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A prescription for security.

A HOSPITAL'S EMERGENCY ROOM staff sees the result of violence on a twenty-four-hour-a-day basis, 365 days a year. On any given day the action in the emergency room may resemble that of a mobile army surgical hospital (MASH) unit. Added to the normal anxiety and disorder, the fear of crime in this setting can affect the hospital's ability to recruit and retain valuable people. Security measures, such as those implemented at the Henry Ford Hospital in Detroit, help manage the environment and give employees a sense of control.

In 1982, the hospital moved its emergency service unit to a new building. Between the time of conception and the end of construction, leadership and staff for the department of emergency medicine had changed dramatically. Security recommendations had been lost in the process or, at best, modified without discussion with security personnel.

The lack of security and its effect on the quality of patient care soon became evident. Inebriated patients, substance abusers, psychiatric patients, and emotionally distraught family members who could no longer cope presented more and more potential for disruptive and combative behavior. Even the security staff had concerns about its own safety and ability to control the environment.

In response to these growing concerns, an ad-hoc committee was formed to address the issues. Members of the committee included emergency department staff, the administrator, and security representatives. The committee served several purposes. The major focus of the group included a review of security incidents and issues. Participants assessed security needs and developed recommendations for improvement.

One primary issue of concern was the access to the treatment area from the walk-in entrance, ambulance entrance, and connecting access points between buildings and the emergency department. To tighten control, the committee developed a plan, which has now been implemented, that would limit public access to two points--the walk-in entrance, located on the west side of the emergency building, and the ambulance entrance, located on the north side of the building.

Depending on the level of care needed, patients seeking medical assistance who enter through the walk-in entrance go through the appropriate registration procedures and are screened by security to see if they are carrying any hazardous objects or materials, such as a knife or even a baseball bat. They are then sent on to the triage and treatment areas. (In triage, their condition is evaluated for priority of medical treatment.) Individuals who enter through the ambulance entrance or are in an acute condition are sent directly into the treatment area where they are also screened by security and medical personnel.

The committee's plan shifted responsibility for access control for the nursing station to the front security desk. Access control devices were installed, including electromagnetic locks, CCTV, and two-way communication. Electronic combination touch pads are available to authorized staff. Others are screened by security.

Walk-in entrance. The walk-in registration area on the west side of the emergency building was designed so that the outside doors are controlled by security or, in an officer's absence, by the registration clerks who have a door control button at their desk.

A security desk, located to the side of the registration desk, places the officer at an elevated position, approximately one foot higher than the floor level, and the desk's counter is too wide for an individual to lean over. The desk is also enclosed on the ends to prevent individuals from coming around behind the officer. Security personnel at this post can see over people standing at the desk and have a better view of the main entrance.

A door located at the north side of the security desk in the walk-in area provides access to the security foyer leading to the ambulance entrance and on to the resuscitation rooms and triage. The door is secured with an electromagnetic lock and can only be opened from the security officer's desk.

Cameras are positioned in the lobby to monitor the security desk, waiting room, and patient registration and discharge area and in the ambulance entrance foyer to monitor the security desk and arriving vehicles. The cameras also provide back-up monitoring in the event security personnel are otherwise occupied and someone pulls up to the ambulance entrance requiring assistance.

Surveillance cameras monitor the corridors of the department. The cameras are staffed by officers posted at the security desk in the lobby. Each of the interior cameras also has two-way audio. This arrangement provides security with the ability to detect problems visually of audibly.

Once patients have registered and are ready to enter the treatment area, they must pass through the screening room, which separates the registration area from the triage area. There, a security officer asks the individuals if they are carrying anything for their own personal protection or carrying any metal objects. They are then asked to place any such possessions in a tray until the screening procedure is completed. These individuals must make two passes through a metal detector in both directions. A hand-held screening device is used if the alarm is sounded. Patients are taken to the triage and then into the treatment rooms. After treatment is completed, patients exit through the security foyer into the waiting room.

The original discharge door leading from the treatment room into the waiting area presented a problem because patients or visitors would open the doors and admit others into the treatment area. In addition, individuals would occasionally slip inside when someone exited. To combat this problem, the discharge door was outfitted with an electromagnetic lock. An infrared sensor next to the crash bar releases the door lock as the hand reaches out to the bar. In addition, an enclosed ten-foot hallway, or security foyer, has been created separating the waiting area from the treatment area. The doors are always locked against entry from the outside. The ten feet between the two doors precludes a person from holding the discharge door open and reaching out to open the second door. In a sense, it is a reverse mantrap.

Ambulance entrance. The ambulance entrance consists of two sets of double retracting doors that are activated by a sensor. There is an outer and an inner set of doors. One of the concerns about the doors was the free ingress. In the event a large group of people should try to enter, it would be impossible to slow them down. A power shunt switch was added to allow security to shut the power off and deactivate the doors. However, this measure is not foolproof, especially since the doors are required to break away to comply with life safety regulations.

A family room was created and located off the inner corridor west of the ambulance entrance and is accessed from the northern security foyer. The resuscitation room, where major trauma cases are taken, is to the east of the ambulance entrance. The purpose of this room is to provide an area close to the trauma patient for family and friends to wait. More important, it prevents visitors from wandering throughout the facility and running into the treatment rooms to see what is being done.

The security foyer was created by adding a door in the hallway adjacent to the family room just before the ambulance entrance. A door was installed in this northern foyer, and access is controlled by an electric-strike lock requiring use of an electronic touch pad on the west side of the door. The door lock can be remotely controlled from the walk-in entrance security desk. A camera views the locked side, or western side, of the door. Family and friends bringing patients into the emergency department from the ambulance entrance are sent to the waiting room, and they cannot reenter the treatment area.

Several modifications continue to occur, but they are viewed as fine-tuning the system as opposed to major changes to the program. One change was the addition of electromagnetic locks and the electronic touch pad to control access into the resuscitation rooms. These have been added to protect the supplies, because ambulance crews had been replenishing their stock from the hospital's inventory.

The security department had to consider access control not only of people but also of vehicles. One day, in the early hours of the morning, a psychiatric patient who believed he was being chased by demons drove his car through the emergency entrance doors. He demolished the two sets of automated double doors and a double door across the inner corridor leading to the triage area. After this incident, several three-foot high cylindrical cement pillars were installed. No one has tested them to date.

The original security system was designed to be controlled and monitored by the emergency department itself. In addition, the computerized security management system that now manages 100 card readers and more than 1,000 alarm points had not been installed.

When the emergency department's security system was expanded and improved, the additional cost of card readers and of tying everything into the hospital's main computerized management system had to be considered. The emergency department opted to maintain its own system and to keep the new hardware consistent with the existing system. Thus, it is a separate security system from that of the main hospital building's security system.

Electromagnetic locks were chosen because they are the most forgiving over time, especially if doors sag or droop from bent hinges or other abuses, wear, and tear. Each door lock, where necessary, is tied to the fire alarm system and automatically releases if the fire system is activated. The locks on the two resuscitation rooms required additional measures. Since electromagnetic locks were being used, anytime the doors closed, they locked. Concern about quick and easy entry and exit had to be resolved. This problem was addressed by adding the infrared sensors inside with a fail-safe large red push button near the door as a secondary release in the event the sensors ever failed. The buttons act as a power shunt switch. The touch pads outside the doors satisfied the entry concerns. Other pieces of hardware that make up the security system include panic buttons that are located in strategic areas of the emergency department.

In 1985, the security department added what many consider the centerpiece of the security system, a magnetometer. It is used to screen all patients and visitors entering the treatment area via the lobby. Patients entering via the ambulance entrance are screened by the officer stationed there. If the patient's condition is serious, the officer waits until the patient is situated in the triage or treatment area; nursing staff assists if necessary.

Does it work? Periodic surveys of the staff, including security, have been conducted since 1985. The medical staff and support personnel have consistently agreed that access control, the presence of professional and trained security staff, and the screening system are the most important factors that make them feel safer. Is the system foolproof? Of course not. However, the system will continue to be evaluated, assessed, and fine-tuned as part of an on-going process.

Tom Kramer, CPP, CHPA (Certified Healthcare Protection Administrator), is director of security at Henry Ford Hospital in Detroit. He is a member of the ASIS Standing Committee on Health Care Services.
COPYRIGHT 1993 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:Health Care Security; security considerations in health care facilities
Author:Kramer, Tom
Publication:Security Management
Date:Jun 1, 1993
Previous Article:Are we shortchanging ourselves?
Next Article:Signing up for security 101.

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