Evolution of Code Silver
One Hospital’s Perspective…
Josh Stivers
System Security Training Coordinator
Swedish Medical Center
Active Shooters or Visitors to your
Sandy Hook Elementary Shooting
December 14, 2012. 20 year old
Adam Lanza shot and killed twenty
children and 6 adults. Children were
between the ages of 5 and 6 years
old. Lanza committed suicide after
the shootings.
Columbine High School Shooting
April 20, 1999. Eric Harris and
Dylan Klebold shot and killed 12
students and one teacher before
taking their own lives.
December 1, 2013- Man dies, woman wounded in Springfield,
Mo. hospital.
December 18, 2013 – Gunman kills 1 and fatally shoots self in
Reno hospital spree.
January 5, 2014 – Gunman kills himself after assaulting 2 nurses
with his gun and asking them “if they want to die today”.
Virginia Tech Shooting
April 16, 2007. Seung-Hui Cho
shot and killed 32 people. It
was the worst act of mass
murder of college students
since 1927 and the Bath School
Disaster. Cho committed suicide
at the end of the deadly
Code Silver
• Definition: Any staff/patient/visitor actively
harming/threatening to do harm with a gun
or hostage situation.
• Old definition included weapon or knife
which was removed due to the different
type of police response for that type of
Hospitals: Small Town of Complex
Human Relations
• So many intense relationships
– Patient/Staff, Visitor/Staff, Visitor/Visitor, Staff/Staff,
– Mental Health Patients
– Forensic Patients
• Family Dynamics Considerations
– Labor & Delivery, happiest place on earth? Not all the time!
• Delivery of health news be it positive or negative
• Cultural Differences
– 94 different languages generally spoken in the Seattle area
• Outside stressors brought in
– Economy
– Personal finances…
Code Silver called at Swedish…
• 2012- Code Silver-External called from the
Cherry Hill Campus
– Witness stated they saw a person with a rifle/gun in
the parking garage across from the hospital.
– Is this a Code Silver?
– What do we expect other staff
in the hospital to do once
- Police response?
Evolution of Code Silver
• October 1, 2009, Hospitals in the state of
Washington encouraged to adopt the
standardized emergency codes
Notice old
Code Silver
Evolution of Code Silver
• January 2013, we started doing code
silver in-services for all departments and
units within the Swedish System including
our Edmonds Campus.
• Approximately 1,500-2,000 Swedish
employees have attended the Code Silver
in-services to date.
Evolution of Code Silver
• 2014 the silver sticker was introduced
• Assessments are completed prior to the in-service to
identify safe rooms (Code Silver rooms) and those
rooms are then identified with the silver sticker preferably
placed in the upper right hand corner of the door
depending on the door and any obstructions.
• SMC rolled out a new updated version of
the ‘shots fired” video in 2013 which
focuses on an Active Shooter event in a
healthcare setting.
• Employees complete this education and
watch the video annually.
• Education continued.
According to the FBI statistics, an active shooter
event is over with 12-15 minutes. One of the education
pieces is how long do you stay in your “Code Silver” safe
room before exiting.
Rule of thumb is a couple of hours, and prior to
exiting the room, turn your cell phones back on and text or
call out to make sure it is over or until found by search
• In 2014, Swedish Medical Center teamed up
with local area hospitals to include Harborview
Medical Center and Virginia Mason along with
the Seattle Police Department to find and define
best practices and mitigate for Code Silvers.
• A team comprised of security and safety have been working on
defining the best practices across the board aside from our meetings
with Seattle Police and local hospitals.
• Our work includes interviewing facilities across the country to
determine lessons learned and gain knowledge from their
• Utilizing CPTED (Crime Prevention through Environmental Design)
and coming up with ways in which to help keep weapons out of the
hospital in general.
A Code Silver is Called;
What Next?…
• Looking at the three events Swedish has
had, we asked the simple question…
What do we want staff to do?
• Patient Safety concerns
• Ethical Implications of Code Silver
– Duty to Patients
– Duty to Non-Patients/Visitors
– Duty to Self
Swedish Code Silver Response
• Code Silver Internal + Location – Lock Down
– Above, Below, and adjacent
– Defend In Place
• Code Silver External + Location – Lock Down
– Stay away from the area
– All areas overlooking stay away from windows
• Code Silver Defend in Place
– Shots fired, no known location of shooter, active
– Everyone in hospital defend in place
De-escalation Training a Must
• Any event can spiral out of control quickly
• Give staff the tools needed to de-escalate
• It is mandatory education at Swedish for
all clinical staff
• Swedish de-escalation is based off of
mixture of CPI and the book Verbal Judo.
• Have had remarkable success
• Half of SMC Code Grays are De-esclated
Who is waiting for you tonight?
Go home to your loved ones
Contact Information
Josh Stivers
System Security Training Coordinator
Swedish Medical Center

Evolution of Code Silver One Hospitals Perspective…