Outpatient surgery managers can study the recent lockdown at Inova Fairfax Hospital in Falls Church, VA, involving an escaped bank robber for lessons that might improve their own emergency planning. The incident affirmed the value of much of the facility’s planning, but it also highlighted some needs that had not been considered, says Greg Brison, the hospital’s director of emergency management and security.
Brison notes that some of the lessons from the experience can apply to many emergency situations, not just an active shooter. He offers this advice gleaned from the facility’s experience with a shot fired and five-hour lockdown:
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Provide access and information to local law enforcement ahead of time.
During an emergency, it might be difficult for anyone to meet police officers at the front door, let them in, and then guide them through the facility. Provide a way for police to gain entry on their own, such as keys or key cards, along with detailed floor plans they can use on arrival.
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Standardize how you name entryways.
Inova Fairfax has numbered all entry points, starting with the main entrance as Door 1 and then working around the building clockwise with sequential numbers. The number is marked prominently on the entryway. This system will improve communication with police who can be told to go to Door 5, for example, rather than having them struggle to find “the west wing entrance near radiology.”
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Security should know where prisoner patients are at all times.
It is not enough for security to know that an inmate is in a certain unit. Security should know exactly what room, and staff members should notify security whenever the patient is moved somewhere else.
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Serve only finger food to prisoners.
Even plastic eating utensils can become effective weapons, so prisoner patients should be designated for only meals that require no utensils, such as a sandwich. Any staff members delivering meals should know of this restriction so they don’t routinely include a utensil packet or comply when the prisoner asks for one. If you decide to provide utensils, you must have a strict accounting of them afterward.
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Use high visibility clothing for prisoners.
As a result of the prisoner escape, Inova Fairfax will no longer provide standard hospital gowns for anyone under police custody. Those patients now wear bright orange gowns to make them easier to spot if they escape and also to serve as a warning to staff that this person could be hostile.
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Enable after-hours security officers to access security video.
It is common for night-time security officers to be limited in their access to security camera recordings, and it frequently requires a manager to come in to the facility and to obtain them. When a violent person still might be on the campus, security officers must be able to gain access to those recordings without delay so they and local police can identify and track the person.
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Have backup command centers.
For much of the lockdown, Inova Fairfax leaders could not get to their command center because it was in an area of the hospital not yet cleared by police. They now are establishing a backup command center on the opposite end of the building, with the same communication capabilities and resources such as job action sheets.
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Arrange police escorts for necessary clinical care.
Even in a lockdown, patients might have a clinical emergency. The staff members responsible for those patients cannot remain in place as they are supposed to during a lockdown, so police should be prepared to escort them and guard them as they work. This system is best accomplished by discussing the need with police ahead of time so they can have adequate personnel on hand.
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Arrange for off-site parking.
Parking might seem a mundane issue when people are in jeopardy, but it quickly became a problem that threatened to hinder the response of staff and local law enforcement. The Inova Fairfax shooting happened at 3 a.m., and the hospital’s shift change is 6:30 a.m. Additionally, outpatients begin arriving soon after, so about 2,000 people and cars were arriving while the hospital campus still was locked down.
Inova Fairfax is developing a plan for designated parking areas in an emergency and a method for notifying those coming to the facility. The plan also will include a way to ferry critical staff to the facility from those off-site parking areas.
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Prepare for media arriving at your campus and other areas.
The plan should call for public relations staff and security officers to be on hand, not just at the hospital campus, but also at any other area where staff members are likely to congregate after evacuation. Reporters will go to those areas to interview staff, so public relations representatives should be there also to help control the public message. Any designated off-site parking area for incoming staff and patients must have media relations and security present.
Another precaution includes handcuffing the patient to the OR table, says Mark Mayo, CASC, executive director of Golf Surgical Center in Des Plaines, IL. Even if sedated, “some prisoners may be ongoing drug users who have a higher tolerance to medications,” Mayo says. Other items to consider include limiting advance notice, in the event the prisoner wants to notify someone on the outside of the facility to try to arrange an escape, and allowing a police escort to be posted just outside the procedure room.
“Staff need to be trained and understand that prisoners, who may look and act normally, should still be considered dangerous,” Mayo says.
Cases with gunshot wounds need extra care, he says. “In many cases of gunshot wounds there is … a need for a proper ‘chain-of-evidence’ handoff so that any retrieved bullet can be used by law enforcement and the courts in any ongoing criminal investigation,” Mayo says.
