1. Active Shooter Situation RUN HIDE FIGHT
A resource for UMMC Emergency Department staff September Megan Halliday Benjamin Lawner

2. Its just a normal day in the UMMC ED when suddenly you hear shots fire from triage… …what do you do now?

3. The best defense is preparedness.
With the ever increasing number of active shooter events world wide, it is important to be prepared by knowing what to expect and how to act in case there is an active shooter in your Emergency Department. Use this power point as a reference and a guide to start having conversations with your colleagues and planning your own defense strategy against an active shooter.

4. Outline Definitions The RUN HIDE FIGHT model
When law enforcement arrives
Who to contact
Resources available in the ED
Triage
Your moral and ethical responsibilities
What to do next

5. Definitions Code Purple Active Shooter
Alert signifying security issue within or with the potential to impact the hospital
Active Shooter
Person(s) who appear actively engaged in shooting or attempting to shoot people

6. The next few slides cover THREE ACTIONS you can take in the event of an active shooter
RUN – HIDE – FIGHT
This plan has been adopted by many institutions across the nation. Read through the slides and imagine different locations, scenarios and situations where you may put these actions into play.

7. RUN Leave if you are able and there is a safe escape route
Encourage others to come with you, but do not delay getting yourself to safety
Have a predetermined location in mind
Leave belongings behind
Prevent others from entering the danger area
Call 911 only once you are safe

8. HIDE Barricade behind large objects out of the shooter’s view
Block the entry way and lock doors
Be silent – including cell phones and pagers

9. FIGHT
As a last resort if you life is in danger, commit to your actions and fight
Attempt to incapacitate the shooter
Improvise weapons from the objects around you
Act with physical aggression and throw objects at the shooter

10. The following is the model provided by UMMC Emergency Management

11. When law enforcement arrives:
Remain calm
Keep your hands visible at all times
Avoid pointing and yelling
Know that more help for the injured is on its way

12. Who will be activated in case of an active shooter?
Hospital Incident Command System (HICS) Team
“Internal staff trained to provide command, control, communication and coordination functions during an active shooter incident.”
Security Services
“Conduct assessment of the situation and provide perimeter control management…meet with responding police.”
Customer connect/SOSC (8-8711)
“Contacts Emergency Services and provides communication to HICS Team”

13. Who should you contact? Security @ 8-8711
Who will then contact Emergency Services (911) and communicate with the HICS Team

14. Emergency Department Resources

15. Get to know what resources are available to you in the Emergency Department
MCI Room/Disaster Closet
Decontamination Room
Emergency Buttons

16. MCI Room/Disaster Closet
Located in the behind the adult ED just inside the ambulance bay doors.

17. MCI Room/Disaster Closet  Various items including PPE and airway supplies

18. MCI Room/Disaster Closet  IV starting carts (not visualized in the picture on the left)

19. MCI Room/Disaster Closet  LifePaks, portable suction and portable ventilators

20. MCI Room/Disaster Closet  RADIOS

21. Triage Cart
The triage cart contains tools necessary for the triage of injured patients
Triage tags, tape, pens, and other equipment is found in the cart
The Maryland state EMS system uses the “START” system, or Simple Triage and Rapid Transport algorithm
The goal is to rapidly sort casualties into categories that match an assigned injury priority

22. Triage Process of “sorting” casualties into priority categories
Rapid assessment that takes available resources into account
Simple tools that can be applied by rescuers of all skill level
4 basic categories
BLACK: Expectant, not expected to survive injuries
RED: Life threatening injuries
YELLOW: Delayed treatment appropriate
GREEN: Minor injuries

25. Sample Triage Process
Able to walk and obey commands? Unconscious, unresponsive ? No spontaneous breathing after reposition? RR > 30, altered MS, delayed cap refill ? Broken bones, bleeding wounds ? Requires resources currently unavailable (CPR, mechanical ventilation)
GREEN
RED
BLACK
RED
YELLOW
BLACK

26. Triage Tips
Patients can change categories! Reassess at frequent intervals
Even black-tagged patients can receive treatment (oxygen, pain meds)
Document vitals and assessment on the triage tag
Communicate with others on your team
DO NOT become occupied with resuscitation until all casualties are tagged

27. Always Remember LSI’s -Life Saving Interventions!
Bleeding control, non invasive airway management, chest decompression

28. Decontamination Room
Can be accessed from the outside door in the ambulance bay or the door in the back hallway past beds 14a and 14b

29. Decontamination Room
Contains two carts with PPE and decontamination supplies and four shower heads

30. Emergency Buttons Located throughout the ED
Can be pressed in case of emergency
Do you know where at least five are located?

31. What are you expected to do ethically and morally?
There is no right answer to this question although there has been much debate on what is right and wrong.
No one can tell you how to act or what to do in this situation. Your actions and the actions of those around you will depend on the situation, the location of the shooter relative to you, your resources and ultimately – YOU
Please read this interesting article from the Annals of Emergency Medicine for a discussion on the fine balance between your duty to provide medical care and your duty to self and family during a pandemic or disaster.
“Fight or Flight: The Ethics of Emergency Physician Disaster Response” by Iserson, Kenneth V. et al.

32. What should you do now?
Talk to your colleagues about what they would do in an active shooter situation.
Participate in the hospital wide and Emergency Department active shooter drills.
Know where your resources are in the Emergency Department.

33. Other resources are available for you
The following are available by following the links or searching on the intra-net:
UMMC Active Shooter Plan
UMMC Mass Casualty Incident Plan
UMMC Adult Emergency Department Disaster Plan

34. References UMMC Active Shooter Plan www.readyhoustontx.gov
They have a great video that discusses the run, hide, fight plan discussed in this presentation.
Iserson, K. V., Heine, C. E., Larkin, G. L., Moskop, J. C., Baruch, J., Aswegan, A. L., … al., et. (2008). Fight or Flight: The Ethics of Emergency Physician Disaster Response. Annals of Emergency Medicine, 51(4), 345–

35. Special thanks to: Craig Savageau Emergency Management Coordinator
Department of Safety and Environmental Health at UMMC