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Go back to security basics to prevent violence


Arming your hospital staff probably is not the answer, according to prominent security expert

Go back to security basics to prevent violence

Arming your hospital staff probably is not the answer, according to prominent security expert

As active shooters and other violent incidents in healthcare facilities continue to occur across the U.S., many safety officers are contemplating the possibility of arming their security staff and even their clinical staff.

Many have turned to full-scale drills that practice what their facility's response would be in the event of an armed intruder, but one security expert says that may not be the way they want to go.

"I don't recommend they do any of these sexy active shooter drills until you spend time and energy on the basics, and then move on," says Thomas A. Smith, CHPA, CPP, president of Healthcare Security Consultants, Chapel Hill, North Carolina, and former director of hospital police and transportation at University of North Carolina Hospitals in Chapel Hill. Smith spoke at a well-attended session at the annual conference of the American Society of Healthcare Engineers in July in Boston, Massachusetts. "If you aren't locking your loading dock at 4 in the morning, don't talk to me about active shooter training."

Smith's talk focused on the growing epidemic of violence in healthcare and the security issues that facilities should be thinking about to help protect themselves. He immediately addressed the issue of armed physicians, a trend that seems to be growing especially in rural areas. The issue took on new life following a July 2014 incident near Philadelphia in which a doctor at Mercy Fitzgerald Hospital stopped an active shooter who had shot and killed a caseworker by pulling out his own gun, shooting, and wounding the shooter.

"There are a lot of things you can do to prevent workplace violence, and guns are a last resort," Smith says, adding that he thinks the doctor in that case knew his patient might be violent, and that perhaps better communication could have stopped the shooting altogether.

"People don't just snap. There's always some indicator that someone is upset and we have to be listening," Smith says. "Was the doctor carrying the gun all the time? I don't know, but it would be interesting to know if that doc knew something was up."

So what are some things that healthcare facilities should be thinking about when it comes to security and keeping violence out? Smith offered his own list of suggestions.

Don't think it can't happen. Smith stressed that violence can happen anywhere, and many smaller facilities tend to take the attitude that just because many high-profile events take place in cities like Boston or Philadelphia, violence won't hit their facility.

"This leads to the mentality that you don't have to take precautions in the small community hospitals," he says.

Look for your weak spots. Whether you are a big or small hospital, your plan for preventing violence is only as good as the security around the places where an armed intruder can enter undetected. As mentioned above, a place such as a loading dock door open at night gives a perfect entry point for an intruder.

"Massive security flaws have been built into some buildings, such as around elevator areas and stairwells," he says.

Now is the time to do a thorough tour of your hospital and look at things through the eyes of an intruder. Where are the places someone can enter and hide for some time, where security is not likely to check during their regular tours?

Listen to the regulators. Regulatory agencies such as OSHA and The Joint Commission are taking workplace violence very serious. The CDC has called it an epidemic. It's time for you to listen to what they say, and to take their advice when you can. OSHA recently came out with an update of its guidelines for updating your workplace violence prevention plan complete with suggestions for facility design improvement that can help you get started. FEMA, the CDC, and Department of Homeland Security all have produced videos about active shooters that can help you train your employees.

Take care of your mental health patients. Smith says one of the biggest epidemics to hit healthcare in recent years has been the decrease in proper care for mental health patients. As a result, many hospitals have these individuals dumped into their ERs, creating a major security danger.

"It used to be that mental health patients would get their care at outpatient facilities, but budgets have been cut," he says. "Many of these patients are now out in the community and not getting the care they need, and when they come over to our EDs they are much more acute and are not taking their medications."

Many hospitals are now redesigning their ER spaces to better serve this population, including making multi-modal rooms that can change to the needs of the patient, and making waiting areas friendlier for long-term stays.

Harden your prisoner policies. Prisoners are another high-risk population that can present a security risk in hospitals. As a result, hospitals must have policies in place for monitoring these patients, as well as a positive working relationship with the law enforcement officials bringing them in.

In recent years, many shootings, stabbings, and other violent episodes have occurred from prisoners attempting to escape their captors in hospital facilities, and it usually occurs when law enforcement isn't paying attention when restraints are taken off.

"The bathroom is a real dangerous point," Smith says. "The guards don't like to go in there when they have that experience and so [prisoners] are going to do things like go through your ceiling tiles and pull down your sprinklers."

For a sample of patient prisoner guidelines developed by the International Association of Healthcare Security and Safety (IAHSS) that you can modify for your own facility's program, please see p. 3.

Design facilities right the first time. Smith says he gets very frustrated when he goes into a hospital to do a security assessment and he sees brand new facilities that weren't designed with security in mind.

If your healthcare system is thinking of building a new facility, you should be consulting healthcare security design experts to help you consider design elements that may not have been thought about, such as entryways and stairwell access, he says. A good place to start is with the IAHSS, which publishes a guideline of security design elements that can help design security measures and incorporate them into existing facilities. Check out the guidelines at www.iahss.org/?page=guidelines.

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