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A recent posting on the web site (www.medlaw.com) of EMTALA and risk management specialist Stephen A. Frew, JD, warns hospitals to assess their vulnerability to acts of terrorism and suggests some precautionary measures. A contribution to the site from the Illinois law firm Sorenson, Wilder & Associates points out that by the very nature of their business, hospitals become likely targets for secondary hits following an initial attack elsewhere in the community.
Hospitals should upgrade security and emergency preparedness plans to address this threat, the firm advises, and offers the following suggestions:
1. Develop and establish tight controls to prevent unauthorized access into the facility, including keeping unauthorized vehicles from entering the hospital campus during a community disaster.
2. Require and enforce the use of staff IDs for all staff and physicians, regardless of title or position held.
3. Require all vendors to report to the purchasing department for an authorization badge. During a community disaster, refuse admittance to any vendor not delivering emergency supplies.
4. Coordinate your hospital disaster plan with the community disaster plan. Make sure emergency providers (police, fire, emergency medical services) understand your plan, and that you understand how your plan integrates into the community Incident Command System.
5. Educate employees to report any suspicious persons or activities they observe in and around the hospital campus.
6. Do not expect local police, fire, or emergency medical services personnel to be an available resource, as they may very well be committed at another location. Develop your plan to be self-sufficient.
7. Keep nuclear medicine and radioactive materials tightly secured.
8. Drill, drill, drill. This is a new threat and it must be prepared for in advance. Drills should be staged to test readiness, as with fires, tornadoes, abductions, and all other identified risks.
The law firm’s advisory also emphasizes that the terrorism threat is not just an urban issue, noting that suburban and rural hospitals are just as vulnerable, if not more so, because of the limited backup and support hospitals immediately available.
Frew adds that one of his major concerns is the serious lack of background checks — not just arrest checks — that typifies hospital-hiring practices. "I have personal concerns that hospitals are potential primary targets and not merely secondary targets," he continues. "Even disabling e-attacks on hospital computer systems can kill people. External attack is not the only means for terrorists to disable a hospital with devastating psychological effect."
"From the lowliest worker to the person claiming lofty credentials," he advises, "check out [potential hires] thoroughly."
In another "e-bulletin" from his site, Frew reports on a recent court decision in which a hospital was held liable for the injuries incurred by a 15-month-old patient waiting for care in the emergency department (ED). The hospital was held liable, he points out, "despite the fact that those injuries were caused by an unsupervised 5-year-old who was running amok while his mother was elsewhere in the ED."
The court stated, Frew adds, that merely warning the unruly child to behave was insufficient, and held that the hospital could be held liable for the injuries to the toddler.