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Baton Rouge Hospital Execs Study Lessons Learned in Shooting

 |  By John Commins  
   September 20, 2010

Thursday's murder-suicide and related gunshot wounding of a physician at Johns Hopkins Hospital in Baltimore provides a horrifying example of violence inside hospital walls.

Unfortunately, it wasn't an isolated incident. Hospital violence is reported almost every day in the media.

Executives at Baton Rouge General Medical Center, for example, are studying the lessons learned from a Sept. 3 domestic violence-related shooting that left one patient and a visitor seriously wounded.

BRGMC COO Edgardo Tenreiro offered a frank assessment of his hospital's response to the shooting, including the flaws.

"The No. 1 thing we learned is we didn't have an appropriate emergency code to notify staff," he says. "The traditional Code White indicates a violent patient. But in cases of an active shooting you don't want to use Code White because staff is going to respond to a Code White. What you want in a situation with a shooter is for staff not to respond, other than security."

BRGMC now refers to shootings as Code Silver, and staff understand that their job is not to backup colleagues, but to ensure that that patients and visitors in their immediate area are safe and locked down. Code Silver also allows employees to provide an explanation for patients and visitors of what could be a stressful situation, with the possibility that they will have to be evacuated, or that heavily armed SWAT police will conduct room-to-room searches.

Second, Tenreiro says make sure your hospital has the ability to establish a mobile emergency command center outside of the hospital, so that you can communicate with employees inside the hospital during a locked down.

"We had to improvise a command center outside on a sidewalk next to the SWAT command," Tenreiro says. "The fact that we didn't have the direct command center communication made it very difficult for us to let folks inside the hospital know the progress that was being made in clearing the hospital."

The mobile command center must have the ability to forward calls to the main command center telephone lines to a designated cell phone, as well as VPN capability to access computer systems remotely.

"The ability to switch the phone and forward to the cell phone, the technology is there and can be easily activated. It just can't be activated the first time you think about it at one in the morning, which is when we thought about it," he says. "You have to have a process in place for that ahead of time so you can activate it automatically."

Tenreiro says it's a good idea to plan potential responses to shootings with police ahead of time, and perhaps run mock drills "You do it on a regulation basis with fire drills, but you never do it for bomb threats or shootings," he says.

It's important that responding police have a familiarity with your hospital. Tenreiro says that many of the police who moonlight at BRGMC as security guards responded to the shooting and guided their SWAT colleagues through the building. "The police need to know the building," he says.

It's also a good idea to have a box of generic ID swipe cards nearby to help police access locked areas of the hospital.

In the aftermath, Tenreiro says BRGMC is providing mental health counselors for staff who may be suffering from post traumatic stress. "One of our staff members who witnessed the whole incident was having some difficulty sleeping. We have a whole mechanism to help and make sure they know that there is help available—that's its normal to ask for it," he says.

There was a lot of talk about installing metal detectors immediately after the shooting, but Tenreiro says he's not sure that is practical. The two hospitals at BRGMC have 88 entrances that provide access to nearly 3 million people each year. "The cost of doing that could be prohibitive. It's not just the metal detectors. It's staffing the metal detectors. Are you going to have them 24/7?" he says. "That is a hospital-by-hospital evaluation. In our case we don't want to convey an image where the hospital is a place that you can't come into."

Tenreiro says he was concerned about the public relations fallout from the shooting, but the hospital issued regular updates to the traditional media, as well as on Twitter, Facebook, and other social media during the shooting and in the immediate aftermath.

The public appears to understand that hospitals aren't to blame for the violence that permeates society, and are just as likely to be crime scenes as any other public area.

 

"The way we handled it was very appropriate. It was low key but at the same time very reassuring. Folks understood that we had mechanisms in place to deal with this," he says. "It had no effect. In fact, the week after the shooting our census went up. We handled it in a way that allowed the public and the media to react very positively. It had no impact on our business."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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