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The patient is in an exam room with her boyfriend, waiting for the clinician to return with
some forms. Patient’s boyfriend begins screaming, threatening her.
Set Up: Choose to act as either boyfriend or patient. Designate a staff member to play other role.
Begin yelling and making threatening gestures.
Action: Each drill should be conducted twice. The first drill is used to see what staff would
normally do and the second to make improvements.
After the first drill review these key points:
• Ask the patient/visitor to change their behavior immediately.
• Tell the patient/visitor to leave the clinic. Let them know the police have been called.
• Instruct someone to call 911 and inform them that you have a disruptive or violent person
in the clinic that need to be removed immediately.
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• Do not get involved in their fight.
• Do not physically get in between the patient and boyfriend.
• Assign staff to move other patients away from incident.
• Document on an Incident Report Form (see sample Disruption/Violence Report).
Perform the drill a second time to:
• Review staff performance and improvements
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• Debrief. These drills may bring up a lot of emotions for you and your staff.
Things to think about:
1) Understandably, staff may feel that it is their job to make sure the patient is safe.
However, emphasize that it is not their responsibility to intervene in these situations, and
that doing so may make the situation worse or delay the response.
2) Consider contacting local law enforcement to solicit their suggestions for this situation,
and what their response time would be. This gives you an idea of how long you will need
to manage the patient and contain the situation.
Manageable Fire
Scenario: It is around lunchtime. A staff member walks into the kitchen and sees smoke and
flames coming from the toaster oven.
Set Up: Instruct a staff person to be the one who notices the fire and proceed accordingly.
Action: Each drill should be conducted twice. The first drill is used to see what staff would
normally do and the second to make improvements.

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After the first drill review these key points:
• All staff should know location of all fire extinguishers.
• All staff should know how to properly use a fire extinguisher (let them pick it up and
examine it)
• In the event of a manageable fire, pull pin and spray back and forth across the base of
the flame from about 6-8 feet away.
• If fire is successfully extinguished call fire department to report the incident anyway.
They will need to come and determine the cause of the fire. If it was electrical, there may
be problems behind the walls that require attention.
• If emptying the contents of one regular-sized fire extinguisher is not enough to put out the
Perform the drill a second time:
• Review staff performance and improvements
Things to think about:
1) Be sure the plastic tie has been removed from the pin on the fire extinguisher so the pin
can be pulled out easily.
2) Do you have a plan for communicating with other staff throughout the office in case of an
emergency?
Unmanageable Fire
Scenario: Fire in chart room due to electrical short.
Set Up: Choose a staff person to find fire in chart room. Designate 2-3 staff to be
patients: one is hysterical, one refuses to leave, the other is in the bathroom.
Action: Each drill should be conducted twice. The first drill is used to see what staff
would normally do and the second to make improvements.
After the first drill review these key points:
• How did you communicate that there is an emergency and a need to evacuate the clinic?
• Have several pre-planned and practiced escape routes. The fire may not start or be set
in a place where it is convenient for you to evacuate out the main door.
• Did you evacuate all patients?
• Did you close all doors?
• Did you remember to bring the schedule so you can account for all patients?
• Have a designated meeting point a safe distance from the clinic and make sure to notify
all staff of which place will be used, prior to evacuating.
• Set a goal of an amount of time in which you want to complete the evacuation and work
toward it.
Perform the drill a second time:
• Review staff performance and improvements
• Debrief. These drills may bring up a lot of emotions for you and your staff.
Things to think about:
1) Did you take copies of emergency numbers, patient lists, and staff contact numbers with
you in case you are unable to re-enter the clinic for a period of time?
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