1. Evolution of Code Silver One Hospital’s Perspective… Josh Stivers System Security Training Coordinator Swedish Medical Center

2. Active Shooters or Visitors to your Hospital? Sandy Hook Elementary Shooting December 14, 2012. 20 year old Adam Lanza shot and killed twenty children and 6 adults. Children were between the ages of 5 and 6 years old. Lanza committed suicide after the shootings. Columbine High School Shooting April 20, 1999. Eric Harris and Dylan Klebold shot and killed 12 students and one teacher before taking their own lives. Virginia Tech Shooting April 16, 2007. Seung-Hui Cho shot and killed 32 people. It was the worst act of mass murder of college students since 1927 and the Bath School Disaster. Cho committed suicide at the end of the deadly rampage. December 1, 2013- Man dies, woman wounded in Springfield, Mo. hospital. December 18, 2013 – Gunman kills 1 and fatally shoots self in Reno hospital spree. January 5, 2014 – Gunman kills himself after assaulting 2 nurses with his gun and asking them “if they want to die today”.

3. Code Silver Definition: Any staff/patient/visitor actively harming/threatening to do harm with a gun or hostage situation. Old definition included weapon or knife which was removed due to the different type of police response for that type of call.

4. Hospitals: Small Town of Complex Human Relations So many intense relationships –Patient/Staff, Visitor/Staff, Visitor/Visitor, Staff/Staff, Patient/Patient –Mental Health Patients –Forensic Patients Family Dynamics Considerations –Labor & Delivery, happiest place on earth? Not all the time! Delivery of health news be it positive or negative Cultural Differences –94 different languages generally spoken in the Seattle area Outside stressors brought in –Economy –Personal finances…

5. Code Silver called at Swedish… 2012- Code Silver-External called from the Cherry Hill Campus –Witness stated they saw a person with a rifle/gun in the parking garage across from the hospital. –Is this a Code Silver? –What do we expect other staff in the hospital to do once announced? -Police response?

6. Evolution of Code Silver October 1, 2009, Hospitals in the state of Washington encouraged to adopt the standardized emergency codes ← Notice old Code Silver Definition

7. Evolution of Code Silver January 2013, we started doing code silver in-services for all departments and units within the Swedish System including our Edmonds Campus. Approximately 1,500-2,000 Swedish employees have attended the Code Silver in-services to date.

8. Evolution of Code Silver 2014 the silver sticker was introduced Assessments are completed prior to the in-service to identify safe rooms (Code Silver rooms) and those rooms are then identified with the silver sticker preferably placed in the upper right hand corner of the door depending on the door and any obstructions.

9. Education SMC rolled out a new updated version of the ‘shots fired” video in 2013 which focuses on an Active Shooter event in a healthcare setting. Employees complete this education and watch the video annually.

10. Education Education continued. According to the FBI statistics, an active shooter event is over with 12-15 minutes. One of the education pieces is how long do you stay in your “Code Silver” safe room before exiting. Rule of thumb is a couple of hours, and prior to exiting the room, turn your cell phones back on and text or call out to make sure it is over or until found by search teams.

11. Collaboration In 2014, Swedish Medical Center teamed up with local area hospitals to include Harborview Medical Center and Virginia Mason along with the Seattle Police Department to find and define best practices and mitigate for Code Silvers.

12. Prevention A team comprised of security and safety have been working on defining the best practices across the board aside from our meetings with Seattle Police and local hospitals. Our work includes interviewing facilities across the country to determine lessons learned and gain knowledge from their experiences. Utilizing CPTED (Crime Prevention through Environmental Design) and coming up with ways in which to help keep weapons out of the hospital in general.

13. A Code Silver is Called; What Next?… Looking at the three events Swedish has had, we asked the simple question… What do we want staff to do? Patient Safety concerns Ethical Implications of Code Silver –Duty to Patients –Duty to Non-Patients/Visitors –Duty to Self

14. Swedish Code Silver Response Code Silver Internal + Location – Lock Down –Above, Below, and adjacent –Defend In Place Code Silver External + Location – Lock Down –Stay away from the area –All areas overlooking stay away from windows Code Silver Defend in Place –Shots fired, no known location of shooter, active shooter –Everyone in hospital defend in place

15. De-escalation Training a Must Any event can spiral out of control quickly Give staff the tools needed to de-escalate It is mandatory education at Swedish for all clinical staff Swedish de-escalation is based off of mixture of CPI and the book Verbal Judo. Have had remarkable success Half of SMC Code Grays are De-esclated

16. Home Who is waiting for you tonight? Go home to your loved ones

17. Contact Information Josh Stivers System Security Training Coordinator Swedish Medical Center josh.stivers@swedish.org