Active shooter protocols in OR?

[Arantius]

What is your plan for this? Don’t think we can run- is it abandonment? So hide or fight? Anyone do drills on this? I’m a resident and I imagine we would try to barricade the door and turn lights/cell phones/ pagers off...

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[deleted480308]

What is your plan for this? Don’t think we can run- is it abandonment? So hide or fight? Anyone do drills on this? I’m a resident and I imagine we would try to barricade the door and turn lights/cell phones/ pagers off...

student/resident me? grab the best weapon/like tool nearby (yes, I actually pay attention to what would make sense given the surgery of the day) if I don't happen to have a knife on me, and then post up by the door while cursing the stupid hospital rule that keeps me unarmed

attending me? unfortunately let the cat out of the bag that I'm carrying

 

[swoopyswoop]

student/resident me? grab the best weapon/like tool nearby (yes, I actually pay attention to what would make sense given the surgery of the day) if I don't happen to have a knife on me, and then post up by the door while cursing the stupid hospital rule that keeps me unarmed

attending me? unfortunately let the cat out of the bag that I'm carrying

how do you plan on carrying into an OR? would be fairly conspicuous in your scrubs...

 

[deleted480308]

how do you plan on carrying into an OR? would be fairly conspicuous in your scrubs...

attending me won't be in an OR....but it's really not conspicuous at all

 

[Arantius]

Leg holster wouldn’t show too much in scrubs- also they make vests that hide a lot now... executive holster/ bulletproof vest combo

 

[anbuitachi]

I thought we are allowed to run. It's self safety first.

 

[Arantius]

I thought we are allowed to run. It's self safety first.

So dose some paralytic and run???

 

[Psai]

Sux dart like dexter

 

[dannyboy1]

100 of roc sevo to 1% and hit the road

 

[dannyboy1]

So dose some paralytic and run???

Absolutely.

 

[ZzzPlz]

attending me won't be in an OR....but it's really not conspicuous at all

Thunderwear?

 

[deleted480308]

Thunderwear?

haha, I loved that ridiculous website

 

[Twiggidy]

I mean I know I've gotten in gun arguments on here with some of you guys, but now you guys have me actually thinking about how bad our security is at my hospital. I'm honestly going to check if our OR doors have locking capabilities. (And maybe go work on my knife throwing skills because that's about all I'll have)

I do know certain parts of the OR are card entry but I think the main door isn't which is a bit of an epic fail

 

[Arantius]

I mean I know I've gotten in gun arguments on here with some of you guys, but now you guys have me actually thinking about how bad our security is at my hospital. I'm honestly going to check if our OR doors have locking capabilities. (And maybe go work on my knife throwing skills because that's about all I'll have)

I do know certain parts of the OR are card entry but I think the main door isn't which is a bit of an epic fail

Yeah- I have concerns about this too. Also what about doors that open outward? How do you barricade those?

 

[narcusprince]

100 of roc sevo to 1% and hit the road

This is terrible lol....

 

[narcusprince]

Honestly stay with my patient. Let the surgeon and OR stuff run. I am staying. I have been through plenty of active shooter drills baracade the doors with IV poles. Most of our ORs have 3 points of entry all potentially lockable with an iv pole. Usually have 3 chairs in the OR you can use those to block the doors. I can find something to use in the OR like a step or enough metal on the surgeons table to mount an offensive. What are the chances an active shooter knows the OR better then you? I grew up in Colorado during the days of columbine. I was taught how to assess an active shooter. My younger sister was in a active shooter situation back home.

 

[anbuitachi]

Honestly stay with my patient. Let the surgeon and OR stuff run. I am staying. I have been through plenty of active shooter drills baracade the doors with IV poles. Most of our ORs have 3 points of entry all potentially lockable with an iv pole. Usually have 3 chairs in the OR you can use those to block the doors. I can find something to use in the OR like a step or enough metal on the surgeons table to mount an offensive. What are the chances an active shooter knows the OR better then you? I grew up in Colorado during the days of columbine. I was taught how to assess an active shooter. My younger sister was in a active shooter situation back home.

Well Im pretty sure according to my hospital, the correct course of action in the event of an active shooter is to run and leave the patient behind. This was brought up after one of those hospital shootings. Though if you had to stay, I would push the OR table behind the door and keep the table on lock.. I'm pretty sure our OR doors are not lockable and cant be locked with a IV pole

In any kind of dangerous situation, the first action on the algorithm is always personal safety first, then rescue

 

[chocomorsel]

student/resident me? grab the best weapon/like tool nearby (yes, I actually pay attention to what would make sense given the surgery of the day) if I don't happen to have a knife on me, and then post up by the door while cursing the stupid hospital rule that keeps me unarmed

attending me? unfortunately let the cat out of the bag that I'm carrying

You can conceal it in scrubs?

 

[Chip N Sawbones]

Load up a ketamine dart and wait by the door.

 

[deleted480308]

Yes

You can conceal it in scrubs?

 

[Laryngophed]

Load up a ketamine dart and wait by the door.

Sux dart like dexter

You guys think this constitutes a violation of the Oath of Geneva or the Hippocratic Oath (whichever you took) as using your knowledge to harm? I think an argument could be made that you are doing far greater good, but I could see it as being construed as a violation as well.

 

[pgg]

1) Barricade the doors and stay put. That may not be possible if any of the OR doors swing both ways.

2) Grab a Mapleson circuit, O2 tank, some propofol (or not) and wheel the OR table into a lockable room.

3) Bail. 98% of the time, the machine does 100% of the work. Most patients under GA could stay that way until the vaporizor ran dry without any intervention. If you truly, truly can't move or leave without killing the patient (on CPB? mid c-section?), you have to stay. Barricade the room as best you can. No environment is so barren a weapon can't be found. Everybody dies. Maybe today's your day, maybe it isn't.


I'm a concealed carry advocate, but I probably wouldn't carry a firearm with me in the hospital. The clothing is poorly suited for concealment and retention. A fanny pack would be a reasonable choice. A moot point anyway since hospitals can legally prohibit carry, and most do. I agreed to their policy when I volunteered to work there.

 

[deleted162650]

I’m gonna hop in the Da Vinci console and go on the offensive.

 

[pgg]

I’m gonna hop in the Da Vinci console and go on the offensive.

This is the best answer so far.

If you can get the stupid thing booted up and running before the shooter is apprehended, tried, convicted, and sentenced.

 

[narcusprince]

Maybe the president will come in armed and protect you......

 

[OB1🤙]

Disconnect patient from circuit. Find a BVM, tell your circulator to bag the patient from some other oxygen source.

On your machine, FGF to 15 LPM pure oxygen, close the popoff valve, hit and hold the O2 flush, hold the open end of the circuit up toward the door/perpetrator, fire some bovie sparks at the open end, and blowtorch the motherf^cker.

Edit: forgot to add- pour some chloraprep solution in the circuit first, and maybe keep an ET tube on to end of it to focus the flame/ add extra fuel.

 

[WholeLottaGame7]

Try to steer them into the nearest gyn-onc OR. They're great at hitting major blood vessels of unsuspecting victims.

 

[Chip N Sawbones]

You guys think this constitutes a violation of the Oath of Geneva or the Hippocratic Oath (whichever you took) as using your knowledge to harm? I think an argument could be made that you are doing far greater good, but I could see it as being construed as a violation as well.

I never had to take any oath to get my diploma, and in any case my patient is the guy on the table with the tube down his throat, not the murderer trying to kick down the door.

 

[Iso4ane]

Why can't we just piss the surgeon off? They'll start throwing things and something gotta stick.

 

[beachbum353353]

Why can't we just piss the surgeon off? They'll start throwing things and something gotta stick.

Because they have terrible aim, otherwise they wouldn't still have a job...

 

[Twiggidy]

I’m gonna hop in the Da Vinci console and go on the offensive.

Go get 'em ED-209!

 

[lord_jeebus]

Nord-Ost strategy. Seal all ventilation ducts with Ioban. Fill an atomizer with remifentanil. Give everyone in the room IM Narcan. Remove the atomizer bulb and attach oxygen tubing. Attach to O2 tank and crank it up. Use Bair Hugger to distribute aerosolized remi around the room. Wait. When the shooter comes by and sees everyone dead on the floor, maybe he'll skip your room.

 

[nimbus]

Maybe the president will come in armed and protect you......

Or an armed 2nd grade teacher from the nearby elementary school.

 

[nimbus]

Disconnect patient from circuit. Find a BVM, tell your circulator to bag the patient from some other oxygen source.

On your machine, FGF to 15 LPM pure oxygen, close the popoff valve, hit and hold the O2 flush, hold the open end of the circuit up toward the door/perpetrator, fire some bovie sparks at the open end, and blowtorch the motherf^cker.

Edit: forgot to add- pour some chloraprep solution in the circuit first, and maybe keep an ET tube on to end of it to focus the flame/ add extra fuel.

I had the misfortune of witnessing a similar scenario when I arrived at an ICU code during residency. The problem is that the circuit immediately melts and the 8 foot flames dance around wildly as if blown by a crazy fire breathing snake, and the room quickly becomes engulfed in dense smoke. There will be plenty of fuel, no chloraprep necessary. Blowtorch on crack would be an understatement. It’s good to know where the oxygen shutoff valve is located.

 

[narcusprince]

Nord-Ost strategy. Seal all ventilation ducts with Ioban. Fill an atomizer with remifentanil. Give everyone in the room IM Narcan. Remove the atomizer bulb and attach oxygen tubing. Attach to O2 tank and crank it up. Use Bair Hugger to distribute aerosolized remi around the room. Wait. When the shooter comes by and sees everyone dead on the floor, maybe he'll skip your room.

Remifentanil and carfentanil suspended in Halothane. I guess in Russia they listen to their anesthesiologist. Unfortunately more people died with this strategy hostages and chechan terrorist.

 

[deleted697535]

I’m gonna hop in the Da Vinci console and go on the offensive.

I laughed out loud!!!

I'd definitely have to take down a few admins at least 4 surgeons, 3 residents and a fellow. After it's all over might have to drive up to ob on the 8th floor and clear out a few midwife's. They're definitely part of the plot too and no one would miss them

 

[deleted59964]

Maybe the president will come in armed and protect you......

or unarmed even

 

[deleted59964]

Leg holster wouldn’t show too much in scrubs- also they make vests that hide a lot now... executive holster/ bulletproof vest combo

meanwhile --- in the rest of the world where we we don't have the right to carry a gun ... we spend our time thinking about beer and football and

 

[deleted697535]

meanwhile --- in the rest of the world where we we don't have the right to carry a gun ... we spend our time thinking about beer and football and

Yeah feck it I'm never gonna work in the US. Crnas and lunatics with uzis.
I could handle one but not both

 

[Mman]

Load up a ketamine dart and wait by the door.

IM sux will stop them from being able to retaliate faster than ketamine will. And with IM ketamine you might just make them even crazier for a little bit before they stop.

 

[deleted126335]

 

[Twiggidy]

meanwhile --- in the rest of the world where we we don't have the right to carry a gun ... we spend our time thinking about beer and football and

#smartworldproblems

 

[anbuitachi]

IM sux will stop them from being able to retaliate faster than ketamine will. And with IM ketamine you might just make them even crazier for a little bit before they stop.

Lol but I'm guessing he can still pull the trigger faster than sux take to work

 

[Ronin786]

Scenario: Ex-lap, fascia is closed and shooter is around the corner. OR team decides to bail.

Do you keep the sevo on and fill the IV with roc or turn up your flows, turn off the gas, put on SIMV and hope the patient extubates themself?

I figure the gas will wear off and they'll wake up eventually.

 

[Twiggidy]

Scenario: Ex-lap, fascia is closed and shooter is around the corner. OR team decides to bail.

Do you keep the sevo on and fill the IV with roc or turn up your flows, turn off the gas, put on SIMV and hope the patient extubates themself?

I figure the gas will wear off and they'll wake up eventually.

I don't think I can advocate patient abandonment. Let's say you survive this scenario, sadly, it still leaves you open with the family for suit. You won win in gold stars for bailing on a patient under anesthesia, but you (or your family if you die) will be praised to high heaven for protecting a patient. Like PGG said, if this is your time then it's your time. I'd do anything and everything to barricade the door even if it means moving the machine in front of the door as a barricade (along with the OR table with patient on it) and hiding along side the door. The doors do open both ways but if a machine is in front of it I dont think a shooter is going to take the time to climb around it to get to us in the room, and if he is, we're running out the other door (our ORs have 2 entries). I think for my facility that may be the best answer.

 

[deleted162650]

meanwhile --- in the rest of the world where we we don't have the right to carry a gun ... we spend our time thinking about beer and football and

Yes, in other countries they kill each other in more civilized fashion - like running over crowds of people with large vehicles.

 

[Psai]

Yes, in other countries they kill each other in more civilized fashion - like running over crowds of people with large vehicles.

Yeah I'm glad we live in a more enlightened area of the world

www.bbc.com/news/world-us-canada-39968710

 

[deleted162650]

Yeah I'm glad we live in a more enlightened area of the world

www.bbc.com/news/world-us-canada-39968710

Yet no one clamors to ban automobiles. Not even the scary black ones.

 

[anbuitachi]

I don't think I can advocate patient abandonment. Let's say you survive this scenario, sadly, it still leaves you open with the family for suit. You won win in gold stars for bailing on a patient under anesthesia, but you (or your family if you die) will be praised to high heaven for protecting a patient. Like PGG said, if this is your time then it's your time. I'd do anything and everything to barricade the door even if it means moving the machine in front of the door as a barricade (along with the OR table with patient on it) and hiding along side the door. The doors do open both ways but if a machine is in front of it I dont think a shooter is going to take the time to climb around it to get to us in the room, and if he is, we're running out the other door (our ORs have 2 entries). I think for my facility that may be the best answer.

Im sure everyones got their own beliefs. I think most of us are against abandoning patients for no reason. But i dont think people expect doctors to put their life in danger to save patients. I also dont think there'd be a case. I have a feeling my hospital discussed this with lawyers before recommending OR staff to abandon patients on the OR table in the event of an active shooting.

Scenario: Ex-lap, fascia is closed and shooter is around the corner. OR team decides to bail.

Do you keep the sevo on and fill the IV with roc or turn up your flows, turn off the gas, put on SIMV and hope the patient extubates themself?

I figure the gas will wear off and they'll wake up eventually.

I think i would just keep it the same. I wouldnt fill the IV with roc since we dont know when we will be able to go back to the OR. No one is going to refill the gas before leaving, so i think you are more likely to get awareness if gas runs out and wears off and the patient is still paralyzed from the IV roc.

I think the turn off gas idea can pass depending on the type o f surgery and where the surgeon is during the surgery. Imagine if it was during the middle of abdominal case and the OR evacuates, hospital gets locked down for hours, patient wakes up, self extubes, and sees his open abdomen! Scary! But in the case you described, i'd keep sevo where it is, not reparalyze, and then head out.

 

[GravelRider]

I don't think I can advocate patient abandonment. Let's say you survive this scenario, sadly, it still leaves you open with the family for suit. You won win in gold stars for bailing on a patient under anesthesia, but you (or your family if you die) will be praised to high heaven for protecting a patient. Like PGG said, if this is your time then it's your time. I'd do anything and everything to barricade the door even if it means moving the machine in front of the door as a barricade (along with the OR table with patient on it) and hiding along side the door. The doors do open both ways but if a machine is in front of it I dont think a shooter is going to take the time to climb around it to get to us in the room, and if he is, we're running out the other door (our ORs have 2 entries). I think for my facility that may be the best answer.

I have had to take active shooter courses at two different hospitals. Both sort of encouraged patient abandonment. There is no concern for liability...unless you are the active shooter. Why lose two lives when you can possibly save at least one (your own)? Plus, you may be needed for helping in a mass casualty situation after the shooter has been neutralized. From a purely ethical/moral standpoint, the right thing to do is save yourself first. Don't you pay attention on flights when they tell you to secure your own oxygen mask first before helping others?