Active Shooter in the OR: Run, Hide, Fight
Congress Daily: Chicago had the Mercy Hospital shooting in November 2018. Four people lost their lives, and the toll would have been greater had the facility staff not just gone through active shooter training. How important is it for hospital personnel to be trained for the possibility of an active shooter? What is the likelihood that an active shooter event will happen at a hospital, ASC, or other facilities where CRNAs work?
Scott-Herring: Active shooter events are on the rise. The overall number reported per year, depending on the source, rose from 6-9 per year to almost 17 by 2013. Since 2000, there have been over 150 hospital-related shootings. As a comparison, The Malignant Hyperthermia Association of the United States (MHAUS) estimates that the total number of malignant hyperthermia (MH) cases in the U.S. is around 150 per year. CRNAs are clinically educated to swiftly respond to rare, critical events. While the likelihood of an active shooter in the OR is small, it is beneficial to have a response plan for yourself and your organization.
Congress Daily: Active shooters can be anyone – patient, family member, disgruntled employee, nurses, doctors, orderlies, administrators, etc. How does a facility plan for any possibility? Are there commonalities among the shootings that have taken place or in developing a plan to survive an active shooter event?
Scott-Herring: Organizations recognize that prevention is key. Human resources and security often keep tabs on disgruntled employees and block their access. Adding metal detectors is helpful, if utilized appropriately. Our organization has added a K-9 unit which patrols the perimeter and interior of the facility, with much time spent in the emergency department.
Hospital shootings occur in facilities of all sizes. Over 50% of shootings have occurred in those with fewer than 40 beds over the last 20 years. It appears that when the number of hospital beds increase, the number of shootings drop. Though unclear, it may be that smaller hospitals have less security and are easier to navigate.
Many hospital have adopted a “Run, Hide, Fight” response to active shooter which we will be discussing at the AANA Annual Congress.
Congress Daily: What is the biggest misconception of what someone should do to protect themselves during an active shooter event?
Scott-Herring: There is not a clear consensus on the responsibility of OR staff in the event of an active shooter. Some of the literature states you must stay with the patient, while others discuss the ethical and moral responsibilities of providers leaving them. According to the DHHS 2014: Nobody can or should be instructed that they must stay or they must leave. Providers will be needed to care for the injured after the event has been resolved.
Congress Daily: Are active shooter events more likely to happen in an urban area?
Scott-Herring: Active shooter incidents are just as likely to occur in rural or urban healthcare facilities.
Congress Daily: Have you been involved in an active shooter situation? How did you become involved in speaking about an active shooter situation?
Scott-Herring: When I was in college there was an active shooter type event in the neighborhood, though this was before Columbine so it was not defined as such. Years later, there was an active shooter situation in the hospital I was working in which highlighted communication deficiencies in a large organization.
Last year I was tasked with building recommendations for an active shooter event in the OR. A review of the literature showed fewer than 20 articles/editorials/opinion papers addressing active shooters and hospitals. Even fewer specifically addressed the OR environment. There is a lot of work to be done!
This session will take place Sunday, Aug. 11, from 2 - 3 p.m., in the Crystal Ballroom B, Lobby Level, West Tower. Please double check all room assignments in the AANA Meetings app.
Congress Daily: Is there anything else you would like our members to know? Thank you for your time!
Scott-Herring: Know where the exits are so you can run if you need to, and identify safe rooms where you can hide and lock/barricade the door if you have to. Fight if you must! You need to survive for 15 minutes until the immediate threat is resolved. In light of the recent shootings at the California Garlic Festival, and in El Paso and Dayton, it’s even more important that every facility take the time to put an active shooter plan in place, and make sure the staff participates in an active shooter drill, so everyone is prepared for what very well might be a situation we find ourselves in.