An active shooter in the hospital: A literature survey of simulated training and recommendations for standardized practice and preparedness

Abstract

Importance: This article surveys the literature for in-hospital active shooter training models. While most hospital systems utilize computer-based Code Silver training modules, evidence suggests that employees are not adequately prepared for an actual event.

Objective: Although several government agencies and case reports advocate for in situ active shooter training, no gold standard simulation training method has yet been implemented across health systems. This literature review seeks to reveal and evaluate the existing training methodologies to progress toward a gold standard active training model.

Evidence review: A literature survey across two platforms was conducted with predetermined inclusion and exclusion criteria. The search yielded three articles that conducted and evaluated in situ Code Silver training exercises with analysis of before and after participant performance alongside review of weak points in existing hospital policy.

Findings: Across the three identified articles, data from interviews, surveys, and video recordings suggest that participants readiness for an active shooter event increases with simulated training exercises. Furthermore, training exercises allow improvement of hospital policy based on identified weakness.

Conclusion and relevance: While the existing body of literature on training for an active shooter event in a healthcare setting is sparse, the data reviewed in this article underscores the importance of real-world training to inform review of current policies. Furthermore, active training models prove superior to computer-based modules for preparation for an in-hospital active shooter event. Development of a gold standard proactive training approach holds the potential to substantially fortify staff readiness and response capabilities across the American healthcare system in anticipation of the growing threat of active shooter incidences.