By C. Wayne Hibbs, PhD, C.C.E.

When I was the director of clinical engineering in an 870-bed hospital, I had between 10 and 15 employees at various times working throughout the facilities. The hospital was spread over four city blocks with 10 street level entrances and overhead walkways connecting the buildings for public and staff access.

In addition to our ongoing technical training, we took part in a safety committee training program after the hospital safety committee realized that we were moving throughout the facilities at unscheduled times. The training began with a Bingo-type game.

Every member of the HTM staff was given a game card. The goal was to identify the location and scheduled inspection date for each fire extinguisher and AED unit in the entire hospital. We were all surprised at the number of items throughout the hospital and where they were hidden. Our first-time search found the extinguisher in the morgue was two years out of date.

Soapbox Hibbs Wayne

C. Wayne Hibbs

We made this an annual part of our training. Over time, we were included in the facilities staff response to the “Code Red” (fire) and the “Code Blue” (cardiac arrest) medical response team. These days, some of our facilities have more than 10 emergency codes to remember and to which to respond. Examples include: “Code Pink” (baby missing); “Code Orange” (hazardous spill); “Code Gray” (bomb threat); and “Code White” (infrastructure failure—steam, electrical, plumbing, fire alarm failure).

Furthermore, our culture has evolved to where a growing number of visitors in the hospital have concealed carry permits. While posted signs at hospital entrances restrict firearms, the reality is not every visitor will return to his or her car and lock up their concealed firearm when they see that sign on the door. In fact, every emergency department has stories of patients coming in with concealed weapons in all types of behavioral or injured conditions.

Since 9/11, the Boston Marathon bombing, and other terrorist attacks, we have been told “See Something, Say Something.” But in the hospital, if we see a backpack, suitcase, or box left in a waiting room, would we report it to security or just keep walking?

It is now time to train for the problem known as “active shooter.” A terrorist thinking that the nuclear medicine hot lab would have medical waste for a “dirty bomb”; a parent with a custody issue who knows we have an infant security system; an addict looking for a score at the pharmacy—TV is full of stories of distraught spouses, parents, or victims of patients.

Homeland Security, the FBI, and local law enforcement have developed the next training slogan that we will all be taught in the next 12 months: “Code Silver: Active Shooter” is now “Run, Hide, then Fight.” The “Run” portion dictates that in an active shooter situation, individuals should head to the nearest exit, get outside, and run away from the building.

If there are emergency personnel outside, hold your hands up to show you are not the shooter. While you may think that helping others is a priority, the experts recommend getting yourself out and staying out of the way.

If running is not an option, then “Hide” is the next course of action. Most HTM staff have either keys or proximity cards to access, around the clock, the areas in which they work. They also know all the odd places where staff hide equipment. Hide behind a locked door, if possible, with the door barricaded and not in the line of sight of any windows. Lights should be off and cell phones on mute. An active shooter in a hallway will not waste time on a locked and barricaded door unless it is his or her actual target.

Typically, shooters will move down the hall, checking for unlocked doors. Hold your position until contacted by known authorities with an “All Clear” announcement. Refrain from peeking outside to see it the coast is clear; it may very well make you a mole in the shooter’s “Whack a Mole Game.”

Finally, “Fight” is the last resort. If confronted by an active shooter, most law enforcement agencies do not recommend negotiation, asking for mercy, or playing dead. While those techniques were common and often worked in previous decades, the contemporary active shooter seeks to make a public statement and has already committed to suicide by law enforcement.

If faced with an active shooter, the recommendation is to fight with everything available. For HTM staff, remembering the locations of all those fire extinguishers could be critical knowledge.

Discharging a fire extinguisher into a suspect’s face, while not lethal, is an extreme disrupter. Subsequently, an empty fire extinguisher is an impressive close quarters weapon. Think of the extinguisher as the hybrid of a cast iron frying pan and an aluminum softball bat. Note that this is not just a recommendation for young, healthy males.

The need to fight is just as important for females, older people, and handicapped persons. Anything you do to buy time until the authorities arrive is important to you and everyone behind you. Thinking like a first responder at work may not be on the certification exam yet, but perhaps it should be.

Wayne Hibbs is a certified clinical engineer, director of technology planning, and principal with BSA LifeStructures, Indianapolis. For more information, contact kstephens@medqor.com.