B.C. is rolling out a new hospital code in the coming months to train staff for a situation it hopes they’ll never have to face: an active attacker.
The directions are straight forward. If someone enters a hospital armed with a gun, a knife or some other weapon and appears intent on harming others, staff must immediately call their emergency switchboard. The switchboard will notify 911 and issue a “code silver” over the hospital’s paging system.
Upon hearing those two words, nurses, doctors and other staff will know to spring into action, but for patients and visitors to the hospital a more plain language order will follow. The gist of it, Health Emergency Management B.C. director Gerry Delorme says is this: run, hide, fight.
“If possible, run. Leave the building, get out of the areas of hazard. If you can’t, hide. Find a room, secure the room so nobody else can get in and hide until the event is cleared.”
And, if confronted by the attacker, staff will be trained to grab any item they can find and prepare to defend themselves.
“The expectation is to fight for your life,” Delorme says. He adds this is what law enforcement recommends and what has been shown to work in similar situations elsewhere in the world.
“And that’s a fairly unusual message to give health-care staff, but that’s how serious this type of situation is,” Delorme says.
The training is broken up into two phases, the first online and the second in person, each about an hour in length. Phase one began rolling out in Island Health, Interior Health and Northern Health at the start of October. It teaches staff what code silver is, how to report it and how to respond. As of Oct. 17, Delorme says 5,703 staff in the three health authorities have completed the training.
Fraser Health and Vancouver Coastal Health haven’t implemented the training yet. Vancouver Coastal said on Oct. 19 that it will be rolling it out “in the coming weeks,” but didn’t provide a specific date. Fraser Health hasn’t provided a timeline.
Phase two is set to begin in January and will go into how different scenarios could actually play out and what ethical obligations health-care workers have towards their patients.
This last one is tricky, Delorme says. Ultimately, staff will be trained in much the same way people who take first aid are.
“You never rescue at all costs,” Delorme says. Staffs’ first responsibility will be to keep themselves safe.
“You may have time to take your patients into a room and help hide them, and barricade the doors and those things. You may not. We tell people to survey the scene, survey what’s going on. If it’s not safe for you to provide care, you don’t provide it.”
Staff will also be carefully trained on recognizing the difference between aggressive or violent behaviour – code white – and an active attacker – code silver. Delorme says the former kind of violence is already widespread in hospitals and other health-care settings. Sometimes it’s someone reacting badly to losing to a loved one, and other times it’s someone struggling with mental health or substance use, Delorme says.
Code silver has never been needed in B.C., but there are a number of instances in the United States when hospitals have been attacked. Delorme says the province is preparing now, in much the same way it runs earthquake drills, so that if the worst case scenario does happen one day people aren’t left not knowing what to do.
“It’s in an abundance of caution.”
Delorme says they’ll incorporate whatever feedback they get from phase one into their January in-person sessions.
Editor’s note: This story was updated on Oct. 19 to include a response from Vancouver Coastal Health.