Active shooter/code silver

17 Dec 2021

Argintaru N, Li W, Hicks C, White K, McGowan M, Gray S, Petrosoniak A. An active shooter in your hospital: a novel method to develop a response policy using in situ simulation and video framework analysis. Disaster medicine and public health preparedness. 2021 Apr;15(2):223-31.


Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel.

The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

Keywords: active shooter; patient safety; simulation; training

James T, Izon-Cooper L, Collins S, Cole H, Marczylo T. The wash-in effect and its significance for mass casualty decontamination. Journal of Toxicology and Environmental Health, Part B. 2022 Apr 3;25(3):113-34.


Decontamination of skin by washing may increase dermal absorption, a phenomenon known as the wash-in effect. The wash-in effect is frequently discussed in studies investigating casualty decontamination where potentially life-saving interventions may enhance the dermal penetration of toxic chemicals, leading to an increase in incidence of morbidity and rates of mortality. However, the wash-in effect is seldom investigated within the context of mass casualty decontamination and real-life consequences are therefore poorly understood. This paper reviews the existing literature on the wash-in effect to highlight the proposed mechanisms for enhanced absorption and evaluate the wash-in effect within the context of mass casualty chemical decontamination.