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A possible bomb, a deluge of family members seeking information in the ED, and a large number of community volunteers are just a few of the security issues that arose for ED managers in the hours following the terrorist attacks at the World Trade Center and Pentagon. "As health care providers, we are trained to assume we are a secondary target until proven otherwise," says Joseph Ornato, MD, FACC, FACEP, professor and chairman for the department of emergency medicine at Medical College of Virginia Hospitals in Richmond.
Here are the security issues identified at the disaster site and at EDs:
• At the field triage site.
While waiting to treat patients at the disaster site, Ornato learned that a mysterious dufflebag had been spotted without any medical insignia. Immediately, the caregivers on site became alarmed at the possibility that the bag contained a bomb. "Under normal circumstances, a bomb squad would have cleared it, but none of those assets were available," Ornato says. "Ultimately, a couple of firefighters walked the bag a block away."
The bag ultimately was determined to be safe. A layperson volunteer had innocently left the unattended bag, but the frightening incident served as a wake-up call, says Ornato. "It showed us that no matter how hard we tried to pay attention to what was going on, security was just not our priority. At that point, we literally had to set up our own security system," he says.
Firefighters and layperson volunteers were recruited to stand on the disaster site’s perimeter, to ensure no one came into the area who didn’t belong, says Ornato. "We certainly did what we could to increase the surveillance and monitoring, but still, it was a wide-open courtyard and hardly a lockdown," he reports. Volunteer laypeople were recruited by medical personnel to lift backboards. "We set up lines to log them in and put arm bands on them," he reports. "This would have given us a nonmedical workforce to move patients."
Ornato acknowledges the security risks of using layperson volunteers immediately after terrorist attacks occurred. "We did ask for photo identification, so at least we knew who they were if any problems occurred," he says. "But in a rapidly unfolding disaster situation, you’ve got to do the best you can with what you’ve got."
• At area EDs.
Security would have been a major problem if the ED at Bellevue Hospital Center in New York City had received thousands of patients, according to Douglas Yoshida, MD, an attending physician at the hospital. "If the terrorists had wanted to do damage to our hospital, it would have been extremely easy to get through," Yoshida admits.
Numerous people looking for information about their lost loved ones were able to access the ED. "Telling these poor people that we had no record of their relative was an emotionally trying and distracting experience," Yoshida says. Dozens of health care providers in the community also showed up, he adds. "There was no way of ascertaining their qualifications, other than it seemed like someone on staff knew who they were," Yoshida says. He stresses that every hospital disaster plan should include an organized security plan, with a screening process for volunteers.
However, other EDs reported that security was a strong point. "I now realize the comfort in knowing we could control hospital access, says Kevin Chason, DO, director of prehospital care and disaster management at the department of emergency medicine at Mount Sinai Medical Center in New York City. The Medical Center covers four city blocks between two avenues, he explains. "In past drills, we noticed how difficult it was to control access to such a large campus with many points of entry,’ he says. "We had even created drills specifically to evaluate the weaknesses."
Prior drills included sending medical students in all states of dress, with and without ID, in an attempt to breach security at many of the access points. "On Sept. 11, we went to a total lockdown," reports Chason. "There was one entrance in and out with ID access only, all scheduled deliveries were confirmed, and all packages were inspected," he says. Staff members escorted patients and family members into and out of the ED, he explains. Chason adds that security in the emergency department also was reinforced. "There were only escorted visitors for short visits, and only personnel assigned to the department were permitted access," he says.