Creation of Code Silver reflects new threats in today’s hospitals
It is a nightmare scenario hospitals must be prepared for, although they hope those preparations will never be used.
On Monday, that nightmare came to Kingston General Hospital when the sound of gunshots shattered the normal hum of the busy hospital.
Millhaven Penitentiary inmate Corey Ward is alleged to have disarmed a correctional officer and fired his gun, wounding a patient’s visiting family member in the foot. Ward has been charged with three counts of attempted murder, and a review has been launched.
In response to the shooting, the hospital declared Code Silver, which is designed to alert staff to the existence of a person with a weapon in the hospital and to set off planned emergency procedures.
Code Silver is the latest colour code that is part of hospital emergency preparedness. It was introduced by the Ontario Hospital Association in 2016, 25 years after the introduction of a standardized system of colour codes, including Code Orange for an external disaster and Code Red for a fire.
Code Silver is, to a certain extent, a sign of the times, with a steady increase in gun violence across the country.
“What happened in Kingston is very sobering,” said Dr. Andrew Willmore, medical director of emergency management at The Ottawa Hospital. “We like to think of hospitals as safe places. When something like this happens and you have significant violence in that special place, it certainly is jarring to the medical community and the public at large.”
Willmore is currently working on modules to train employees at The Ottawa Hospital on what to do in the event of a Code Silver.
Hospital shootings remain rare in Canada, although not in the United States. Between 2010 and 2011, there were 154 hospital-based shootings in the U.S., according to one study. Numbers have most likely increased since then.
On Monday, while Kingston General was dealing with Code Silver, a police officer, a doctor and a pharmacy resident were all shot at Chicago’s Mercy Hospital.
“This is a rather rare event, but not so rare that we can’t pay attention to it,” Willmore said. In fact, he noted, there has been a steady rise in gun violence in Canada — especially in Ontario — in recent years.
“Every year they say it is the worst year. The next year it happens again.”
Kingston General is not the first Canadian hospital to be shattered by gunfire. In Cobourg, a man shot his wife and then was shot by police at the local hospital in 2017. There have been several other shootings in hospitals across the province in recent years, including in Fort Erie and Northumberland.
The Ottawa Hospital, which held a Code Orange training exercise last week based on the scenario of a mass shooting in the community, is, like other hospitals, preparing for a possible shooting within one of its campuses.
Willmore is working on a 15- to 20-minute simulation module that staff in various departments can do. The exercise presents a scenario involving an active shooter in the hospital and takes them through what they should do.
The reality of active shooters, though, is that there are few things people can do to remain safe.
“It really comes down to run, hide, survive.”
The options are limited to running, hiding or trying to survive by whatever means possible, Willmore said. That could include fashioning a weapon out of equipment in the hospital to try to disarm the shooter. The scenario also raises potentially difficult ethical questions — including whether to remain with a patient who is unable to hide.
Dr. Alan Drummond, an emergency physician at the Perth hospital and co-chair of public affairs for the Canadian Association of Emergency Physicians, said there is growing alarm about violence against staff in hospitals, including gun violence.
“Canadian emergency rooms should not have to worry about active shooters. It is disturbing that Code Silvers even exist in this country.”