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EMS World Expo: Active Shooter in the ED—This is Not a Drill

EMS trains for the unthinkable, because the unthinkable happens. On the afternoon of November 19, 2018, a mass shooting at Chicago’s Mercy Hospital and Medical Center left four dead, including the perpetrator. At the time, it was the deadliest shooting at a U.S. hospital in over 20 years.

In painful irony, the hospital’s ED staff had completed active shooter training just one week prior.

On Thurs. Sept. 17, 2020, Teri Campbell, RN, BSN, CEN, CFRN, and Beth Ciolino, paramedic and ambulance commander for the Chicago Fire Department (CFD), walked attendees through the events of the shooting and the response by law enforcement and EMS during their session “Active Shooter in the ED.” Campbell and Ciolino interviewed key individuals to prepare their presentation, including Chicago Police Department (CPD) SWAT and Mercy ED staff.

Attendees heard an edited version of the 9-1-1 call that emergency room physician Tamara O’Neal placed when she was threatened by her ex-fiancé with a gun in the hospital’s parking lot. Within minutes, the offender fatally shot O’Neal before shooting at responding officers and running into the hospital’s emergency department. He fatally shot a pharmacy resident and a CPD officer before being shot and killed by CPD SWAT.

There were 22 patients in the ED at the time, Campbell said. These patients were moved to locked closets, recovery rooms and fast-track areas by nurses, X-ray techs, custodial staff and security. All three victims were brought to the Mercy ED, worked on scene and transported to Level 1 trauma centers. CFD commandeered city buses to evacuate “blue” and “green” patients while police interviewed them. Chicago Fire Department paramedics and nurses transported critical patients who were in the ED at the time to four trauma centers and one Level 2 hospital.

The presenters continued by sharing some lessons learned from the shooting:

  • Have a “safe word” for police to identify themselves—as SWAT searched floors, staff who had barricaded themselves in rooms did not believe they were police.
  • Armed security personnel would have been more effective to intervene (Mercy now staffs professional armed police officers).
  • Make firm decisions and act. Every minute of indecision adds 10 minutes to the overall scene time, Ciolino said.
  • The end of the ambulance staging area was too close to the scene. Ultimately there were 19 ambulances on scene, which took up a large amount of space outside the hospital. Stage a large group of vehicles far enough away.
  • Confusion over transport—hospital administration made the decision to treat the shooting victims at the ED, but there were no staff on hand to treat them.
  • The physical construction of the building hampered radio communication and added to reports of a second shooter (due to echoing of the hard surfaces).

Positive takeaways included the fact that a perimeter was established immediately. Likewise, the forward fire command and incident command post were established very quickly. CPD and CFD worked well together to secure the building for 4–6 hours following confirmation that the shooter was neutralized.

A nationwide debate continues surrounding what agency should be in charge of an active shooter scene. Ciolino stressed that at no time should any fire department be in charge of an active shooter scenario.

“I have no desire to go down hallways and look for a perpetrator who could be shooting at me,” she said, adding that CFD and CPD, who co-train for these events, agree that an active shooter incident is a police scene until deemed safe.

There were 154 shootings on hospital grounds between 2000–2011, concluded Campbell. Almost two-thirds were within the hospital walls. In the emergency department, 23% of these shootings involved a security officer’s gun.

“Unfortunately, active shooter incidents seem to be increasing,” Campbell said. SOPs are the guidelines and marching orders that govern these events, but hospital staff must be flexible. Not every MCI will be the same, and even the most thoroughly devised plans won’t work in every situation. “One of the best things we can do is empower our people,” Campbell said.

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