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Preparing and educating your facility for gang violence


"Not in our hospital" and the common misconception that hospitals are considered neutral territory for gangs are two mindsets regarding gangs and gang-related violence that need to be changed. Gang violence is a societal issue that doesn't stop at the hospital doors.

Preparing and educating your facility for gang violence

"Not in our hospital" and the common misconception that hospitals are considered neutral territory for gangs are two mindsets regarding gangs and gang-related violence that need to be changed. Gang violence is a societal issue that doesn't stop at the hospital doors.

Across the country, gang members enter hospital emergency rooms on a daily basis as victims of shootings, stabbings, and beatings, as well as for non-violence-related medical needs. Many are admitted for short- or long-term care. Often accompanying these patients are fellow members of their sects. If a rival gang injured the patient, there is always the chance that adversary gang members will come to the hospital to finish the job. While these types of incidents are rare, they do occur.

Several years ago at a Baltimore hospital located in an urban area populated with various gangs, a gang member presented himself to the emergency room as the victim of a beating by rival gang members. The patient suffered head trauma from a baseball bat. Not long after the patient entered the ER lobby, a rival gang member entered carrying a baseball bat and began striking the patient with the bat. As security and police responded, the assailant ran from the ER.

As recently as November 2011, a 29-year-old member of the Burnside Money Getters was arrested for opening fire in a Bronx hospital ER lobby. The gang member, in an attempt to finish off a member of the Riverpark Towers Crew who was seeking treatment for injuries sustained in an earlier gang altercation, entered the ER and discharged a handgun several times. The intended target was not struck. However, a 37-year-old nurse and a 42-year-old security guard received non-life-threatening gunshot wounds.

To deal with the potential for gang violence, we first need to understand why gangs exist, the gang culture, and the continuing gang threat.

Why gangs exist

The National Gang Intelligence Center (NGIC) defines a gang as a group of three or more individuals who engage in criminal activity and identify themselves with a common name or sign.

People join gangs for a variety of reasons. Many are searching for a sense of family. For those members, the gang is their family and support network. They exist as brothers in a world that otherwise rejects them. For many members, the gang is the only organized structure in their lives.

Some who enlist in gangs are looking for a sense of recognition or respect. They achieve status and gain respect through their actions and accomplishments to promote gang objectives, more often than not through violence and intimidation.

Others join gangs to overcome distressed socioeconomic conditions, enlisting to improve their financial security through the distribution of drugs, prostitution, and other criminal enterprises. While there are various reasons for gang existence, the common denominator is to make money through illegal activities, often facilitated through violence.

The gang culture

Most gangs are structured in the same manner as a large business. Gangs are generally organized in a typical pyramid structure, with the leadership at the top and the rank-and-file soldiers at the bottom.

Gangs provide their own boundaries and levels of discipline for violations of the membership code, up to and including a sentence of death.

Gangs may identify themselves by wearing certain colors and through symbols, tattoos, and graffiti. Bandanas and sports apparel of a specific color are often the clothing of choice. Blood members often wear Chicago Bulls jerseys; Crips often wear Dallas Cowboys jerseys; and MS-13 members may be seen in a Dan Marino #13 Miami Dolphins jersey. Gang members will never wear the colors of a rival gang.

To better understand gang culture, you need to comprehend how a gang member thinks. Reputation, respect, and retaliation are the three R's of gang life.

Reputation is crucial for the continued existence and achievement of any gang member. Additionally, gang reputation is critical in the endurance and promotion of the gang as a viable criminal enterprise. The fear of reprisal and violence is created through reputation. Acts permeated, as well as the willingness of a gang member to do whatever it takes in furtherance of gang objectives, gain the member status and reputation.

Respect is a dominant desire for all gang members. Gang members seek respect and demand respect for themselves and their gang. They insist that rival gangs respect their territory, their colors, and their fellow members. They are often willing to risk serious injury or death to ensure that this occurs.

Retaliation happens when gang members believe that they or the gang has been disrespected or their reputation has been violated, often very harshly.

Disrespect from rival gang members can often lead to open gang violence. The Bloods and the Crips have been violent rivals since the '60s and have had many violent episodes. They often disrespect each other through graffiti, tattoos, and attire.

Graffiti is placed on buildings, signposts, streets, sidewalks, or basically wherever visible to show that the community belongs to a particular gang and that criminal activities in this territory are to be conducted only by members of this gang. Gang members enter rival gang communities and spray paint their gang colors over the existing adversary gang graffiti as a sign of disrespect.

Tattoos on gang members may also be a sign of disrespect for rival gangs. Blood members will tattoo the initials "CK" on their bodies, which signifies "Crip killers." Crip members tattoo the word "SLOB" on themselves as a sign of disrespect to the Bloods.

Attire worn by gang members may also be a sign of disrespect to rival gangs. Blood members have been known to wear Calvin Klein (CK) jeans, the "CK" again meaning Crip killers, while Crip members often wear Dallas Cowboys jerseys as a sign of disrespect to the Bloods. In the Crips' world, Cowboys stands for "Crips on wheels blasting on young slobs."

The gang threat

Violent street gangs once primarily found in large cities now affect public safety, community image, and quality of life in communities of all sizes in urban, suburban, and rural areas. No region in the United States is untouched by gangs. From the inner cities to the suburban gated communities, gangs cause heightened fear of potential violence.

The Gang Threat Assessment published by the NGIC in November 2011 indicated that there are an estimated 1.4 million active street, prison, and outlaw motorcycle gang members in more than 33,000 gangs operating in all 50 states, the District of Columbia, and Puerto Rico. Gang membership continues to increase.

The assessment found that gangs are responsible for 48% of violent crime in most jurisdictions, and up to 90% in several others. The assessment also pointed out that gangs are acquiring high-powered military-style weapons and equipment, which poses the potential to engage in lethal encounters with law enforcement and citizens alike, including hospital security.

The Gang Threat Assessment further revealed a growing threat of "hybrid gangs." The hybrid gang culture is characterized by members of different racial/ethnic groups participating in a single gang, individuals participating in multiple gangs, unclear rules or codes of conduct, symbolic associations with more than one well-established gang (e.g., use of colors and graffiti from different gangs), cooperation of rival gangs in criminal activity, and frequent mergers of small gangs.

Hospital staff education

All healthcare facilities, not just those hospitals located in the inner cities, need to adopt a gang awareness training program that incorporates area and regional gang identification, workplace violence, obvious warning signs, and reporting procedures. This education should be available to all employees, especially ER, ICU, and security staffs.

Local police and the Federal Bureau of Investigation track gang activity. Many police departments have a dedicated gang enforcement unit or officer. It is paramount that hospital security departments utilize these resources to gain pertinent information on gangs operating in the surrounding communities and to be involved in creating a viable gang awareness training program for hospital employees.

Northwest Hospital in Randallstown, Maryland, where I am director of security, has kept gang awareness to the forefront, keeping an open line of communications with the Baltimore County Police Department (BCOPD) Gang Unit to keep the hospital staff abreast of gang activities in the area and to provide gang intelligence to law enforcement, while keeping HIPAA laws in mind.

With the assistance of Sergeant James Conaboy of the BCOPD Gang Enforcement Unit, the Northwest Hospital Security Department has conducted several gang awareness seminars for the security and clinical staffs. Additionally, gang identification resource books are being created for the security department, emergency room, and ICU. These resources will describe the area gangs and their colors, tattoos, graffiti, and potential for violence.

In December 2010, Northwest Hospital coordinated an "Active Shooter" training drill with the BCOPD, which was centered on a gang member coming to the ICU to kill another rival gang member who was a patient. Over 100 persons attended the drill, including the entire hospital administration, police executives, local precinct police officers, the BCOPD Gang Unit, the BCOPD Intelligence Unit, and local Emergency Medical Services personnel. The drill was deemed a huge success.

It is imperative that hospital security staff are thoroughly educated on gang activity, including how to recognize and deal with it. Hospital security departments should have procedures in place to deal with the potential for gang members entering their facility.

At Northwest Hospital the security staff investigates all shootings and stabbings. The patient's criminal background is checked. Police are interviewed to determine if the incident had possible gang ties. The clinical staff is also asked to look for gang-related tattoos. All information is documented in a security incident report, and if required, an action plan is designed to better protect the patient, staff, and visitors.

It is very important that security and clinical staff be trained regarding potential warning indicators related to potential gang violence. These are some of the signs:

  • Obvious signs of agitation of patients and/or visitors arriving at the ER, or signs that they just came from a fight.
  • The staring down of other visitors or staff members may be an indicator of looming violence. Known as "mad dogging," this tactic is often used between rival gang members.
  • Gang indicators, whether it is the wearing of gang colors, identical clothing or sports attire, or tattoos or the use of hand signs.
  • A patient suffering trauma arriving with a group or posse, or a shooting, stabbing, or assault victim being dropped off at the hospital entrance.
  • A patient refusing to give up clothing or packages. These may contain weapons or illegal drugs.

A workplace violence policy should be in place and all hospital employees should be familiar with its content. This policy should be a part of any new employee orientation program and should detail the procedures for incident reporting, not only incidents of violence but also the potential for violence. The LifeBridge Health system, a four-hospital corporation located in Baltimore, has recently designed and implemented an annual workplace violence course, which is mandatory for all employees. This course discusses a wide range of warning signs, tactics, and reporting procedures.

The clinical staff should receive education regarding the best methods to employ while interacting with suspected gang members. Should gang members feel disrespected by a nurse or physician, he or she may retaliate and lash out at the staff. Hospital staff should be straightforward and honest with the patient regarding his or her injuries and treatment. Treat the gang member patient respectfully, as you would any other patient. Staff should be cognizant that a gang member's clothing may represent his gang affiliation, so care should be taken when handling these items.

Gang graffiti found on hospital property should be photographed and reported to police. The graffiti should then be immediately removed. Under no circumstances should the graffiti be crossed out, as this may be seen as a sign of disrespect to the gang and be cause for future violence.

Like all patients, gang members cannot be turned away when seeking emergency medical treatment. Therefore, preparing for incidents of potential gang violence through training, education, and cooperation with law enforcement, as well as proper reporting procedures and protocols, are the keys to a successful campaign against gang violence in a hospital setting.

Editor's note

This story originally appeared in Facility Care, a publication of Thompson Information Services. Charles Moore, CHPA, is the director of security at Northwest Hospital in Randallstown, Maryland. He has been a healthcare security administrator for almost eight years. Moore was a member of the Baltimore County Police Department for over 28 years, retiring as a detective sergeant in 2004. During his law enforcement career, Moore worked in various special assignments, including the Vice-Narcotics Division and the Community Drug & Violence Interdiction Team.

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