2. Informal Discussion of Simulated Emergency Time Relaxed Low Stress Focus on Evaluating Plans and Procedures Allows for resolution of questions of concern, and coordination There are no wrong answers

4. John is a former employee of Memorial Foundation Hospital While working at Memorial John met and began a romantic relationship with another Memorial employee who currently works in the E.D. John and this person recently broke up leaving John extremely upset and angry

5. John is so upset that he comes to Memorial to attempt to speak to his ex He asks ED Patient Registration to allow him to enter the ED but because he is not a patient, he is not allowed to enter He begins to shout out his ex’s name so loudly that Hospital Security Officers have to intervene and escort him from the building

6. Using our current plans and policies, is there any more that can be done at this point? Contact 911? Notify the targeted employee? Post additional Security Officers?

8. Friday night at approximately 9:45 the E.D. is near capacity with many people (both patients and visitors) in the waiting room An ambulance arrives with a patient on a cot and the Paramedic swipes his badge to transfer the patient into the ED patient care area Right behind the EMS staff is John and John enters the ED patient care area while the doors remain open

9. Giving the fact that the ED was extremely busy and John was able to simply walk in behind EMS, was there anything that could have prevented this from happening?

10. Shortly after John enters the ED, most people inside the ED heard a series of loud popping noises that sound like fire crackers. A few seconds later, John’s ex is found lying on the floor of the ED

11. According to our current plans/policies, what would be the next steps taken?

12. People are running all over the ED Security has arrived but the police have not The door to the computer office/Resident’s dictation room (directly across from the ED Nursing station is closed and appears to be locked or barricaded It is suspected that John is in there but no one is sure if he’s alone

14. The police have arrived and Security gives them a report of what happened as they know it The police call for the evacuation of the entire ED

15. Do our current plans or policies address evacuation of the ED Do they address evacuating to other, more safe areas in the hospital How can the ED staff gain resources safely to assist with the evacuation

17. The police send in a contact team, they hear one shot fired from inside the computer room and decide to forcefully enter the room Inside the room they find John, unconscious and not breathing with one apparent GSW to his head Post incident: 2 dead including the shooter Many ED staff, patients, and visitors extremely frightened and afraid

18. Do our current plans or policies identify resources to assist the mental/emotional needs of our employees after this type of incident

20. Six Memorial Emergency Department employees have quit Another four have notified the ED Director of their intention to change departments Two Security Officers have quit and one Security Officer is on medical leave for PTSD

21. What changes (if any) can we make to current policies/plans to better protect our staff, patients, and visitors