Nurse Leader Network · 2022-05-26 · 16 min
Key moments - from our scoring
Substance score
44 / 100
Five dimensions, 20 points each
This episode addresses the critical need for healthcare facilities to prepare for active shooter and active weapon incidents. Racinos draws on three direct experiences - gang-related shooting in an ER, an active shooter alert near UCLA, and a mistaken identity rifle report - to illustrate that no facility is immune. He references Joint Commission data showing 39 shooting incidents in healthcare between 2010 and 2020, resulting in 39 deaths (21 staff members). The core message centers on five interconnected elements: developing a Code Silver plan collaboratively with local law enforcement, establishing clear communication protocols so staff know how to alert leadership, training frontline staff and incident command center personnel on response procedures, conducting regular drills that involve patients and staff (including per diems and contracted workers), and implementing post-event debriefing using resources like chaplain services or structured conversations (Tea for the Soul). Racinos emphasizes that plans are worthless without communication and practice, and that staff must prioritize self-protection behind locked doors rather than attempting risky patient relocations during active threats.
Staff should immediately get behind a locked door - whether a patient room, med room, or break room - and remain there until receiving an all-clear from law enforcement, prioritizing their own safety first so they can help others.
Facilities should use a dedicated blast communication system (such as cell phone alerts) to send rapid, accurate updates from leadership rather than leaving staff to seek information on Facebook or Twitter.
Police will not know who staff or suspects are, so officers may have guns drawn; staff must remain calm, follow 100% of law enforcement instructions, and not try to get officers' attention.
Part-time and contracted workers may not be present during facility-wide drills and meetings, so targeted training ensures all staff - regardless of schedule - understand their response role during an actual incident.
Tea for the Soul is an informal debriefing approach where chaplains and leaders gather staff to discuss traumatic events (active incidents, unexpected patient deaths) over tea, helping manage collective fear and anxiety.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains practical, actionable frameworks for active shooter preparedness in healthcare settings, including specific planning steps (coordination with law enforcement, communication protocols, staff training, post-event debriefing). However, substantial portions are devoted to personal anecdotes and general awareness-raising rather than novel operational insights. A nurse leader familiar with emergency preparedness frameworks would find the core recommendations somewhat familiar, though the healthcare-specific application adds value.
The important piece is that we have to practice with the staff so we can have the best laid out and documented and written plan. But if the staff have no clue about it, it doesn't matter. It's meaningless.
We want to make sure that the law enforcement has, um, diagrams and pictures of the layout of the facility. And then we need to know who the liaison is.
The episode applies standard emergency preparedness methodology (planning, communication, training, debriefing) to the active shooter context in healthcare. While the healthcare-specific angle is relevant, the core frameworks draw from well-established incident command protocols and workplace safety standards. The approach is solid but not contrarian or first-principles thinking; it mirrors standard emergency management doctrine.
There has to be a plan in place for this Code Silver. So most of you work at an organization, and it's highly likely that they have a plan in place. The problem is, though, that a lot of times those plans are not communicated to the staff
Once that plan has been drafted up and we have executive leadership and law enforcement and all of the managers and the staff understanding like there, this plan has been created and it is agreed upon, the next step is going to be the training.
This is a solo host episode with no guest. The host (Chris Racinos) appears to be a nurse leader with direct experience managing three active shooter events in healthcare settings, which is relevant practical experience. However, the lack of a multi-perspective conversation and absence of voices from law enforcement, security experts, or other institutional stakeholders limits the caliber and depth of the discussion.
I'm recording this on Wednesday. So it was yesterday. On Tuesday, there was another school shooting in Texas.
In my career, there's been three times where I have been in the hospital during an cold silver or when there was a report of a gun or a knife in the hospital.
The episode references specific data from Joint Commission (39 shootings, 39 deaths, breakdown of victims between 2010-2020) and names a real location (UCLA active shooter incident). However, most recommendations lack concrete metrics - no timelines for plan development, no specific door locking procedures, limited detail on communication systems, and vague guidance on patient care protocols during incidents. The anecdotes provide context but not measurable benchmarks for implementation.
Joint Commission, uh, reports that they had 39 shootings that resulted in 39 deaths...In those deaths, um, the Joint Commission reported that 21 of those deaths were staff members, and 10 of them were shot by a pat...18 were patients who were shot by a family member, and 12 of them were murder suicides.
So this active shooter was actually at ucla and we were told to close down our facility.
This is a solo host monologue with no interviewer or guest to challenge, probe, or refine ideas. There are no follow-up questions, pushback on recommendations, or exploration of implementation obstacles. The host makes claims (e.g., about staff behavior during incidents) without critical examination. The delivery reads as a presentation of best practices rather than a dynamic, investigative conversation that would test ideas or uncover nuance.
And I'm going to share those experiences with you today. And I'm also going to share with you what you need to know as a nurse leader
So to recap, nobody is immune from having an active weapon at their facility.
Computed from the transcript - who did the talking, and the words that came up most.
Send a text Recent workplace and school shootings across the country have reminded us that no one is immune to being involved in an active shooter scenario. In this episode, we talk about previous hospital active shooter experiences and how to prepare to be sure you, staff and the patients in the facility remain safe.
Transcribed and scored by The B2B Podcast Index.
Speaker A: Welcome to the Nurse Leader Network podcast with your host, Chris Racinos. Wherever you're going on your Nurse Leader journey, we're here to help you get there. Welcome, everybody, to the Nurse Leader Network podcast. I decided today to kind of switch it up. So we had an episode planned for today. However, yesterday, um, I'm recording this on Wednesday. So it was yesterday. On Tuesday, there was another school shooting in Texas. And I sat there kind of watching the news and sharing with my son what was happening and what that meant. And it brought my older son back to a couple of months ago when there was a threat at his school of a school shooter. So one of the kids had put on Instagram that he was going to come in with a gun and a, um, the entire school was on lockdown. And I remember my son texting me when the school went on lockdown. He was really fearful. And as I was thinking about it, I realized that it doesn't just happen in schools. So in my career, there's been three times where I have been in the hospital during an cold silver or when there was a report of a gun or a knife in the hospital. And I'm going to share those experiences with you today. And I'm also going to share with you what you need to know as a nurse leader in terms of prepping for an event like this. Um, so nobody is immune to it. Like I said, this has happened to me three times already in the course of my career, and so I'll share each one of them. The very first one happened when I was working in an emergency room, and we had two gang members that, uh, came in. They had had a fight previously, and we brought both of them in. They had both been shot, and their family members had come in to the hospital and began shooting. So we, we knew that they were rival gang members. And we had one, uh, in triage and then which was on one side of the, um, facility or the er, and then we had one in the main ER and they still found each other and shot. And so that was one event. Luckily, nobody was actually hit and nobody was hurt. The second event happened and we got alerted. I remember I was working as at this facility and we had gotten called from the police department that there was an active shooter in the neighborhood. So this active shooter was actually at ucla and we were told to close down our facility. And so we immediately initiated the command center. We closed down the facility and we enacted all of our protocols for an active shooter with that case. Nobody ever came to the facility. There was A murder suicide at ucla. Um, and so we did end up having precautions, though, and, um, it was definitely a learning experience for the staff. And then the most recent event happened at a facility I was working with when there was a report of a patient with what appeared to be a rifle or some type of, like, AK47 is a large gun. And, um, we again had the police department quarantine the entire neighborhood, the facility, and we enacted again, command center and our Code Silver protocols. That episode actually ended up being a case of mistaken identity. The patient did not end up having a rifle. He had something that looked very much like a rifle. And so in those three events that I've experienced, there were some things that I've learned and some things that I'd love to share with the audience so that you all could prepare yourselves for an event, whether it be a real event or whether it be something like a, uh, case of mistake in identity. So first things first, when it comes to any type of active shooter or active knife, any, anything like that, the reality is that it happens, right? So, for example, in between 2010 and 2020, Joint Commission, uh, reports that they had 39 shootings that resulted in 39 deaths. So it is something that happens and you just don't know. We can't say what type of facility. There's not any common thread around where or when this is going to be happening. In those deaths, um, the Joint Commission reported that 21 of those deaths were staff members, and 10 of them were shot by a pat. Uh, 18 were patients who were shot by a family member, and 12 of them were murder suicides. So I've heard of events over the last couple of months actually of active shooters or suicides that have happened in, um, healthcare facilities just recently. So, again, this is something that we need to be prepared for. Now, some things to consider is that there has to be a plan in place for this Code Silver. So most of you work at an organization, and it's highly likely that they have a plan in place. The problem is, though, that a lot of times those plans are not communicated to the staff, and there's not drills that happen so that when an actual event happens, um, staff know exactly what to do. So I can say, you know, in some of the facilities I worked in, there was a great plan and there was a great communication plan, and there was active drills, right? So there's active drills for Code Silvers or shooters or knives. There was active drills for even, like, baby abductions. So different things like that. So the important piece is that we have to practice with the staff so we can have the best laid out and documented and written plan. But if the staff have no clue about it, it doesn't matter. It's meaningless. So the number one thing is really making sure that the executive leadership have come up with some type of plan in the event that this happens. Now, when that plan is being created, uh, we can't do it in a silo. So we have to make sure that that plan is created. With local law enforcement, we need to make sure that they understand what their role is. We understand what our role is. We need to make sure that they understand the layout of the building, they understand where your command center is going to be. We want to make sure that the law enforcement has, um, diagrams and pictures of the layout of the facility. And then we need to know who the liaison is. Right? So, yes, we can call 911, but usually there's a liaison that we are going to contact. So we want to make sure that that information is widely available to everybody within that command center. The second is really looking at the communication plan. So we want to make sure when something happens, how is that being alerted? Right. So our staff expected, if they see something to, you know, make a phone call to somebody, are they expected to pull it, push a red button? What is the actual communication method? When the person who has whatever weapon that they have has been identified, how do we communicate that? Once that communication has taken place, there needs to be a communication plan to the rest of the facility. So if nurse and unit A identifies something, there needs to be a rapid way for this nurse to communicate with whoever it is that's going to start that incident command. Incident command needs to immediately go into effect and make those contacts with the police. And then the rest of the facility needs to be notified that it's time to shelter in place. Once that piece of the plan has been described, then we want to look at how do we make sure that we have patient and employee safety. One of the things that I noticed from one of the events that I attended was that the nurses do what nurses do, and that is they protect their patients. And so according to our plan, they were to immediately get behind a locked door and stay behind that locked door. And, and in some of the cases, the nurses were trying to move patients to somewhere more safe. Um, they were exposing themselves to areas that could have been direct line of fire. So we want to remind our nurses and our staff that you can't help anybody else if you become a victim. So your number One priority, obviously is to save patients, but is to save yourself. Right? So when for example, that alarm went out, active shooter immediately. We have doors, double doors, and these are the fire rated doors. Usually like if we're looking at a hospital that are going to lock and close and we ask all of the nurses then to do a quick closure of each of the doors and then to lock themselves behind a locked door. Um, so that may be with a patient, it may be in a med room, it may be in a break, uh, room. But we want them to be locked behind a locked door and we do not want them to come out until they receive like uh, an all clear. That all clear usually comes from law enforcement. So law enforcement will usually come through. Now that being said, we also need to understand how to care for critical patients during that time. So let's say, for example, you know, we have our ICU staff. What does the care look like for these critical patients when we are being behind this locked door? How do we keep them safe? And then when do we need to do an evacuation? So what is the criteria for an evacuation? Sometimes it's going to be based upon law enforcement's recommendations. But when do we look for, um, evacuation? So step one, usually shelter in place, make sure you're behind a locked door. You're trying to preserve your safety and then the safety of the patients that are on that unit. And again, do not move until then. One of the other things that I found in one of the events I had was the communication because it wasn't coming from the facility in a way where everybody could access the information. All of the staff were on Facebook and Twitter and looking at the news and the, um, information that was there was not correct. So there was people saying like, oh, so many people have gotten shot and blah, blah, blah, blah, blah. That wasn't the case. Nobody had gotten shot, but there was nowhere else for them to, uh, receive information. So it's important to look at in that communication plan. How does a facility have means to blast out information? Right. So it might be, for example, cell phone. Right? So we have everybody's cell phone information and that is how we're going to notify if there's a fire. That's how we're going to, whatever it is. But that would be a, uh, channel in which you could send out these important announcements so that people have a clear source of where to get their information versus social media and the media. So we've talked about some of the things that need to go into the plan. It's really preserving the safety of the staff and then preserving the safety of the patients and then really examining how we're going to be managing patient care in the event that that happens. We also want to, once the plan is drafted up and we have executive leadership and law enforcement and all of the managers and the staff understanding like there, this plan has been created and it is agreed upon, the next step is going to be the training. So things that you want to make sure that you train your staff on are how to report, how to respond, what to do, what to expect when law enforcement arrives. I, one of the things I saw with my, um, staff was that a lot of them were trying, like when law enforcement would come in, a lot of them were trying to like, get their attention. But you have to remember the police don't know who the suspect is. The police are going to come with guns. And so it's important that your staff know to follow 100% of the direction, to try to keep calm and to follow the police officer's, uh, instruction. Because again, the police officers don't know whose staff or who is the suspect. Sometimes the suspect is wearing scrubs as well. So you want to make sure that they understand, uh, that they need to follow that law enforcement, um, guide. We also want to make sure that they understand how to protect the patient. So again, staff in some of the departments, in some of the facilities I worked in had those locked doors. Some of them even put furniture behind the locked door so it'd be harder for them to get in and then made sure that they locked all the patient doors. It's important to make sure that when you are training the frontline staff, that you also train staff that maybe isn't there every day, right? So some of your per diems, um, you want to make sure you're training house soups. You want to make sure you're training the leadership on how to run an incident command center. My very first command center was the very first command center I was in. I had never had any exposure to it. I didn't even know what an incident command center was. Um, and so I was new to the role, new to leadership. And so you want to make sure that the folks that are running the command center also understand their duties, that they're assigned rapidly, and that everybody understands what their piece of the incident command center is. The next piece is really doing the actual training. So you want to do periodic drills of active shooter, active knife, whatever, the active weapon, so that they understand what these drills are. Now when you are Going to host a drill, it's your responsibility, it's a facility's responsibility to not only inform the patients, but also inform the staff. Right. We don't want them to be fearful. We want them to know that this is a drill. The same token, we want to take it seriously. Right. Just because we know it's a drill doesn't mean that we should be like, okay, I'm not going to really participate. I'm not. Whatever we would do in a live, active shooter or active weapon, we want to make sure we're doing that as well on the drill. So we want to make sure that they understand that. I know as a faculty member, I also had the opportunity to partner with the fire department and with, I think it was the Orange county sheriffs here in Orange, um, county. And I was able to take my nursing students in to this mock drill. Right. So it was outside of the hospital. There was a hospital that, um, had been shut down. It was no longer being used. Not only did the police department train, but the fire department trained and the nursing train and other healthcare disciplines trained. And it was really just a way for us to, number one, make sure that we kept ourselves safe, but also to triage people that may have been harmed by this active weapon. The last piece of this, once we've done our training, is to not forget about the post event things that need to occur. So whether it is a drill or whether it is real life, there needs to be a debriefing. This debriefing needs to help manage fear and anxiety for staff, for patients. The leaders need to be able to express this as well. Sometimes it happens immediately after, Sometimes it's going to happen in the days after. It just really depends on the circumstances of the event. A lot of times you're going to want to bring in things like the employee assistance. Sometimes you want to bring in chaplain services. If you have chaplain services, um, sometimes you might want to do things. We did things like Tea for the Soul, where we just brought a bunch of tea. We had the chaplain and we sat down, we talked about different events that have happened. Which, by the way, that's a good thing to do anytime you need to do a debriefing. So let's say, for example, a patient passes away, um, unexpectedly, or it was just a traumatic loss. T for the Soul is actually a, uh, great thing to do, you know, aside from any type of shooter or weapon, just in general. So to recap, nobody is immune from having an active weapon at their facility. Whether you are in hospital Whether you are academics, whether you are a tech company, nobody is immune from it. It happens. The reality is we need to be prepared for it. There has to be plans in place, and it cannot be done in a silo. It has to be collaborative with other organizations that are going to help support that event. Once that plan has been developed, which should include the communication, what the staff should be doing, how they should notify, how they should keep themselves and their patients safe, and what patient care should look like, once that's been created, it's time to communicate it to the staff so that they understand. And once that communication has taken place, it's now time to practice. Right. So we know in healthcare, we practice what it is that we learn. And so we want to have those drills and then close the events off with that debriefing so that everybody has a time to identify and manage any of the emotions that come up when an event like this happens. That's what I have for you today. I hope that this has been helpful. If you're, uh, sitting here and you're like, chris, I don't know what our plan is. I know we, you know, we have a code silver, whatever it is your facility calls it, but I don't know what it is. Your job today is to go and find that out. Your job today is to make sure that you are elevating that and heightening that, hey, we have this plan, but people don't know what to do with it. And so you want to make sure that you're going back to the facility that you work for and that you discuss this and that that drill takes place and not in six months from now. Right. This is something that we want to make sure our staff are prepared for today because we don't know what could happen tomorrow. I know this is a super somber topic, but it's just one that we have to be prepared for as nurse leaders. I'm going to sign off by just sending love and prayers to Texas until next week, everyone.
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