Code Silver

1
Code Silver

• Responding to Active Shooters
• Eric Smith, CPP

2
Overview

• Planning the policy and drill
• Coordinating with police and staff
• The drill
• Lessons learned

3
The Scenario

• A father comes to the Emergency Department after
  learning his son is sick
• Checks in with security and is allowed into the
  department
• Situation escalates after an encounter with the
  childs mother and staff intervention
• Suspect brandishes a weapon, takes the mother
  hostage, and shoots at staff on his way out of
  the department

4
Back to the beginning

• The Code Silver policy
• Research on incidents in hospitals
• Review policies from other hospitals
• Government and law enforcement resources
• Consistent with other hospital policies
• Write, rewrite and rewrite again

5
Policy

• Approval process
• Support the need for the policy
• Why do we need this policy?
• What is gained from it?
• Use teams/groups for support
• EOC
• Emergency Management

6
Training

• Considerations
• Which comes first?
• How much training is needed before the drill?
• At ESJH
• Policy created
• Training module placed on intraweb
• Drill was announced ahead of time
• One goal was to increase interest/awareness

7
Designing the Drill

• Outline the primary goal and objectives
• Mission statement
• Test responses by staff, police and security
• Activation of ICS
• Effectiveness of policy and lockdown procedures
• Co-ordination with police

8
Drill Objectives

• What are some of the drill goals?
• Is the plan called per policy?
• Is the area isolated?
• What was staff response?
• Evaluate communications
• Evaluate mass notifications
• How quickly did PD get to the scene?

9
Scenario Issues

• Where can you conduct the drill without
  interfering with patient care?
• Make it a realistic situation
• Workplace violence or domestic related
• Where do you get your disturbances?
• Set appropriate limits
• Time and areas affected

10
Logistics

• Coordinate with internal and external groups
• Involvement of clinical staff
• For education
• For patient care
• Local police response
• How will they get in
• How will they ID in-play areas
• Where will they set up ICS?

11
Logistics

• Communications plan
• Is the drill to be announced or unannounced?
• If unannounced, how will you deal with staff and
  patients during the drill to avoid any panic
• Full communication with all involved parties
• Understand the space requirements of the police
• Who will play the role of suspects/victims?

12
The Drill

• Felt real to involved staff
• ED staff hit the duress alarm and called 55 and
  911 immediately
• Staff attempted to hide from suspect
• Victims were treated as soon as safe
• Suspect barricaded in one zone of the ER

13
Security Response

• Responded to duress in less than a minute
• ED/Hospital lockdown was implemented
• Identified suspect location in zone 3

14
Security Response

• Set up liaison with incident command center
• Escorted PD to scene
• Provided drawings/layout of area to police

15
HICS

• Set up promptly and roles assigned
• DPD sent a liaison
• Member of senior team went to DPD command post
• Staffing/supplies were appraised

16
HICS

• OR schedule reviewed
• Began discharging patients
• IT response
• Shut off public Wi-Fi
• Area phones forwarded
• Facilities
• Turned off cable channels

17
Drill Conclusion

• Police set up communications with suspect
• Negotiations were underway and the one hostage
  rescued
• Suspect surrendered

18
Positive Outcomes

• Communications were key
• Patients in the ED were told about the drill and
  were excited to see what was happening
• Initial notification by staff was quick and
  appropriate

19
Positive Outcomes

• Safety risks identified prior to drill
• Great collaboration with Denver PD
• Tested the Code Silver Response

20
Lessons Learned

• Evacuation of patients when area secured
• Improved communication internally
• Confusion/concern about the status of the
  original pediatric patient
• ICS training for staff to understand the role of
  IC and their own role
• IC roles pre-assigned and additional training

21
Lessons Learned

• Update facility drawings for crisis response kit
• Long delay in getting police to scene inside the
  hospital
• Wider security training as liaison with police
• Security to provide crisis tool kit to police
• Access an issue

22
Lessons Learned

• Security officers need to relay key information
  to police assertively
• Police recommended that the hospital consider
  armed security

23
Recap

• The key to a successful drill, just like the key
  to successful response in an emergency is
  planning and preparation.
• Develop a realistic and workable policy
• Drill based on real situations
• Carefully outline the involved groups and
  necessary logistics
• Debrief and act on lessons learned

24
Questions?

• Thank you