(O-E6) Active Threat: Evaluating a Borderland's Emergency Department Staff’s Preparedness

Objectives: The purpose of the study was to determine the fundamental knowledge of the current active threat policy and the effectiveness of training provided to the ED personnel at an urban borderland Level 1 Trauma Center in El Paso, Texas, over the course of one year.

Background: The Department of Homeland Security defines an active shooter as "an individual actively engaged in killing or attempting to kill people in a confined and populated area; active shooters use firearms with no pattern or method to their victim selection”. In 2012 Annals of Emergency Medicine published a study highlighting 154 hospital related shootings from 2000 to 2011 in the United States. Furthermore, Texas was cited as one of five states that accounted for more than a third of the hospital related shooting, with 53% of shooting events occurring in hospitals that had between 100 and 399 beds.

Methods: This study took place at the University Medical Center (UMC) in El Paso, Texas. UMC is an urban Level 1 Trauma Center that sees 70,000 patients annually in a 45-bed emergency department. A total of 193 surveys were collected from ED personnel, which included resident physicians, faculty physicians, advanced practice providers, bedside nurses, technicians, paramedics, and nursing management. The purpose of the study was to determine their knowledge of the current active threat policy and the effectiveness of the training provided. We initially collected pre-test surveys, then provided didactic training, and immediately collected post-test surveys. The didactic training took place in the form of a standardized PowerPoint lecture given at resident conference and staff meetings over three months. We then used t-tests and ANOVA to compare across pre and post-test survey results. Seven months post education an Active Threat tabletop simulation was conducted to gauge ED personnel's retention during a simulated high pressure scenario. Participants were informed that participation in the survey was anonymous and voluntary, all answers were kept confidential, and their participation in the survey had no bearing on their current and/or future employment.

Results: The following survey questions were statistically significance when comparing pre and post survey results. “In the event of an active threat, the current policy at UMC calls for you to take 1 of 3 actions in a specific order. What are those actions in the correct order?” 16% answered incorrectly on the pre-survey, while no one got it wrong on the post-survey, p < 0.001. "In the ED, where would you go to secure yourself if there was an active threat?” 36% answered incorrectly on the pre-survey, while 19% answered it incorrectly on the post-survey, p 0.034. “If you see a situation that has the potential to be an active threat do you call 911 or UMC security?” 62% chose the incorrect answer on the pre-survey, while 22% chose the incorrect answer on the post survey, p < 0.001. “On a ten point scale, please rate how confident you are that you would know how to protect yourself and your patients in the event of an active threat, with 0 being not confident at all and 10 being completely confident”. The mean pre-survey score was 5.32, while the post-survey score was 7.33, p < 0.001.

Conclusions: Our aim was to determine the fundamental knowledge of the current active threat policy and the effectiveness of training provided to the ED personnel at a urban borderland Level 1 Trauma Center in El Paso, Texas. Training included a didactic presentation and an Active Threat tabletop simulation seven months post education to gauge ED personnel's retention. Four survey questions indicated a statistically significant change suggesting that even a brief didactic training can be effective. Responding to an active threat does not come naturally to most healthcare workers, which is why ED personnel warrant structured education and training.

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Funding (Optional): N/A