Abstract
IntroductionDuring a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.MethodsForty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.ResultsPreparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.ConclusionSimulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.
Highlights
During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients
Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run
Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident
Summary
During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. Active shooter incidents have more than doubled between 2011–2018, with 27 reported in 2018.1,2,3 The Hartford Consensus was developed in an effort to address this growing issue, as well as to establish a national protocol to enhance survivability from AS and intentional mass casualty events by supporting the “run, hide, fight” algorithm to mitigate risk.[4] Healthcare settings are uniquely vulnerable targets because patients may be unable to “run, hide, fight.”. Training healthcare providers how to respond to mass casualty incidents such as active shooters often involves active training exercises such as simulation Outcomes of such training programs typically focus on improving knowledge and skills around the medical response to preserve life.[6,7] The benefit of simulation-based training (SBT), as compared to didactic-based education, is that it allows the learner to have more time hands-on and encourages active participation. When studied side by side, simulation-based education was perceived as more enjoyable by students.[20] and when teaching simulated patient emergencies, was found to generate superior team performance.[21,22] previous studies have used simulation to successfully evaluate resident response to ethical dilemmas.[23]
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