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Should ED security be armed with guns, Tasers, or pepper spray? “Arming security officers assigned to work in the ED is a highly debated issue among healthcare security leaders,” says Michael S. D’Angelo, CPP, CHPA, director of security at South Miami (FL) Hospital.
A recent study examined the type of personnel serving as security in hospitals as well as policies and practices related to training, carrying, and using weapons.1 Some key findings of data pertaining to 340 hospitals:
Although D’Angelo is opposed to arming the hospital security force, he acknowledges that hospitals may have valid reasons for it. “On the surface, armed guards appear to be a strong deterrent to ED violence,” he notes.
D’Angelo says the decision on whether to arm the ED security team should be based on available data, not just subjective opinions. “For all the proactive deterrent advantages an armed force may bring, there are several factors the hospital would have to thoroughly review before considering such a significant change,” he says. Here are some considerations:
“This would likely involve your hospital legal team’s oversight. You are arming your team with lethal weapons,” D’Angelo says.
The potential for harm has increased substantially, so there is no question that the hospital’s overall liability exposure also increases. “The potential for force involving great bodily harm or death is significantly higher than any of the less than lethal tools your security officers may now carry,” D’Angelo explains.
State licensing departments may put in place requirements that even proprietary security forces must meet. In Florida, for instance, in-house security teams are exempt from state security licensing requirements. “The same is not true for armed officers,” D’Angelo says.
D’Angelo says to consider carefully the value of arming the ED security force, pointing to recent research on hospital-based shootings.2 Some findings:
“Even more alarming, 18% of these ED-related shootings began with an unarmed perpetrator,” D’Angelo notes. Eight percent took the firearm from the armed guard or police officer.
“When you review this data, it is very easy to see how the exposure to liability can be significant,” D’Angelo says. Law enforcement agencies routinely face civil action stemming from shootings. “And their training with firearms arguably surpasses even the most advanced security training,” D’Angelo adds.
One or two security officers typically are posted in an ED, depending on the ED’s size and demographics, D’Angelo explains. Usually, their primary function is directing patients to appropriate triage and registration areas and general crowd control. A second security officer might be posted in clinical areas, with the primary responsibility of safeguarding staff.
“Expecting a single armed security officer to be in the appropriate place at the needed time is unrealistic,” D’Angelo says. “In most targeted hospital shootings, the shooting is over before security can respond and react.”
In a use of force situation, there is the possibility either party will be injured. “When the answer to an escalating situation becomes a lethal weapon, ED physicians may now be faced with treating more severe injuries or additional patients,” D’Angelo says.
Regardless of whether it was a justifiable use of force on security’s part, D’Angelo concludes, “the potential for injury and the exposure to liability increase when a firearm is involved.”
Jack Rozel, MD, MSL, medical director of the Pittsburgh-based re:solve Crisis Network and president-elect of the American Association for Emergency Psychiatry, says, “My greatest concern is misuse of armed security in leading responses to behavioral emergencies that are clinical events requiring skilled medical intervention.” Additional risks include misplaced or accidentally discharged weapons.3
Still, says Rozel, for some EDs with high rates of violent crime due to their location or clinical population, armed security makes sense “to deter some types of aggression or criminal behavior, handle law enforcement functions, and provide rapid response to violent crime in or near the facility.” Hospital practices and policies strengthen the defense in the event of litigation, if they:
There will always be outlier events and unexpected repercussions of decisions. “Defensible hospital practices will show reasonable efforts by decision-makers to identify and balance these issues,” Rozel says.
Financial Disclosure: The following individuals disclose that they have no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study: Arthur R. Derse, MD, JD, FACEP (Physician Editor); Stacey Kusterbeck (Author); Jonathan Springston (Editor); Kay Ball, RN, PhD, CNOR, FAAN, (Nurse Planner); and Shelly Morrow Mark (Executive Editor).