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What If a Killer Walked Into Your Facility?
Prepare for the worst to keep your patients, staff and surgeons safe.
Beth Chrismer
Publish Date: May 25, 2016
OR Excellence
Beth Chrismer, MSN, RN, CPHRM Beth Chrismer,

Speaker Profile

  • Director of Medical Care Review at the Ambulatory Surgery Center of Good Shepherd Medical Center in Longview, Texas.
  • Has more than 38 years of healthcare experience and 15 years in healthcare risk management.
  • Transitioned to the ambulatory surgery setting 2 years ago and says she "loves every minute of it."

Two days before Thanksgiving 2013, the 22-year-old son of a GI patient stabbed 5 people at the Ambulatory Surgery Center of Good Shepherd Medical Center in Longview, Texas. A perioperative nurse and a father accompanying his son died in the attack, which could have been much, much worse had the facility not been properly prepared, says Beth Chrismer, MSN, RN, CPHRM, Good Shepherd's risk manager. In this ORX session, Ms. Chrismer will share her experience and the lessons learned to help you prepare for and avoid a similar tragedy at your facility.

  • An attack out of the blue. Just before 7 a.m. on November 26, 2013, an inpatient from the adjoining hospital was scheduled to undergo a GI procedure at the ambulatory surgery center. The patient's son, identified as Kyron Rayshawn Templeton, had accompanied her to the hospital, and was in the waiting room when he got up to go to the bathroom. He came out wielding a knife, and began stabbing staff members and visitors, wildly screaming "You're not going to kill my mother." When it was all said and done, Mr. Templeton had attacked 5 people within 30 seconds, resulting in the death of a nurse and an 82-year-old man waiting to pick up his son after surgery.
  • As awful as it was, the situation could have been even worse. The staff at the center had just completed a training session a few weeks earlier on what to do if an armed assailant entered the facility. "I can't help but believe that this helped shape our staff's response that day and ultimately saved lives," says Ms. Chrismer.

  • The threat of workplace violence in health care. Workplace violence can occur in unexpected settings. Sometimes really tragic things can happen in the places we least expect them to, such as in an ambulatory surgery center. "That's why it's so important to be prepared for the unthinkable," says Ms. Chrismer.
  • Healthcare facilities also have unique factors that put them at risk. Most of the time, patients and family members in these settings are stressed. They feel out of control, and there is sometimes a perception that there is easy access to drugs or other mood-altering substances. The nature of the business makes surgical facilities a target.

Kyron Rayshawn Templeton
Harris Teel\
Gail Sandidg\e STABBING SPREE From top to bottom: Kyron Rayshawn Templeton, the son of a patient, fatally stabbed Harris Teel, 82, who was waiting to pick up his son from surgery, and seconds later Gail Sandidge, RN, 57, who was preparing a patient for surgery.
  • Getting a plan in place. Be prepared for the unexpected. Develop a plan and drill with that plan, just as you would for anything else. The good news is that you don't have to reinvent the wheel to have this plan in place. There are plenty of resources available. Look to organizations like FEMA and the Department of Homeland Security, which have plans that you can adapt to your facility.
  • Ms. Chrismer stresses that you team up with local resources as well, whether that's the fire department, police department, other local hospitals or ASCs, or even your neighbors. Creating alliances with these groups can help you to be prepared.

    Finally, most plans also need to teach employees and surgeons how to run, hide and fight. The general idea is that if you can run away, do it. If you can't, then hide, and if neither of those options is available, then fighting the attacker is the last resort.

  • Finding a balance between being secure and welcoming. When it comes to making your facility secure, one of the biggest challenges — especially for ambulatory surgery centers — is finding a balance between being an open, welcoming environment and having a secure and safe facility. It's not like a hospital's emergency room. People are more tolerant of metal detectors and being patted down in those larger settings. But in a center where people are paying out-of-pocket for elective surgery, it's off-putting to have these in-your-face security measures. You want patients to feel safe and secure, not that you're always anticipating something bad to happen.
  • Before the attack, patients and family members could come and go as they pleased at the surgery center. Many doors stayed open and unlocked. But after the attack, the center began using radiofrequency identification technology, so staff and physicians needed to swipe their badges to access certain areas. "We thought that this was a subtler way to secure the center," says Ms. Chrismer.

  • Stay engaged. Another key characteristic of having a secure facility is that everyone, from leadership on down, is engaged. There's a situational awareness instilled in everyone. People are aware if a patient or escort is acting "weird," or they notice that one of the doors isn't closing like it should. It also means empowering staff to be assertive with visitors at your facility. They can say to someone tailgating them through personnel-only doorways, "Is there a way I can help you? Because this isn't an authorized area for visitors."

Leadership plays a key role in this as well. If you want your staffers to be aware of security concerns, but you brush them off or don't make them a priority when they report their concerns, you'll encourage complacency. If a manager gets a report of a loose lock or RFID doors not working, there needs to be a sense of urgency to fix those problems. It should be a priority. "It's better to be prepared and avert a crisis than to do these things after something has already happened," says Ms. Chrismer. "You can avoid the scars and wounds and trauma." OSM