In early May 2018, two women were shot outside of Mount Sinai Hospital (Chicago) while waiting for news on a relative who was shot earlier in the day.  In June 2017, a gunman shot one doctor and injured five other people at Bronx-Lebanon Hospital Center (New York). These unfortunate tragedies and other events over the past year, specifically “active shooter events” (ASE) or “acts of terrorism” have made us all aware of the need for vigilance and preparation.  As Safety Directors we develop and implement Emergency Procedures for fire, oxygen toxicity, communication failure etc… but what we do in an “ASE”? 

As the Safety Director of a hyperbaric facility, your role is to ensure that processes and systems are in place to proactively reduce risk and ultimately… the occurrence of catastrophic events.  The challenges of the Hyperbaric Director are well documented; those challenges are generally associated with “what can or can not go into the chamber”. 

Hospitals or healthcare facilities are unique work environments, as healthcare providers we have the professional obligation to care for and ensure the safety of our patients. The hospital or healthcare facility where you work should and likely does have a work-place violence policy and/ or an ASE plan. 

The intent of this safety discussion is NOT to insight fear or to provide policy elements,

but rather to encourage discussion of (possible) action steps necessary to protect those in our care.

It is important to recognize that the nature of shooting incidents

 in hospitals and health care environments is significantly different in many ways

and these differences should be reflected in all aspects of preparedness and response planning.

Researchers at Johns Hopkins “Hospital-Based Shootings in the United States: 2000-2011” [1] analyzed 154 hospital-related incidents involving 148 hospitals in 40 states.  From 2000 – 2005 an average of 9 incidents per year occurred.  From 2006-2011 the occurrence average increased to 16.7 incidents per year.  The total number injured or killed period reviewed was 235.  Other facts and findings that emerged:  

• 59% the shooting incidents occurred inside the hospital
• 41% outside of the hospital.
• 29% of incidents occurred in the Emergency Department
• 23% in parking lots
• 19% in patient rooms.

The study also noted a close relationship between the shooter (94% of shooters were male) and his victim.

• 32% of victims were current or estranged intimate relationships
• 25% of victims were current or former patients
• 5% of victims were current or former employees
• 13% no obvious association between the shooter and victim could be identified.

As previously mentioned the intent of this safety topic is to initiate discussion that will hopefully result in the development of strategies that will be incorporated into policies and procedures in an ASE. 

Consider the following:

• Does your program limit access to the hyperbaric suite?
• What is the visitor policy for the hyperbaric and or wound care facility?
• If an ASE occurred while patients are in the chamber… Would you ascend them?
• If so, at what rate… 3 psi/minute, 5 psi/ minute perhaps emergent decompression?
• If ascending the patient(s) in an ASE, do you have standing physician orders?
• Who are the vital contacts or team members required to develop and implement the HBO specific ASE policies?

We have learned through our own individual experience and the recounted experiences and documented mishaps within hyperbaric facilities that being proactive in our preparation and actively practicing safety procedures is paramount to ensuring the safety of the staff and patients.

Resources

The WoundReference Hyberbaric Oxygen Therapy Knowledge Base features guidelines to promote high standards of patient care and operational safety within the hyperbaric program and other important tools. The WoundReference Curbside Consult gives you actionable, specific answers from our expert panel in a timely manner. 

For customized safety programs and other wound care and hyperbaric medicine consultation services, visit MidWest Hyperbaric. 

This government page describes what to do if you find yourself in an active shooting event, how to recognize signs of potential violence around you, and what to expect after an active shooting takes place. 

Acknowledgement

We thank Julie Rhee ScM, for style editing