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{
    "pk": 14817,
    "title": "The Power of an Active Shooter Simulation: Changing Ethical Beliefs",
    "subtitle": null,
    "abstract": "Introduction:\n During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.\nMethods:\n Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.\nResults:\n Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.\nConclusion: \nSimulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.",
    "language": "New York",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Simulation, Active Shooter, Training,  Ethics"
        }
    ],
    "section": "Violence Assessment and Prevention",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9hg0w4tr",
    "frozenauthors": [
        {
            "first_name": "Maria-Pamela",
            "middle_name": "",
            "last_name": "Janairo",
            "name_suffix": "",
            "institution": "State University of New York Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York\nKings County Hospital Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        },
        {
            "first_name": "Annemarie",
            "middle_name": "Marier",
            "last_name": "Cardell",
            "name_suffix": "",
            "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Lamberta",
            "name_suffix": "",
            "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        },
        {
            "first_name": "Nubaha",
            "middle_name": "",
            "last_name": "Elahi",
            "name_suffix": "",
            "institution": "Osceola Regional Medical Center, Department of Emergency Medicine, Kissimmee, Florida",
            "department": "None"
        },
        {
            "first_name": "Amish",
            "middle_name": "",
            "last_name": "Aghera",
            "name_suffix": "",
            "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York",
            "department": "None"
        }
    ],
    "date_submitted": "2020-12-15T19:30:26Z",
    "date_accepted": "2020-12-15T19:30:26Z",
    "date_published": "2021-05-21T20:22:12Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14817/galley/7533/download/"
        }
    ]
}