the chances of survivability in the event of a real active shooter situation.
近年来，大规模枪击事件不断增加，“银色代码”（北美许多省份或州医院针对持枪者，如活跃枪手的应对措施）正迅速从一种理论上的安全措施转变为医院必须让员工做好准备应对的现实场景。“银色代码演习”（CSE）的构想是进行一次独立的心理实践演习，对场景和问题给出书面回答，随后与所有参与者进行引导式汇报总结，并对其可行性和有效性进行了试验。CSE作为一项质量改进和应急准备举措，在三种不同场景下进行了试点，包括在医院急诊科或重症监护病房现场、在大型会议室工作坊进行场外演练，以及通过虚拟平台进行在线演练。这些演练在加拿大的4个不同城市开展，其中包括3家学术教学医院。现场和虚拟CSE的参与者完成了模拟前后的调查，结果显示参与后对“银色代码”协议的理解有所提高。CSE是一种可重复的模拟方式，旨在以可持续的方式在大型医疗机构实施“银色代码”政策。这种培训模式可以在多种场景下进行，包括现场（现场或场外）和虚拟方式，使其具有通用性，参与者易于参与。该演习使参与者能够在其独特的工作环境中在脑海中演练对活跃枪手的实际应对措施，并在与其他医疗服务提供者进行的引导式汇报总结中讨论其应对措施的伦理和医疗法律影响。在医院实施CSE进行培训可能有助于员工在活跃枪手事件发生前建立心理模式，从而间接提高在实际发生活跃枪手情况时的生存几率。
