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Emergency room violence prompts hospitals to tighten security

Security spending geared towards better locks, security staff and more cameras, but most important spending on risk assessment and staff training.

David Weldon, Contributor

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Several recent high-profile attacks against healthcare workers in U.S. hospitals have exposed dangerous flaws with security at healthcare providers, prompting hospitals administrators and even lawmakers to look for ways to better safeguard staff.

In California, a bill recently approved in the state Assembly seeks to close one dangerous loophole in hospital security. Under current law, anyone convicted of assaulting a physician or nurse rendering emergency medical care outside of a hospital or healthcare facility faces a fine up to $2,000 and/or up to one year in jail. Place the same assault inside the actual hospital, and the incident is treated as a lower misdemeanor, punishable by only up to six months in jail.

 “I just read an OSHA report today that indicates that assaults in healthcare far exceed any other occupation or any other industry,” said David LaRose, president of the International Association for Hospital Security and Safety. “It is a significant aspect of the healthcare industry.”

According to LaRose, emergency rooms are often the top target of violence. However, behavioral health departments and facilities are another primary target.

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For several years hospitals have initiated “perimeters within perimeters,” LaRose said – increased security in maternity wards to protect newborns or in the pharmacy to deter theft of drugs.  Much of the new security attention is focused on protecting points of entry without impacting the “public openness and accessibility” mission of the hospital.

LaRose said security spending is certainly going towards better locks, more security cameras and the obvious trappings of a more secure building. But the most important spending is on risk assessment and staff training.

Risk assessment also requires a team approach – clinicians, support staff, security professionals, and outside security experts all need to participate. However, that’s also where many hospitals fail: They don’t ask enough questions of enough people.

“Sometimes there wasn’t enough assessment done before a solution was relied upon,” LaRose said of problems he has seen. “You can’t just throw technology at something and say that’s going to fix your problem. You can’t just say that a staff member is going to fix your problem. That’s why you really have to have a collaborative cohesive stakeholder meeting. You need to understand the workflow, you need to understand what the organization’s goals are, what the culture is, who your customer and patients are.”

No quick fix

While healthcare administrators may look fora silver bullet cure to violence in their facilities, the solution is actually very practical, said William (Bill) Nesbitt, president of Security Management Services International, a leading security firm serving the healthcare industry.

“Generally, physical security really applies to things like locks, access control systems and fencing – actual devices and security officers. It is in fact very situational,” Nesbitt said.

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“One of the first things we do when we go into any site, no matter where it is, is that we’re looking to find out what the crime environment is like,” Nesbitt said. “The threat environment is so different from one locale to another. There are sociological differences. There are ethnic differences. We look at what kind of history does the hospital have. We’ll go back through two or three years of incident reports to see if there are patterns and the kinds of things that go on.”

But there is one thing that all hospitals and healthcare centers have in common when it comes to security and safety, Nesbitt said. The facility needs to be open to everyone. But just how open should depend on how each visitor is assessed from a risk perspective.

 “Probably the most vulnerable is the emergency department, especially if you’re a level one trauma center” Nesbitt says. “That’s where the sexual assault victims will be coming in, the gunshot victims, victims of other violence, people high on PCP or something, people with psychological problems.”

Training for employees is on the rise, and Nesbitt said he is encouraged that extreme acts of violence against healthcare workers may decline.

“One of the things that is getting better is the training programs that train people within hospitals on how to deal with adverse behavior,” Nesbitt said, which can often mean knowing how to diffuse a hostile situation before it becomes violent.

And while shootings or armed threats can definitely prompt security overhauls, it’s not the only type of encounter that prompts hospitals to seek out a security provider.

“In some cases it definitely is an incident,” Nesbitt said. “In some cases it is a member of staff that starts to express feelings that they don’t feel safe.”

“It could also be property crime – cars being broken into in the parking lot, purse snatches in the parking lot,” Nesbitt said.

Whatever the security challenge or crime,, the first line of defense should be the employees themselves.

“The most important single factor in keeping the hospital safe is getting the employees involved in being the solution. That takes some training,” Nesbitt said.

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