372 - Active Shooter Simulation in the Operating Room
Description: Active Shooter Simulation in the OR As our hospital continues on its journey to become a high reliability organization, we have embarked on many initiatives. Our director of security & public safety (SPS) has orchestrated active shooter drills, or ALICE drills (alert, lockdown, inform, counter & evacuate). These drills occur in various departments, but never in the perioperative area. One of our anesthesiologists felt strongly our team participate, as we are not a lockdown area. Buy-in from our director created a team consisting of the clinical practice specialist, OR director, director of SPS, and chiefs of anesthesia & surgery. It was highly recommended that all team members be present, including surgeons and anesthesiologists. The team came up with a scenario involving a veteran with PTSD who brought his wife to the hospital for a routine procedure; the wife coded & expired unexpectedly. The surgeon informed the husband, who was unable to process this sudden news, & along with PTSD, the husband took the surgeon hostage & proceeded to go through each area of the OR & PACU with the surgeon. As the husband absorbed the news, he opened fire. Our team was doing their usual preparation for cases during this time. As part of the planning, we offered CME’s to physicians to help encourage participation. Contact hours were offered to all RN’s and techs. The simulation was scheduled during meeting time, when there were no patients/surgeries in progress. Implementation involved a brief, with director of SPS reviewing ALICE, & allowing anyone who did not want to participate to decline. The scenario lasted 12 minutes. A debrief was performed, discussing what went well/did not go well, & systems issues that might have prevented a positive outcome. Ninety-four persons participated with good results. There was good verbal communication b/t staff members; code carts & other equipment were used as barricades; OR lights were turned off to make the area look as if it was empty; some team members called Security & police; one person countered the shooter; ten people escaped, & there were 7 fatalities. Implications for periop nsg include knowledge of emergency issues that were realized as a direct result of this simulation. Some of these issues include: emergency fire egress doors would not open, rendering escape useless; locks on individual OR suite doors did not work, causing intruder entry; intercom system, through the phone system, was not audible in rooms where phone volume was turned down–staff did not know what was going on; there is a need for visual alarms to use as notification for OR staff, in the event of an active-threat incident; need for a code word if there is an agitated patient/family member w/i department. A team was put together to address our issues. As a result, our OR is in the process of becoming a lock-down unit, to help us prevent issues that may affect the safety or our team, our patients, & their families.