A code silver was called after shooting at London's ER. Nurses say they weren't trained to respond

A week after a brazen shooting outside the region's largest emergency department that left people scrambling for cover and staff inside shaken, nurses say the London Health Sciences Centre has been ignoring calls for better safety measures for years. 

"Workplace measures to keep nurses, health-care professionals and the patients they care for safe have been inadequate at London Health Sciences Centre (LHSC) for years, particularly in the emergency departments," said Erin Ariss, the provincial president of the Ontario Nurses Association. 

"Management of LHSC has been resistant to taking action to improve the safety of its staff and patients."

The incident happened on Dec. 14 at around 2:30 a.m., when a truck pulled into the Victoria Hospital ER bay, smashing into a cement pillar. A second vehicle arrived and shots rang out, said London police Sgt. Sandasha Bough. Police have yet to make an arrest but are looking for a suspect who was driving a silver Hyundai. 

One person who was in the emergency department at the time of the shooting said they heard four or five gunshots before seeing those in the waiting room started to run for cover. 

The nurses' union has been asking since 2016 for increased safety measures in the emergency department, Ariss said. Metal detectors, which the union has long pushed for, will be installed shortly, the CEO said in the hours after the shooting. 

Ariss praised the debriefs and follow ups that have happened since the shooting, saying it could signal a turn in how seriously hospital officials are taking things. "Management of LHSC has shown an improved commitment to health and safety," she said. 

Hospital preparedness 'woefully inadequate'

During the shooting, a Code Silver was called in the hospital, letting staff know there was someone with a weapon or active shooter on the property. Generally in Ontario, there's not enough safety planning in hospitals, said Dr. Andrew Willmore, the former medical director of emergency management at the Ottawa Hospital. 

"I think 'woefully inadequate' would be an appropriate summary," he said of a paper he helped write for the Canadian Association of Emergency Physicians about emergency preparedness. Often, there is a reluctance by hospital management to focus on, and pay for training. 

"You're trying to mitigate something that may not happen in a resource-limited environment," Willmore said. There needs to be a better, coordinated approach to disasters, including active shooters, he added.    

"I think it's critical psychologically and operationally," he said. "Active shooter situations in hospitals are very particular, because our institutions are inherently permeable and there's more morbidity and mortality associated with limiting access." 

Run, hide, survive

It's important that health care workers such as doctors and nurses are part of the training and figuring out what should happen in an emergency situation, Willmore said.

"You look nationally and a lot of times emergency preparedness is run by non-clinical security-guard roles, whereas the model should be interprofessional. Oftentimes, people are just looking for the accreditation bare minimum. They've ticked a box and said 'Great, we've done it, we're prepared' but that doesn't translate into the best plan and it won't translate into any kind of action unless you drill it and practice it." 

Dr. Julie Kim, an emergency room doctor in Kingston who used to work in London, worked with Willmore and developed an exercise for people to practice in case of a Code Silver. Because hospitals can't be shut down to practice active shooting drills, Kim's is a low-cost simulation alternative to prepare hospitals for an active shooter event. 

"It's very challenging because Code Silver is not preventable and not predictable. What has to be reinforced is to run, hide, and survive.' You run, not necessarily in the building, but evacuate the area if it's safe to do so," she said. 

"Hide, using a room with a locked door, possibly turn off the lights, silence phones, hide behind a large object. Then, if you're immediate danger, survive by any means possible, including incapacitating the attacker." 

Having staff take 15 minutes to visualize what they would do in different parts of the hospital or emergency department, if a Code Silver is called, can help them feel more safe and prepared. Before her Code Silver exercise, only six per cent of of health care workers surveyed said they had enough instruction on how to react in a Code Silver situation. 

The Ontario Nurses Association told CBC News the London Health Science's Centre's joint health and safety committees were provided with a debrief after the shooting, and that it appears management is showing "an improved commitment to workplace health and safety" in the week since. 

Now, with the shooting fresh in people's minds, is a good time to debrief and hold Code Silver exercises, Kim said. 

Hospital CEO David Musyj said the hospital network has held Code Silver training recently and will do so again this spring with a live scenario involving the London Police.

"There is definitely a commitment from management to work on safety measures," he said. "The proof will be in the pudding." 

Already, staff that didn't get a notification from the hospital about the Code Silver on their phones will update their alerts, he added after a Friday meeting about the shooting. "It was all of us, physicians, nursing leadership, housekeeping, talking about things we learned and things we can change moving forward. We have to learn from it."