Active shooter in the emergency department: a scenario-based training approach for healthcare workers.
BACKGROUND
An active shooter in the emergency department (ED) presents a significant danger to employees, patients, and visitors. Very little education on this topic exists for healthcare workers. Using didactic and scenario-based training methods, the authors constructed a comprehensive training experience to better prepare healthcare workers for an active shooter.


METHODS
Thirty-two residents, nurses, and medical students participated in a disaster drill onboard a US military base. All were blinded to the scenarios. The study was approved by the institutional review board, and written consent was obtained from all participants. Each participant completed a 10-item pretest developed from the Department of Homeland Security's IS:907 Active Shooter course. Participants were exposed to a single active shooter scenario followed by a didactic lecture on hostage recovery and crisis negotiation. Participants were then exposed to a scenario involving multiple shooters. Many of the participants were held hostage for several hours. The training concluded with a post-test and debrief. Paired Student's t-test determined statistical significance between the pretest and post-test questionnaire scores.


RESULTS
Paired Student's t-tests confirmed a statistically significant difference between the pretest and post-test scores for the subjects, as a whole (p < 0.002 [-0.177, -0.041]). There was no difference in scores for nurses (p = 1 [-1.779, 1.779]). The scores for resident physicians (p < 0.01 [-0.192, -0.032]) and medical students (p < 0.01 [-0.334, -0.044]) were found to be significant.


CONCLUSIONS
Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.
Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
Joseph G
JG
Kotora
Chief, Education, Certification, & Technology, New Jersey Department of Health, Office of Emergency Medical Services, Trenton, New Jersey.
Terry
T
Clancy
Research Assistant, Newark Beth Israel Medical Center, Newark, New Jersey.
Lauren
L
Manzon
Research Assistant, Newark Beth Israel Medical Center, Newark, New Jersey.
Varun
V
Malik
Professor, Program Director, Criminal Justice & Homeland Security, Georgian Court University, Lakewood, New Jersey.
Robert J
RJ
Louden
Program Director, Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey; Adjunct Associate Professor, Rutgers University School of Public Health, Piscataway, New Jersey.
Mark A
MA
Merlin
D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005389:Firearms; D006282:Health Personnel / Q000193:education*; D006801:Humans; D016544:Patient Simulation; D010934:Planning Techniques; D017751:Safety Management / Q000458:organization & administration*; D064450:Workplace Violence / Q000517:prevention & control*