In 2015 the Ontario Hospital Association determined that hospitals should develop Code Silver policies to manage a response to an incident with a person with a weapon.  Let’s begin by saying that “person with a weapon” may be too broad a category to be covered by a single policy – and that the particular target of a Code Silver should really be an incident involving an active shooter.  (This will be even more significant when we look at the principles contained in the OHA’s approach to Code Silver.)  These events, are, of course, very rare – so very low probability, but with the potential for catastrophic consequences.  

The OHA Guidance for the development of Code Silver policy (https://www.oha.com/Documents/Code%20Silver%20Development%20Guidance.pdf) 

Contains the following statement:

4. a. HCW (Health Care Workers) should be aware of the “run, hide, survive” concept 

b. HCW working on site should be informed of the importance of having a personal plan (i.e. what specific actions they would take if a Code Silver occurred, including exit route, hiding places, etc.)

Run, hide, survive, means flee, drop everything, run, seek safety, save yourself – and, in so doing, abandon your patients to whatever fate may await them. 

Nowhere in the OHA Guidance does it make any mention of a commitment to patients or make any reference to any sort of obligation to seek to protect or care for patients.  Just save yourself.

Does that sound right?  I don’t think so.  I think many in the caring professions would see themselves as having some sort of duty to protect the vulnerable patients in their care.   That is, they would not think solely, and first, of themselves but would rather feel an inherent responsibility for the safety of those in their care.  Of course, there are limits to that responsibility – and those limits are certainly worth identifying and discussing – but the fact that there are limits to the responsibility to care and protect, means that the responsibility exists in the first place.   I think Code Silver policies should include – and work from, a basic commitment to the care of patients.  Furthermore, it seems to me that any hospital that viewed itself as committed to patient centred, or patient driven care should be reluctant (ashamed) to adopt and promote a policy that so clearly advocates the abandonment of patients.

What do you think?

Robert Butcher February 2017