Patient access needs strategies to cope with a surge of visitors, as well as interest from law enforcement and media in the aftermath of disasters.
- Verify the identity of arriving family members at an outside area.
- Instruct registrars to cooperate with law enforcement.
- Have processes in place for identification of victims.
Patient access will face these challenges in the aftermath of mass shootings or other mass casualty incidents (MCIs):
• There will be a surge of people arriving at the hospital.
After an MCI such as a shooting, “we would implement a closely managed vehicle and pedestrian circulation control plan,” says Dan Yaross, MSM, CPP, CHPA, director of security at Nationwide Children’s Hospital in Columbus, OH, and chair of the Healthcare Security Council at the International Association for Healthcare Security & Safety, a Glendale Heights, IL-based organization for healthcare security, safety, and emergency management professionals. The plan includes signs to direct families and visitors to a few doors with security officers, as well as other staff members, present to provide assistance and maintain order.
An outside area can be used to verify the identity of arriving family members. “It’s a challenge when you have masses showing up and trying to control that,” says Yaross. “It can initially begin as uncontrolled chaos, until the facility implements its circulation control plan and locks down most of the normal entry points.”
• Patient access will need to cooperate with law enforcement.
Law enforcement typically takes over the facility during the incident and will interview anyone even remotely involved, says Richard Sem, CPP, CSC, president of Burlington, WI-based Sem Security Management. “They definitely will talk with patient access staff, if they were in or near the incident,” says Sem. “Also, being frontline staff and gatekeepers, there is a chance that attackers may have earlier passed or interacted with patient access staff.”
Michael S. D’Angelo, CPP, CHPA, director of security at South Miami (FL) Hospital, says that when victims are transported from the scene of the event to the hospital, “we create an extension of the crime scene.”
Victims’ injuries may contain material evidence. “There is no doubt that many of the victims who are alert will have eyewitness recollection of some of the events leading up to the attack,” says D’Angelo.
Although investigative agencies recognize medical care is a priority, patient access must understand that law enforcement needs immediate access to victims, says D’Angelo. “We have gone so far as to have detectives ‘scrub’ into surgery so they can be there when evidence is removed from a patient,” says D’Angelo.
• The hospital will become the focus of intense media interest.
During emergency preparedness drills at South Miami Hospital, media sites are set up. “This minimizes their intrusion into regular hospital areas and from maneuvering their way through regular hospital operations,” says D’Angelo.
D’Angelo recommends having the hospital spokesperson make hourly visits to the media site. “This aids greatly in gaining their cooperation with staying in this designated area,” he explains.
• Processes are needed to identify victims.
“In our jurisdiction, the identification of victims from any mass casualty, terrorism, or criminal incident would be done by the medical examiner’s office,” says D’Angelo.
A family reunification center would be set up to help people locate their family members, whether hospitalized or deceased, and patient access would assist in directing people to this location.
The location of South Miami Hospital’s family reunification center is already identified and is included in its disaster drills. “Patient access, as well as all other staff, should be aware of its location during an actual event,” says D’Angelo.
• Patient access employees will need counseling/debriefing.
Sem emphasizes that MCIs are traumatic for all employees, not just clinicians. “As part of the recovery phase, it will be essential to provide counseling and other support to all, including patient access,” he says.
- Dan Yaross, MSM, CPP, CHPA, Director of Security, Nationwide Children’s Hospital, Columbus, OH. Phone: (614) 722-2126. Email: Dan.Yaross@nationwidechildrens.org.