B.C. hospital staff being trained for Code Silver: how to respond to an active attacker
In the presence of an active attacker, staff will receive the code silver alert over the hospital intercom with the attacker’s last known location and instructions to exit the facility if it is safe to do so
Training is being conducted across the province to prepare hospital staff for a new type of emergency – Code Silver – so they can learn to run, hide or even fight from an attacker.
Mass shootings and other violent attacks around the world have sparked the online tutorials, which launched in Island Health and Northern Health this week and will roll out to all health departments next year.
In-person sessions will follow, beginning at Nanaimo Regional General Hospital, Victoria General Hospital and Royal Jubilee Hospital in Island Health. The training module is expected to become mandatory learning for new employees.
Gerry Delorme, senior director of province operations at Health Emergency Management BC, said there has not yet been Code Silver at a BC hospital but there is a need to prepare for any potential threats.
“It’s deeply troubling that people go in with intent to cause harm, whether we’re talking about kindergarten, whether we’re talking about school, whether we’re talking about a workplace or a hospital — that’s our workplace –” said Delorme . “But our role is to make sure the healthcare system is prepared.”
“We need to have these conversations – and they’re difficult conversations – but we need to have these conversations to make sure our staff and patients are safe at the end of the day.”
A previous online module was tested to collect feedback on employee questions and concerns and revised with input from various experts. The course was launched at Island Health on Monday and 600 people have already attended it and given positive feedback, Delorme said. Further revisions are to be expected.
Hospitals have an international standard emergency code list, which includes code blue for cardiac arrest, red for fire, white for violence or aggression, yellow for a missing patient, black for a bomb threat, green for an evacuation, brown for a hazardous spill, and orange for a code one catastrophe or mass casualty.
Code Silver for an active attacker is very different from Code White and indicates a patient who may become verbally or physically violent, threatening, aggressive, or angry, Delorme said.
“Some people in our facilities are having the worst day of their lives,” Delorme said. “These people come into our hospitals without intention, but something happens.” The employees are trained in de-escalation for such scenarios, he said.
In the case of a Code Silver, Delorme said the goal is not de-escalation but the use of mitigating strategies to keep staff and patients safe. “Run, hide or fight,” he said. “That’s best practice around these things.
“The first strategy is out, right, but when you’re confronted and cornered and can’t get out and the person moves towards you, that’s proof that ‘the fight’ is using everything you have and around you life fights.
“We know from the evidence that a passive approach doesn’t work and police say not to be passive.”
According to Island Health, active attacker policies and procedures have become commonplace in healthcare facilities in some provinces and across the United States.
In the face of an active attacker, staff are instructed to use personal alarms or direct the nearest receptionist to call a Code Silver over the hospital intercom; 911 is also called.
The message includes the attacker’s last known location and instructions on how to leave the facility if it is safe to do so.
There is no prescribed approach as it will be “situational” and will require a series of quick decisions based on risks and the immediate environment, Delorme said.
“We need to talk about judgment and not ‘log’ everything,” said Delorme, who said strict logs in such situations could lead to more harm. “We rely on the judgment of our healthcare teams every day to make very momentous decisions.”
Health Emergency Management BC brought in ethicists to help develop the training model because abandoning a patient or fighting an attacker can be counterintuitive for healthcare workers.
Delorme likens it to first aid training, where first responders learn to first determine if a rescue is safe.
“The first thing we teach is that we need to protect our employees,” Delorme said. “Secondly, we have to protect the patient and we know how difficult that will be.”
Delorme said the in-person sessions will address “moral distress” some caregivers may be feeling.
Health Emergency Management BC has also consulted with the police, who are eventually asked to conduct site visits at hospitals to assess the plan.
“We are seeing what is happening in the South and we are doing so with great caution to really protect our staff and our patients,” Delorme said.
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