11/11/2025
Article published in ASC Focus Magazine by our very own Emergency Coordinator, Marcy Moon:
Improving Emergency Preparedness
Collective effort is key
BY ROBERT KURTZ | NOVEMBER-DECEMBER 2025
In May 2021, emergency preparedness at Union City Surgery Center (UCSC) in Union City, Tennessee, was tested in multiple ways. A man drove his car into an occupied operating room (OR), then exited with a firearm before leaving through the hole in the wall. ASC staff immediately initiated two emergency response phases: “active shooter,” since the armed suspect was unaccounted for and his intentions were unknown, and “earthquake,” because the crash was classified as an external disaster that caused structural damage.
Flames of fire reaching up toward a green exit sign.
“Every staff member fulfilled their emergency roles exactly as trained,” says Marcy Moon, RN, UCSC’s emergency coordinator. “Patients and team members were protected, and no injuries were reported. The outcome of this event was positive because of the extensive knowledge we drill into our staff about emergency preparedness.”
Sheila Rilee, CASC, who has served as an administrator for multiple ASCs in Virginia, has experienced several different events in recent years that tested her and her centers’ emergency preparedness. These include heating, ventilation and air conditioning (HVAC) failures, a power outage and a generator malfunction when backup power was needed.
“I am passionate about being on top of preparedness and making sure my team is fully trained,” Rilee says. “Everyone must understand their role in an emergency, with the goal of ensuring patient safety and protecting our people.”
Actions to Boost Readiness
Understanding how to strengthen your ASC’s preparedness can help ensure you are ready for emergencies of any size at any time.
Expand your drills. At Blaine Orthopedic Surgery Center (BOSC) in Blaine, Minnesota, staff complete code blue, malignant hyperthermia, local anesthetic systemic toxicity, fire and severe weather drills on a quarterly or annual basis. More recently, the center has added new scenarios based on events that occurred onsite or in its community. These include drills for incapacitated staff or visitors; loss of generator power, electricity, Wi-Fi, HVAC or other critical utilities; and an armed intruder or disgruntled patient.
“We continue to expand our drills and incorporate new scenarios because every new event highlights a new risk,” says Janessa Learn, RN, preoperative and postoperative nurse manager at BOSC. “It is important to practice a range of scenarios so our staff members are confident in their response.”
Act on staff input. Moon conducts quarterly fire and disaster drills with UCSC staff and invites suggestions after each exercise. “We have used many ideas to strengthen our response,” Moon says. The center has added positioning bed pads with handles for patient transfers when stretchers cannot be used, two-way radios throughout the facility to support communication, and battery-powered headlamps and lanterns in the ORs for use during generator failure.
Put staff in difficult situations. At her ASCs, Rilee has designed drills that place staff in challenging roles and then conducted structured debriefings afterward. The process highlights what went well and what needs improvement, while also revealing situations where staff feel less confident, such as airway emergencies and active shooter scenarios where personal safety must come first.
“I try to push staff outside their comfort zones so I can see where more training is needed,” Rilee says. “The debriefing is just as important as the drill because it allows me to build confidence and prepare our people for real-life situations.”
Eliminate confusion. At UCSC, staff roles during emergencies and inclement weather are clearly posted throughout the center, including the front office, ORs, preop and post-anesthesia care unit. “This helps ensure no one has a question about their responsibilities in a crisis,” Moon says.
The center has further strengthened staff readiness by partnering with its local fire department for walkthroughs of the facility, allowing staff to familiarize themselves with key systems like the fire panel, electrical room, medical gas room, cutoff valves and sprinkler system.
Call on the experts. Like UCSC, BOSC has brought in outside expertise to enhance its emergency preparedness. The ASC partnered with a company that reviewed building safety, provided recommendations for improvements and trained staff on how to respond in different scenarios.
“We went through our space to visualize where to retreat, what to use as a barrier and how to escape,” Learn says. “It was particularly helpful for staff who had never been on other floors of the building.”
Make a game of it. Staff at both BOSC and one of Rilee’s ASCs benefited from game-based training, with each ASC leveraging a drill in escape room style to prepare for a malignant hyperthermia event. Rilee designed puzzles and locked boxes that staff must solve to access expired dantrolene and syringes, giving them practice with the difficult reconstitution process while reviewing team roles, including how to work with anesthesia. “Our staff loved the game format because it got them more involved,” she says.
Learn adds, “Interactive drills give staff a real feel for the experience and make the training more impactful.”
Rilee also has applied the game approach to other high-stakes scenarios such as code pink drills, which simulate an infant abduction. She assigned staff to cover exits and designated someone to attempt to sneak a real baby out of the building. “The exercise was realistic and pushed staff to think about how they would respond,” she says.
Look for vulnerabilities. UCSC leadership works on an ongoing basis to find vulnerabilities in the facility and evaluate new safeguards, Moon says. One focus has been its ORs, where existing doors provide limited protection in the event of an active shooter or a security breach. Proposed solutions include magnetic covers for the OR door windows and sliding locks on the inside of the doors.
“It was determined that if a surgery was in progress, the OR would not provide a level of protection that is high enough,” Moon says. “The magnetic covers would keep a gunman from seeing into the OR, and locks would help provide time for us to move people away from the window to reduce the likelihood of harm.”
Learn from others. Resources like ASCA Connect have helped Learn uncover new areas of focus. A recent forum comment suggested planning for a scenario in which badge scanners fail. The idea sparked discussion and planning at BOSC for a situation the team had never considered. “Just because something has never happened does not mean it cannot happen,” she says.
Avoid Complacency
Unlike hospitals, ASCs often operate with limited resources, so preparedness is especially critical, Learn says. Many centers lack a rapid response team or extra specialists, and on a low-volume day only a handful of staff may be onsite. The nearest emergency department or ICU might also be far away. “You need to be ready with the people and resources you have, because help is not waiting in the wings,” she says.
Keeping preparedness top of mind is the best way to ensure staff readiness when it matters, Rilee says. “My ASCs have been tested, but the staff always rose to the challenge. Each emergency taught us something new and made us better prepared for the next one.”
Moon emphasizes the collective effort behind readiness: “The more prepared we are as a unit, the better we can manage emergencies as they arise and the more likely we are to prevent casualties and negative outcomes.”
