The Practical Value of Active Shooter Training In Emergency Departments

By Leslie Sanchez, clinical educator, Children’s Medical Center in Dallas, Texas.

Leslie Sanchez
Leslie Sanchez

Active shooter training was initially seen as cumbersome and just “more training” to complete in our emergency department. However, after staff received the active shooter education which included statistics, active shooter profiles, videos of active shooters in action, and recorded interviews with victims and survivors from active shooter events, it made our staff realize the potential of it happening here in our facility.

Staff immediately recognized several ways that a shooter could not only enter the facility undetected, but could easily get access to various parts of the hospital with little to no effort. The second part of the active shooter training involved a functional exercise in the form of a simulation with various patient scenarios, actors and patients that would typically present to the emergency department. After the simulation, staff realized how difficult it is to not only walk away from your patients, but also from your peers, who quickly become your work family over the course of months and years and are the people you work with daily to save lives.

Many staff members voiced their inner turmoil of having to contemplate “RUN, HIDE, FIGHT” concepts and the idea of not taking their peers or patients with them when escaping danger. Staff were also surprised how they reacted when confronted with a hostile actor who held them at gunpoint or with a knife in hand. Some staff did not know how to react and they either stated they froze, decided to run away or grabbed items to fight the assailant, or did their best to hide in an area and barricaded doors with equipment and bed stretchers.

They also, at times, did not know what to say to the parents or patients in the room and had a hard time being direct when asking them not to cry or yell for help because of the absolute need to remain quiet, turn off the lights and to hold the door with force in case the assailant was nearby.

Each scenario played out differently and it amazed me how quick staff reacted to the aggressive actor with a gun or knife. There were times staff watched and waited for the active shooter to present themselves, while other times staff didn’t even notice that the shooter was “shooting people” in the room next door to them. Some staff thought we had simulated gun shots and swear they heard gun shots, which were never simulated. After the simulation, staff continued to share concerns about their safety in the ER and how they could be more proactive in their own safety by being vigilant about people roaming our hospital without proper identification.

They also continued to escalate and voice concerns to our leadership team about additional safety measure they believe should occur at the front entrance and ambulance bay when patients are brought into our department. Other staff talked about their heightened overall awareness in public areas after our training and how they now pay attention to their exits, who is around them and any behavior that is out of character.

Overall, staff said they truly appreciated the training because, first, it was something that had never been offered for Emergency Department staff and, second, it included various scenarios and opportunities to learn about their reaction to such situations. It was truly an eye-opening experience for everyone involved.

Participating in this exercise, and walking away with a new appreciation for the potential for violence in our facility, delivered the point featured in a recent study I co-authored for the Journal of Emergency Nursing, the official journal of the Emergency Nurses Association.

The goal was to develop and successfully implement a safety strategy that increased the ability of a large pediatric emergency department staff to effectively respond to an active shooter in the hospital. The corresponding survey results, published online in the Journal of Emergency Nursing on August 27, showed that out of 202 emergency nurses and ancillary staff members who participated in active shooter training, 92 percent felt better prepared to respond if a shooting occurred at their facility. Additionally, 70 percent of participants reported an increase in knowledge and readiness.

Active shooter situations and mass casualty incidents have become an unfortunate and increasing reality in society today. That has put emergency nurses on the front line of caring for victims of mass casualty incidents, but also on alert for the possibility their facility could become part of a large-scale disaster or tragedy.

Because of the complexity and potential devastation of such an incident, it is critical for emergency nurses to be prepared by regularly engaging in active shooter training and mass casualty preparedness.

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