Q&A: Understand the risks and benefits of arming security
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October 19, 2019
In June, a patient in a South Carolina emergency room was charged with assault after a security guard had his Taser® taken away during an altercation. The conductive-energy weapon was then used on a nurse.
The issue of arming security officers in healthcare is complicated, and we asked longtime security consultant Lisa Terry, CHPA, CPP, vice president, vertical markets – healthcare, for Allied Universal in Charlotte, North Carolina, for help in sorting out concerns.
Terry co-authored a special report, “Defensive Weapons and Equipment In Healthcare,” for ODS Security (now Allied Universal) in 2016.
The following Q&A has been lightly edited for clarity:
Q: Once a hospital has made a decision to allow weapons for security officers—whether they are private contractors, hospital employees or local police officers (on duty or off)—how do you ensure those weapons (firearms or other weapons such as Tasers, pepper spray, batons, etc.) are secure at all times?
A: Understanding both the risks and benefits of “armed” security professionals is critical when considering allowing the presence of firearms or other defensive equipment, including conducted energy weapons (Tasers), into the healthcare environment. Decisions must be made on facts, trends, foreseeable risks, and the unique challenges of each hospital. A thorough review and risk assessment should be conducted before this critical decision is made.
Once the decision is made, a comprehensive and well-thought-out plan should begin. This plan should include the development of very detailed policies and procedures. Careful consideration of legal requirements and regulatory expectations should drive the policies. The requirement that officers utilize appropriate safety retention level holsters (level two or three) as well as the presence of a safe location to secure a firearm or a conducted energy weapon (Taser) are important facets of any defensive equipment program. There are certain situations/locations in which an officer should avoid bringing a firearm or a conducted energy weapon (Taser). Thus, the establishment of a robust training program with continuous oversight is essential in facilitating those policies and procedures.
Q: Presumably there is some level of training associated with arming officers—how often should organizations require the training? What competencies are required? Who should do that training (for instance, local law enforcement if they agree to, or a private security training operation)?
A: There are individual state requirements regarding competencies and the certification of the instructors. The maximum amount of training required should be completed. I would recommend that consideration be given to utilizing a certified instructor with the additional knowledge and capability to conduct the training in a manner which takes into account the unique healthcare environment (regulatory requirements to include CMS, specific medical and safety precautions, etc.). In my opinion, this is an important conversation that the healthcare administrator and the security leader should have with the instructor prior to scheduling the first class.
The course outline may include a portion dedicated to the unique healthcare environment.
Q: If security is provided by a contractor, what should be in that contract to ensure that training is being done, and being done to the hospital’s requirements?
A: The value of continued and improved training cannot be overemphasized. This training should be viewed as a priority investment and worth added cost which may be incurred. In addition to the specific state-mandated certification requirements, I recommend that supplementary defensive weapons training (firearms or conducted energy weapons—Tasers) be implemented on a quarterly or semiannual basis. The training should be competency based. Officers must demonstrate competency in each phase of the training process before being allowed to continue on to the next phase. Competency-based training focuses on what is learned rather than simply measuring what is taught.
The hospital should be specific in the contract as to their expectations of training (amount, type, etc.). However, the contractor will no doubt be specific on charges for this training due to staffing during the training, etc. There is significant value associated with this ongoing training for the officers. It is important that the contractor provide a value proposition that appropriately meets the needs of the hospital to this end.
Q: What kind of training should non-security personnel go through? For instance, do you train ER staff on what to do if they realize a patient has just gotten a hold of a weapon?
A: In my opinion, a hospital should provide active assailant/active shooter training for their non-security personnel on an ongoing basis. This type of training can be customized for each department as necessary to include the unique situations most prevalent to that area.
Q: In reading CMS reports and media reports over the last few years of times when Tasers have been involved in incidents at a hospital, it’s almost always been at an emergency room, involving an out-of-control patient that needs to be restrained. CMS has specific restrictions on restraint. Should all security officers go through that training? And what about the use of weapons in those instances?
A: If there is an expectation by the hospital that a security officer participates as a member of the “healthcare team” and assists in restraining an “out of control” patient, it is recommended that the security officer be provided the same training that the other “healthcare team” members in terms of the CMS Conditions of Participation. These expectations should be specific and be made very clear by the hospital administration to the security director (or placed in the contract for the security provider) to ensure that appropriate training is conducted, procedures developed, etc.
It is difficult for me to generalize past incidents in which a Taser has been used involving an “out of control” patient in the emergency department. I do believe that when possible, the best option is for officers to secure their weapons before conducting a “one-on-one” with a behavioral health patient. However, there are exigent situations that may preclude that option.
Q: Some of the incidents have involved an officer who was trying to scare a patient into submission. The affidavit sample (recommended in the ODS special report) says that officers will affirm they won’t do that—how can you ensure that?
A: There are no guarantees, but steps can be taken with special care to eliminate candidates who are physically or psychologically unfit to carry a weapon.
Consideration may be given to adding the psychological assessment and the integrity testing components to the selection process for armed officers. There are reputable and affordable companies with online products which provide these services. However, continued training and appropriate supervision remains the key to an effective program.
Q: The affidavit says in times when a patient is being restrained, you should take the clip out of your weapon—is the same thing true for Tasers?
A: Exceptions occur, as in the case of an emergency where there is no time, but it is a recognized best practice for the officer who is the “contact” officer (making contact with the patient) to not have his/her conducted energy weapon (Taser) on his/her person. He/she should have secured it prior to making contact with the patient.
If possible, there should be a secondary officer who is still in possession of the conducted energy weapon (Taser) who is not in direct contact with the patient who could utilize the weapon in the event an emergency.
Q: In your experience, how often is the use of firearms or other weapons in a hospital setting connected to poor training, lack of resources or overtired officers (either someone pulling extra duty or shifts that have been extended)? This question goes to resources, which are of course limited everywhere but especially at hospitals.
A: Every situation provides an opportunity for analysis and identification of areas for improvement to strengthen the program. For example, officers may have properly utilized force when they deployed their conducted energy weapons (Tasers) on various occasions in defense of another individual’s life. However, as the debriefs and root cause analyses were conducted, opportunities for improving the training and program oversight were determined.
Q: Training, adequate staffing—all of this takes resources. For the financially strapped hospital or for the compliance officer who’s trying to argue for more resources for training or personnel, what advice could you offer? What arguments do you focus on—to track incidents and provide a quality report? Present the C-suite with risk assessments?
A: Risk assessments are a good first start. Risk avoidance is a good argument for ongoing and enhanced training and oversight. Hospitals can be violent places. The answer to changing that unfortunate fact is not to simply arm hospital security officers. Firearms or Tasers, whether carried by officers protecting the hospital or brought into it by others seeking to do harm, are only part of the equation. Investing in non-violent crisis de-escalation training for the security team as well as other staff members is good response. It is imperative that the entire healthcare organization work as one unit in the management of violent patients and potentially violent situations, regardless of improvements in security systems and the presence of security personnel. Seamless integration of these officers into the patient- and family-centered care environment is critical to the ongoing safety and security of everyone.