In 2013, two nurses at a Milwaukee hospital heard gunshots. Instead of taking cover, they ran toward the gunfire. Only when they spotted the armed man running at them did they turn and flee.
A police officer cornered the gunman and restrained him with pepper spray. The gunman screamed: “I can’t see! I can’t see!” Once again, the nurses responded as trained caregivers, running to help. When they did so, they pressed a button and opened a door that had held the gunman in place, allowing him to escape.
It turns out that training as caregivers conditions workers to go into a situation and take charge to care for wounded people. But in a violent situation, that can be exactly the wrong response, putting the caregivers and others at increased risk.
Healthcare workers need guidance on how to assess and respond to violent situations. Their tendency, given the training that enables them to take charge and provide care, is to put themselves in danger unnecessarily—as the nurses in Milwaukee did when they ran toward an active shooter.
At a daylong symposium at Johns Hopkins University in April 2014, presenters discussed frontline hospital staff’s responsibilities in violent incidents as well as how to improve training and response. Symposium participants plan to release a guidance document this fall.
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In the meantime, here are some of the recommendations for frontline staff from the symposium.
Provide accurate information to staff. In an active-shooter or other violent situation, it’s vital that staff understand the incident’s seriousness. Make sure you can clearly signal to your staff that you are not running a drill. Staff cannot safely take some actions in a drill situation that must be done quickly in an actual violent situation (like turning off all monitors in patient rooms), so they need to know the difference.
Identify first responders. In a violent situation, wounded staff, patients, or visitors may require immediate medical care. But it might not be safe to help victims before the threat has been neutralized and the “all clear” has been given.
To balance caregivers’ impulse to provide care with the need for safety, the symposium recommended that facilities identify in advance the person who is in charge in a violent situation in each department, along with a designated first-responder team. The first-responder team will be tasked with and trained for potentially hazardous duties, such as helping victims before a threat has been neutralized. These individuals should volunteer for this role, and they must know they may be called on to go into a situation that is still dangerous.
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Train workers in “run, hide, or fight.” When violence erupts, staff will have three options: run, hide, or fight. In a healthcare setting, “running” will include moving patients and visitors to a safe location. If staff determine that they have enough time and cover to do so, they should move everyone to safety and then call 911.
If it’s not safe to move, hide. Lock doors and block them with heavy furniture or medical equipment. Turn off lights, move away from windows, and keep out of sight. Silence cell phones, pagers, nurse call systems, and anything else that could make noise.
If you’re cornered—and only if you’re cornered—recent studies indicate that the best thing to do is fight. You must fully commit to disabling the attacker. Throw the heaviest objects you can lift to distract, disable, or disorient the attacker. For example, you could spray the attacker with a fire extinguisher. Do anything you can think of to go on the offensive.
Once police arrive, staff should put down anything they’ve been holding, keep their hands visible, and move slowly until the “all clear” is given.