ED managers react to threat against hospitals: Here are security strategies
Solutions range from ID badges to revamped lockdown procedures
When the Federal Bureau of Investigation disseminated a statement to medical centers in four cities warning of a potential terrorist attack in mid-December, emergency department (ED) managers reacted decisively to implement effective security measures. Those measures are being examined by EDs around the country that want to ensure their facilities are fully protected.
"Although the current threat is probably not credible and hospitals have, thus far, been unusual targets for terrorists, I’m certain that there are individuals who would seek to advance their cause by attacking a health care facility," says Brent R. King, MD, FACEP, FAAEM, FAAP, chief of emergency medicine at Memorial Hermann Hospital in Houston. "That being the case, we should always be prepared."
The potential threat was reported to hospitals in Chicago, Houston, Washington, DC, and San Francisco. The challenge is to keep EDs accessible to patients while increasing security measures to prevent possible terrorism, King says. "The very nature of emergency medicine means that we work in a relatively open environment," he says. "We want people to have ready access to our EDs in their time of need."
ED managers were quick to share the news with staff. Michael F. Boyle, MD, FACEP, medical director of emergency services at Memorial Hermann Southwest Hospital in Houston, reports that immediately after he was informed of the threat, he sent an e-mail to alert his colleagues.
"The EDs appreciate the warning, because it serves to help us maintain vigilance," says James G. Adams, MD, chief of the division of emergency medicine at Northwestern University Medical School in Chicago.
Boyle says staff will be more likely to report suspicious activity due to the threat.
"It’s a good thing for us to be tested in this way," says Timothy Seay, MD, FACEP, regional medical director for Greater Houston Emergency Physicians. "There is no downside to having this information."
Here are some steps taken to increase security at the EDs in the threatened cities:
• The number of security officers is being increased. The ED is a difficult security environment, Seay says. "Traditionally, [the ED] is the thoroughfare into the rest of the hospital after visitor hours," he says.
Northwest Community Healthcare in Arlington Heights, IL, increased the number of uniformed officers in response to the threat, and the local police were asked to increase their mobile surveillance, explains Arlene Stucki, chairwoman of emergency management. In addition, some employees, such as nonclinical directors, have been cross-trained to function in security roles when needed, she says. These individuals wear identification vests, monitor exits, screen visitors, and have radio access to trained security guards, she says. "We use them in any event that exceeds the capacity of our security staff, which is three to four people on a normal day," she says.
• EDs are practicing lockdown procedures. Stucki’s facility has practiced its lockdown procedures, which would be used whenever the ability to continue operations is threatened due to contamination or security. In addition, policies were developed for employee housing, child care, and pet care in the event of a lockdown. The facility administrators considered going to lockdown status in response to the recent threat, she adds. "We have policies and procedures in place for a lockdown status if needed, but did not see that as appropriate to this threat," Stucki says. "We have chosen to remain an open facility at this point."
Policy allows for traffic, parking restrictions
The facility’s lockdown policy allows for rapid expansion of the security force if needed, Stucki notes. During lockdown, access to the ED, traffic, and parking are all controlled, she says. "We can control who enters and who exits the facility, and where," she says. If a mass casualty event occurred and the ED needed to decontaminate patients or use a secondary ED site, security would direct and restrict traffic appropriately, Stucki explains. Security staff also are needed to support clinical triage decisions, Stucki says. "People who are panicky, but not clinically ill, may resist triage decisions that will place them in a holding area," she says. "So it’s definitely got to be a combined effort."
• Revamped disaster plans are being used. Most ED managers said they drew heavily upon recently revamped disaster plans to address the current threat. "Every aspect of bioterrorism and disaster management was hashed out in a detailed way based on new threats, but not in response to this particular threat," Seay explains. "We are already well equipped to handle it." He points out that since Sept. 11, 2001, the level of preparedness has increased dramatically. "We were behind, as an industry, in recognizing this problem," Seay says. "Now everybody has access to external decontamination showers, and there is a central supply system that has bioprotective clothing, so all of those items are stored and available."
Boyle reports that the ED will be actively conducting drills with new bioterrorism equipment and decontamination supplies. "We have a fully stocked bioterrorism pharmacy, along with a central system stockpile," he reports.
When Stucki met with others at her facility to discuss their response to the threat, the facility’s revised disaster plan was a cornerstone of their planning. "We mainly relied upon the changes we have made prior to this announcement, to decide our response," Stucki continues. She explains that the plan now includes specific responses to the Washington, DC-based Office of Homeland Security’s color-code system for terrorist threats. (See facility’s responses to each color code, below.)
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Match your security response to the current threat alert At Northwest Community Healthcare in Arlington Heights, IL, the disaster plan addresses the color-code alert system from the Washington, DC-based Office of Homeland Security. Here is the facility’s minimal response to each threat level:
Green: Low risk of attack.
Blue: General risk of attack.
Yellow: Significant risk of attack.
Orange: High risk of attack.
Red: Severe risk of attack. |
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For example, when the code changed to "orange" status the week of 9/11/2001, campus security was increased and the Incident Command Center was activated, Stucki says. "When the FBI threat came forward, we did the same, even though the color code was not elevated, because the threat was leveled specifically at hospitals," she adds.
• Tabletop exercises are being conducted for these scenarios. King recommends conducting tabletop exercises, which involve the gathering of key players to talk through a response to a given scenario, to address possible scenarios based on the threat. "As it currently stands, the greatest risk to hospitals and to their personnel is a contaminated environment that might harm staff and other patients and might close the hospital," he says. He emphasizes the need for advance planning to manage a smallpox outbreak, or contamination from a chemical, radioactive, or biological agent inadvertently brought into the facility by a victim.
• Identification (ID) badges are being used. Boyle says that his facility is about to implement a new ID card system to increase security.
David K. Zich, MD, assistant professor for the department of emergency medicine at Northwestern Memorial Hospital in Chicago, says his ED uses prominently displayed ID badges for all employees, and it limits access to patient care areas by the general public. "All visitors to the ED are required to wear visitor badges after checking in with the security desks," he says.
• Bomb threats are being addressed. Stucki reports that an updated bomb threat policy was presented at a monthly information meeting that is open to all employees. "We have retrained our hospital staff in the correct response to bomb threats or bomb presence in the facility," she says. She says that 1,400 employees participated in an inservicing that included training in communication in the event of a bomb.
Scenario puts all staff through their paces
An extensive tabletop exercise recently was held using the scenario of a bomb threat, with fire and police department personnel participating, she says. Hold drills with scenarios that resemble actual events, advises Stucki. "I wrote the exercise, and submitted it to our fire and police departments to be sure they agreed that it was realistic as to time sequences and actual outcomes of the incident," she says. By doing this drill, ED staff learned about the correct interface with emergency agency providers and how far staff should go in emergency rescue and treatment, Stucki says. "We also talked through the utility failures that would result from this scenario, and the actual evacuation of patients, both horizontally and vertically," she says.
Sources
For more on responses to the terrorist threat, contact:
• James G. Adams, MD, Chief, Division of Emergency Medicine, Northwestern University Medical School, 216 E. Superior St., First Floor, Chicago, IL 60611. Telephone: (312) 694-7000. Fax: (312) 926-6274. E-mail: [email protected].
• Michael F. Boyle, MD, FACEP, Medical Director, Emergency Services, Memorial Hermann Southwest Hospital, 7600 Beechnut, Houston, TX 77074. Telephone: (713) 776-5552. Fax: (713) 937-6918. E-mail: [email protected].
• Brent R. King, MD, FACEP, FAAEM, FAAP, Chief, Emergency Medicine Service, Memorial Hermann Hospital, 6431 Fannin St., Houston, TX 77030. Telephone: (713) 500-7863. E-mail: [email protected].
• Timothy Seay, MD, FACEP, Regional Medical Director, Greater Houston Emergency Physicians, 211 Highland Cross, Suite 275, Houston, TX 77073. Telephone: (281) 784-1500. Fax: (281) 784-1522. E-mail: Tim. [email protected].
• Arlene Stucki, Chairwoman, Emergency Management, Northwest Community Healthcare, 800 W. Central Road, Arlington Heights, IL 60004. Tele-phone: (847) 618-4665. Fax: (847) 618-5259. E-mail: [email protected].
• David K. Zich, MD, Assistant Professor of Medicine, Department of Emergency Medicine, Northwestern Memorial Hospital, 251 E. Huron St., Chicago, IL 60611. E-mail: [email protected].
When the FBI disseminated a statement to medical centers in four cities warning of a potential terrorist attack in mid-December, emergency department managers reacted decisively to implement effective security measures. Those measures are being examined by EDs around the country that want to ensure their facilities are fully protected.
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