Posted: 10/11/24

Q: Policy on Active Shooters

A: 

I would defer to the institution’s local policy. It is not our place for the Safety Committee to weigh in on individual procedural documents. We could give references that may be useful in guiding document creation. 

Good examples of these are the San Diego ASM presentations and posters that were so well done. These talks may still be available for CME.  Visit www.courses-uhms.org. 

•  ACTIVE SHOOTER IN THE PRESSURIZED ENVIRONMENT SETTING: Geness Koumandakis, RRT, CHT
•  ACTIVE SHOOTER IN THE PRESSURIZED ENVIRONMENT: Jacquline Hocking, CHT 
•  ACTIVE SHOOTER IN THE PRESSURIZED VESSEL HUMAN OCCUPANCY ENVIRONMENT: ACTIONS – CONSIDERATIONS – RECOMMENDATIONS: JULIO R GARCIA RN, WCC, ACHRN
•  CODE SILVER / ACTIVE SHOOTER: Jolene E Comier, CHRN, CHT

A quick search of UHM showed the below older abstracts.

• E 8: Responding to an active shooter: Learning from one facility’s experience: Ptak J, Cormier J: UHM 2018, VOL. 45, NO. 5 – ASM 2018 SESSION E: HBO2 OPERATIONS, CHAMBERS AND EQUIPMENT
• Gunshot damage to monoplace hyperbaric chamber acrylic; UHM 2020, VOL. 47 NO. 2: Lindell K. Weaver; Kayla Deru; John Foley 

A couple of related MEDFAQs as well:

https://www.uhms.org/resources/featured-resources/medfaqs-frequently-asked-questions-faq/safety-technical/search.html?yrfaqsearch=shooter

I work in a clinic setting with wound care on one side of the building and I am alone on my side with HBO2. My boss would like to put a push button code lock on my door and I'm wondering if this is permitted? If there was a fire I'm concerned about the Fire Department not being able to get in. Does anyone have a similar issue? Is it ok to have this type of device on the HBO2 room door? We need some type of Safety policy and procedure for an active gunman in the building and I’m not sure how to go about this.

Thank you for your question. The UHMS hyperbaric oxygen safety committee (SC) can provide information but the ultimate responsibility for these types of questions is with the medical director and safety director of your facility.

Security is a real concern and we agree that Hyperbaric Facilities need to develop Policy and Procedures to manage active shooter / Code Silver, Bomb threats and other security concerns. We are required by NFPA 99, chapter 14, to have emergency drills on a regular basis. These threats should be added to your emergency response plans.

The SC would refer you to your local Authority Having Jurisdiction (AHJ). There are codes and regulations regarding locked doors. For guidance you can start with NFPA 101 Life Safety Code, 2012 edition, 7.2.1.5 Locks, Latches and Alarm Devices and NFPA 99, 2012 edition, Chapter 13, Security Management. Work with your local AHJ and Safety and Security department, possibly Emergency Management, to complete a threat assessment. These resources will help decide if a key pad is necessary.

In general we see no issue with a cipher lock on the entrance to the hyperbaric suite. In fact, we are aware of many facilities with ID badge, card access, push button locks and even keyed doors entering the room housing the chamber(s). The Fire Department will be able to gain access in the event of an emergency. Consideration should be given to enabling not only the Fire Department, but other responders such as code teams or security. The chamber room can be considered a restricted area, with authorized entry only. The concern is that evacuation in the event of an emergency is not hindered. There must always be an exit path, and the lock mechanism must not impede egress (or ingress of authorized personnel).

We also note that a chamber operator working alone is concerning. NFPA 99, 2015 edition, chapter 14 requires that there be a qualified chamber operator at the control panel with visual and audible communication with the occupants any time the chamber is in use. We would encourage the use of the UHMS Guidelines for Hyperbaric Facility Operations, 2nd edition, Section 3, Staffing Guidelines, to staff the chamber operation. Consider how to insure the safety and security of the single operator and any patients being treated, as described in this question. Is there a communications link for immediate help? Consider a panic button or regular rounding (closed circuit video feed?) by someone to check on the chamber operator and patients to provide support as needed. During your emergency drills, do you have the help you need to manage the number of patients?

 
DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

Published Date:      02/2017
Review Date:         02/2020

Question:  I work in a clinic setting with wound care on one side of the building and I am alone on my side with HBO2. My boss would like to put a push button code lock on my door and I'm wondering if this is permitted? If there was a fire I'm concerned about the Fire Department not being able to get in. Does anyone have a similar issue? Is it ok to have this type of device on the HBO2 room door? We need some type of Safety policy and procedure for an active gunman in the building and I’m not sure how to go about this.

Thank you for your question. The UHMS HBO₂ safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

Security is a real concern and we agree that Hyperbaric Facilities need to develop Policy and Procedures to manage active shooter / Code Silver, Bomb threats and other security concerns. We are required by NFPA 99, chapter 14, to have emergency drills on a regular basis. These threats should be added to your emergency response plans.

The SC would refer you to your local Authority Having Jurisdiction (AHJ). There are codes and regulations regarding locked doors. For guidance you can start with NFPA 101 Life Safety Code, 2018 edition, 5-2.1.5 Locks, Latches and Alarm Devices and NFPA 99, 2018 edition, Chapter 13, Security Management. Work with your local AHJ and Safety and Security department, possibly Emergency Management, to complete a threat assessment. These resources will help decide if a key pad is necessary.

In general, we see no issue with a cipher lock on the entrance to the hyperbaric suite. In fact, we are aware of many facilities with ID badge, card access, push button locks and even keyed doors entering the room housing the chamber(s). The Fire Department will be able to gain access in the event of an emergency. Consideration should be given to enabling not only the Fire Department, but other responders such as code teams or security. The chamber room can be considered a restricted area with authorized entry only. The concern is that evacuation in the event of an emergency is not hindered. There must always be an exit path, and the lock mechanism must not impede egress (or ingress of authorized personnel).

We also note that a chamber operator working alone is concerning. NFPA 99, 2018 edition, chapter 14 requires that there be a qualified chamber operator at the control panel with visual and audible communication with the occupants any time the chamber is in use. We would encourage the use of the UHMS Guidelines for Hyperbaric Facility Operations, 2^nd edition, Section 3, Staffing Guidelines, to staff the chamber operation. Consider how to ensure the safety and security of the single operator and any patients being treated, as described in this question. Is there a communications link for immediate help? Consider a panic button or regular rounding (closed circuit video feed?) by someone to check on the chamber operator and patients to provide support as needed. During your emergency drills, do you have the help you need to manage the number of patients? 

Thank you for your question. The UHMS hyperbaric oxygen safety committee (SC) can provide information but the ultimate responsibility for these types of questions is with the medical director and safety director of your facility.

The answer to your question is dependent upon the emergency decompression rate selected by your facility and the capability of your particular chamber. Additionally, it is important to assess the risk of rapid or maximum decompression, as the rate may be designated by the particular emergency or medical condition of the patient.

• We suggest that the maximum decompression rate for the facility be decided by the medical director and safety director. This detail should be reflected within the facility’s emergency procedures, and the capability tested routinely as part of the facilities’ preventive maintenance program.
• Consider the emergency in your decision to rapidly decompress. In some cases, it may be prudent to decompress rapidly but not at the maximum rate. The medical condition of the patient, active shooter, severe weather, mechanical failure, and the ability to egress are just a few factors to contemplate. Of course, in the case of fire inside the chamber, the maximum decompression rate is recommended.
• Although applied from air decompression schedules, it is known that some facilities have previously adopted the maximum decompression rate of 30 feet of seawater per minute as described in the U.S. Navy Diving Manual, Revision 7, Volume 2, Chapter 9.
• By this measure, decompression from 2.4 ATA would occur in approximately 92.4 seconds. However, it is important to note that this rate applied at 3 ATA would be too slow to meet the NFPA requirement of 2 minutes from 3 ATA (132 seconds).
• UHMS Clinical Hyperbaric Facility Accreditation Manual, Fourth Edition HBOO 7.1: “The ability to decompress a Class B monoplace chamber from 3 ATA to surface in less than 2 minutes is documented.”
• 2018 NFPA 99, chapter 14 states that monoplace (class B) chambers ”shall be capable of depressurizing from 3ATA in no more than 2 minutes.”
• It is important to read the above references carefully, as the requirement states that the chamber must be capable of decompression at this rate (1 ATM per minute). It does not say that this is an acceptable rate in every emergency.

Respectfully,

The UHMS Safety Committee

DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.