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Ketterer AR, Austin AL. An Ethical Framework for Conducting Active-Shooter Simulation in the Healthcare Environment. Simul Healthc 2022; 17:270-274. [PMID: 35093977 DOI: 10.1097/sih.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Active shooter events, although rare, are increasing in frequency in the United States, and healthcare settings are not immune to such events. Of the 277 active shooter events that took place in the United States between 2000 and 2019, 15 (4.5%) took place in healthcare facilities. Healthcare workers (HCWs) must be (1) well trained to respond to an active shooter event and (2) trained to respond to active shooter casualties. Educational activities related to active shooter events require a clear focus on goals and objectives, balanced to assure the physical and psychological safety of all participants. This article outlines how the recommendations of the National Association of School Psychologists might be adapted to conduct active shooter drills in the healthcare setting. This approach provides a framework for managing some of the ethical considerations in active shooter simulations.
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Affiliation(s)
- Andrew R Ketterer
- From the Department of Emergency Medicine (A.R.K.), Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA; and Modeling Virtual Environments and Simulation (MOVES) Institute (A.L.A.), Naval Postgraduate School Healthcare Modeling and Simulation Program, Monterey, CA
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Kim JJ, Howes D, Forristal C, Willmore A. The Code Silver Exercise: a low-cost simulation alternative to prepare hospitals for an active shooter event. Adv Simul (Lond) 2021; 6:37. [PMID: 34674767 PMCID: PMC8529569 DOI: 10.1186/s41077-021-00190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
Mass-shooting incidents have been increasing in recent years and Code Silver—the hospital response to a person with a weapon such as an active shooter in many Provinces or States in North America—is quickly shifting from a theoretical safety measure to a realistic scenario for which hospitals must prepare their staff. A Code Silver Exercise (CSE) involving an independent mental practice exercise with written responses to scenarios and questions, followed by a facilitated debrief with all participants, was conceptualized and trialled for feasibility and efficacy. The CSE was piloted as a quality improvement and emergency preparedness initiative in three different settings including in situ within a hospital Emergency Department or Intensive Care Unit, offsite in a large conference room workshop, and online via virtual platform. These sessions took place in 4 different cities in Canada and included 3 academic teaching hospitals. Participants of the in situ and virtual CSE completed pre- and post-simulation surveys which showed improved understanding of Code Silver protocols following participation. The CSE is a reproducible simulation alternative, designed to operationalize a Code Silver policy at a large healthcare institution in a sustainable way. This training model can be administered in multiple settings in-person (in situ or offsite), and virtually, making it versatile and easily accessible for participants. This exercise enables participants to mentally rehearse practical responses to an active shooter in their unique work environments and to discuss ethical and medical-legal implications of their responses during a facilitated debrief with fellow healthcare providers. Implementation of a CSE for training in hospitals may help staff to create a mental schema prior to an active shooter event, and thus indirectly improve the chances of survivability in the event of a real active shooter situation.
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Affiliation(s)
- Julie J Kim
- Department of Medicine, Division of Emergency Medicine, Lawson Research Institute, Western University, London, Ontario, Canada. .,Department of Emergency Medicine, London Health Sciences Centre, Victoria Hospital Campus, 800 Commissioners Road East, Room E1-125, London, Ontario, N6A 5W9, Canada.
| | - Daniel Howes
- Department of Critical Care Medicine, Queens University, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | - Chantal Forristal
- Department of Medicine, Division of Emergency Medicine, Lawson Research Institute, Western University, London, Ontario, Canada.,Department of Emergency Medicine, London Health Sciences Centre, Victoria Hospital Campus, 800 Commissioners Road East, Room E1-125, London, Ontario, N6A 5W9, Canada
| | - Andrew Willmore
- Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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Design, build, train, excel: using simulation to create elite trauma systems. Int Anesthesiol Clin 2021; 59:58-66. [DOI: 10.1097/aia.0000000000000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dubé M, Kaba A, Cronin T, Barnes S, Fuselli T, Grant V. COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada. Adv Simul (Lond) 2020; 5:22. [PMID: 32821441 PMCID: PMC7432586 DOI: 10.1186/s41077-020-00138-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.
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Affiliation(s)
- Mirette Dubé
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Alyshah Kaba
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Theresa Cronin
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Sue Barnes
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Tara Fuselli
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Vincent Grant
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- KidSIM Pediatric Simulation Program, Alberta Children’s Hospital, 28 Oki Dr NW, Calgary, Alberta T3B 6A8 Canada
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Brydges R, Campbell DM, Beavers L, Khodadoust N, Iantomasi P, Sampson K, Goffi A, Caparica Santos FN, Petrosoniak A. Lessons learned in preparing for and responding to the early stages of the COVID-19 pandemic: one simulation's program experience adapting to the new normal. Adv Simul (Lond) 2020; 5:8. [PMID: 32514385 PMCID: PMC7267752 DOI: 10.1186/s41077-020-00128-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022] Open
Abstract
Use of simulation to ensure an organization is ready for significant events, like COVID-19 pandemic, has shifted from a "backburner" training tool to a "first choice" strategy for ensuring individual, team, and system readiness. In this report, we summarize our simulation program's response during the COVID-19 pandemic, including the associated challenges and lessons learned. We also reflect on anticipated changes within our program as we adapt to a "new normal" following this pandemic. We intend for this report to function as a guide for other simulation programs to consult as this COVID-19 crisis continues to unfold, and during future challenges within global healthcare systems. We argue that this pandemic has cemented simulation programs as fundamental for any healthcare organization interested in ensuring its workforce can adapt in times of crisis. With the right team and set of partners, we believe that sustained investments in a simulation program will amplify into immeasurable impacts across a healthcare system.
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Affiliation(s)
- Ryan Brydges
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Douglas M. Campbell
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Lindsay Beavers
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nazanin Khodadoust
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Paula Iantomasi
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Kristen Sampson
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Alberto Goffi
- Department of Medicine, Division of Critical Care Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Filipe N. Caparica Santos
- Department of Anesthesia, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Andrew Petrosoniak
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Toronto, Canada
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Dieckmann P, Torgeirsen K, Qvindesland SA, Thomas L, Bushell V, Langli Ersdal H. The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK. Adv Simul (Lond) 2020; 5:3. [PMID: 32308988 PMCID: PMC7160610 DOI: 10.1186/s41077-020-00121-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
In this paper, we describe the potential of simulation to improve hospital responses to the COVID-19 crisis. We provide tools which can be used to analyse the current needs of the situation, explain how simulation can help to improve responses to the crisis, what the key issues are with integrating simulation into organisations, and what to focus on when conducting simulations. We provide an overview of helpful resources and a collection of scenarios and support for centre-based and in situ simulations.
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Affiliation(s)
- Peter Dieckmann
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, Opg. 1 - 25th floor, DK-2730 Herlev, Capital Region of Denmark Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Kjetil Torgeirsen
- Stavanger Acute Medicine Foundation for Education and Research (SAFER), Stavanger, Norway
| | - Sigrun Anna Qvindesland
- Stavanger Acute Medicine Foundation for Education and Research (SAFER), Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Libby Thomas
- Emergency Department, Kings College Hospital NHS Foundation Trust, London, UK
- The Blizard Institute, Queen Mary University, London, UK
| | - Verity Bushell
- Postgraduate Medical and Dental Education Department, Kings College London, Denmark Hill, London, UK
| | - Hege Langli Ersdal
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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