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 Our first-time search found the extinguisher in the morgue was two years out of date.
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 [email protected].
I agree active shooter scenarios are one of the most scary emergencies one could face. Know your hospitals plan and drill. Know your resources and capabilities. I worked for 19 years in a Biomed shop that was part of facilities. As such I was cross trained in many of the emergency drills and procedures that facilities had lead roles in. I had incident command center training and I had collateral duties in many EOC related roles and had a job or position assigned for almost every disaster drill. This experience was invaluable in learning how and why a hospital “works” both day to day and during emergencies. This body of experience will always be something I can draw from and support my current employer. The Hospital itself is the largest piece of medical equipment on the campus. It is essential for BMETs and CEs to have a basic level of understanding of what the hospital is and how it works. I also think that Biomeds are one of the more versatile, adaptable and robust employee types and as such we should seek out roles in disaster preparedness. It is good practice to stay tuned into the hospital’s disaster response plans and be ready to help.
J Scot Mackeil CBET Quincy Ma.
In 1999 I was involved in an active shooter incident where the suspect killed 3 of my coworkers, a nurse, a pharmacist, and our EVS manager. I was passed in the stairwell by my pharmacist friend and he met his fate at the top of the entrance to the 2nd floor. The shooter was about to open the stairwell door when Vince came running through the door. The shooter shot him point blank in the throat and then put 3 more slugs into his back as he fell to the ground. The shooter started coming down the stairwell as I started running back down at halfway up. I ran out of the 1st floor door to where I met Ron the EVS manager. Ron told me yo run through the admin hallway and tell people to lock their doors. I did just that. The shooter came out of the stairwell and put a few slugs into Ron point black with a 357 magnum hollow points. I cleared the corner so the gunman never saw me again. I ran into the CEO boardroom with 3 other ladies who were terrified. All I had was a typewriter over my head, ready to throw at the gunman if he came through the unlocked boardroom door. He never did. They caught the suspect after killing Ron, the 3rd victim. I was trained to go to the boardroom through disaster training and I did exactly what I was supposed to do. We went through 5 years of court proceedings to nail this suspect with as much time as we could throw at him. He will die in prison. He still says he would do it again if he could.
That is so horrific, Andy. I’m so sorry for your experience and loss of your coworkers!