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:

  • Typically, security personnel were non-sworn officers directly employed by hospitals (72%).
  • Available tools included handcuffs (96%), batons (56%), oleoresin capsicum products (such as pepper spray, 52%), handguns (52%), conducted electrical weapons (47%), and K-9 units (12%).

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:

  • The security department’s use of force polices would have to be revised significantly.

“This would likely involve your hospital legal team’s oversight. You are arming your team with lethal weapons,” D’Angelo says.

  • The organization’s insurance premiums and limits will be affected.

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.

  • Training requirements will need to meet a much higher standard.

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.

‘Significant’ Legal Exposure

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:

  • More than half (55%) of hospital shootings occurred in or around the ED (34% occurred inside the ED, and another 21% occurred near the ED ambulance ramp, parking area, or walkway).
  • In 74% of these shootings, an armed security officer did not use his gun on the shooter.

“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.”

Use Defensible Practices

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:

  • reflect comprehensive approaches to security;
  • articulate clear rules for engagement and use of force;
  • delineate the function and role of armed security;
  • show approaches to recruiting, training, and supervising armed security staff who support the clinical mission of the ED team.

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.


  1. Schoenfisch AL, Pompeii LA. Security personnel practices and policies in U.S. hospitals: Findings from a national survey. Workplace Health Saf 2016;64:531-542.
  2. Kelen GD, Catlett CL, Kubit JG, Hsieh YH. Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med 2012;60:790-798.
  3. Rozel JS. Armed law enforcement in the emergency department: Risk management considerations. ABA Health eSource, 2016. Available at: Accessed March 6, 2017.


  • Michael S. D’Angelo, CPP, CHPA, Director of Security, South Miami (FL) Hospital. Phone: (786) 662-8895. Email:
  • Jack Rozel, MD, MSL, Medical Director, re:solve Crisis Network, Pittsburgh. Phone: (412) 864-5013. Fax: (412) 864-5044. Email:

EDs Report Increased Violence

More than half (51%) of hospitals reported increasingly violent patients and family members in their EDs, according to the 2016 Hospital Security Survey conducted by Health Facilities Management and the American Society for Healthcare Engineering. Other findings:

  • Seventy-five percent of hospitals said that maintaining security has become more challenging over the past two years;
  • Eighty-five percent of hospitals use aggressive management training (another 5% plan to implement the training in the next year);
  • Seventy-eight percent of hospitals conduct a physical facilities security assessment at least annually;
  • Almost half of hospitals use a combination of in-house and outside security firms to conduct security/risk assessments;
  • Most hospitals (64%) do not hire contract security officers, off-duty police officers, or a combination of both;
  • One-third of hospitals are using handheld metal detectors, and 7.5% are using walk-through metal detectors.