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Healthy security at Children's hospital.

CHILDREN'S NATIONAL MEDICAL CENTER OPENED 120 years ago as a small, twelve-bed hospital in a rented townhouse. Today, the vast complex, located in Washington, D.C., includes a 600,000 square foot, eleven-story pediatric facility where more than 58,000 children are treated each year. The challenges faced by security are as wide ranging as the problems brought to the hospital's doors daily by its several thousand visitors.

Children's is one of only three pediatric centers in the country. Its unique fields of specialization, such as bone marrow transplants for children with cancer, bring patients from all over the world. The medical staff faces a daunting 200 emergency room visits daily, including eight to ten life-threatening trauma victims flown in, via the hospital's rooftop helipad. Two hundred separate research projects are also being conducted at the center. Ten off-site locations, around Washington and the nearby Virginia and Maryland suburbs, include a warehouse and several consultation clinics where doctors can see children who may need treatment at the main hospital.

Although located near poor neighborhoods in the city's northwest sector, the center is fortunate in that it does not face the more troublesome inner-city problems, notes J. Michael Fingerhut, director of security for Children's. "Part of our advantage here is that we are located in [something like] a campus of four hospitals ... so we don't have problems with neighborhood type crime." The other area hospitals are unrelated, but serve to create an enclave that keeps away violence.

Even so, when Fingerhut joined the hospital in 1988, he confronted a number of concerns. Security officers were not highly visible, response times were slow, petty vandalism occurred in the parking garage, VCRs and other electronic equipment was sometimes stolen, and security equipment was limited and not well coordinated. "When I got to the hospital," he notes, "someone handed me five different [access] cards. We had five different systems."

A single card now affords staff members access throughout the facility. That is only one of the many changes security has undergone over the last few years. Not all of the modifications have been enhancements, however. Like most managers in recent times, Fingerhut has had to contend with budget cuts that have left him with a much smaller guard force-twenty-six proprietary officers, down from a high of fifty-two, some of which were contract officers.

Fingerhut anticipated the trend and compensated by modifying both his training program and the mix of equipment to personnel. As a result, he says, the department accomplishes as much or more with fewer people. "When we weren't in a money crunch, we committed our resources to electronic security," he explains. The loading dock, for instance, used to require a twenty-four hour guard. The location is now monitored remotely by cameras viewed from the command center, located on the first floor near the entrance to the emergency room. The center serves as command post, control room, and security base of operations.

"At the same time," he notes "we have never laid people off in our department. If some quit, [he hospital] would eliminate that position, but people who are here been getting regular performance reviews and merit increases." That approach has helped the department avoid morale problems.

Fingerhut's strategy has been to make sure that the remaining force is small but elite. He has also taken steps to raise security's value to the corporation by expanding the services the security department provides patients and hospital staff and by raising the visibility of officers.

All officer candidates are prescreened. Background checks are conducted both by the hospital's human resource department and by local authorities in connection with the officer's application to become a police officer.

Security staff members are all commissioned as special police officers with the authority to make arrests. "In a city where you sometimes have to wait forty-five minutes to three hours for a police car ... it's a necessity," says Fingerhut. Even so, the focus is on assistance, not enforcement. Fingerhut seeks out officers who work well with people and who can communicate calmly, particularly in tense situations. "In a hospital, you get a lot of parents who are under tremendous stress because their child is sick. Our job is to understand that," he explains.

Officers are given training in stress management. Lydia Chapman, a clinical manager on the hospital's staff, cites one occasion where the father of a young patient lost control and began beating the wall. Although the nurses thought he should be stopped, the security officer let him continue until he cooled down and then guided him to a room where they could talk about his problems. "The security officer was able to realize this guy needed to ventilate, and that was a positive way he could get his frustrations out," says Chapman.

Of course, officers must intervene at times. Security training includes instruction in aikido, which is a method of restraining individuals nonaggressively. "Sometimes the parents tend to blame each other and, of course, they may get physical, and we will have to separate [them]," says Fingerhut. At other times, parents get upset when they have to wait in the emergency room, or they may be reluctant to let doctors handle their child. In those cases, security has the delicate task of separating family members from their children and taking them to a waiting room.

Fitness is a key element of officer training. To improve response times and ensure that officers will be ready to handle physically demanding duties, a strenuous fitness regiment is followed. Officers must pass a monthly physical test where they run at least a ten-minute mile as a team, and then compete for the best time in individual runs.

The department also simulates a helipad emergency in which hospital elevators are not working or are unavailable. Officers are tested quarterly on their ability to climb the eleven flights of stairs in four-person teams. Once they reach the helipad, they pick up a backboard with a child-sized mannequin strapped to it, lift it, and carry it into the hospital--all in about three minutes. Timing is important, because the hospital may get less than a minute's notice when a real trauma patient is arriving by helicopter.

Extensive fire brigade drills are another part of the program. A fire brigade at the hospital consists of up to fifty people, including engineers, plumbers, nurses, the cleaning crew, and transport technicians. It is the security officer's job to command the members of the group. "Two or three times a year, every single officer has practice where they learn what it is to command all of those people," says Fingerhut."

Infection control training is an essential concern for security at a hospital. Officers may, in unloading a helicopter or ambulance or in restraining a visitor or patient, come in contact with potentially life-threatening bodily fluids or airborne contaminants. All officers carry rubber gloves in a pouch on their belts and have access to masks and gowns. "They understand what procedure to use to protect themselves," says Fingerhut, "and, if exposed, what washing procedures to use."

Officers also receive special training for dealing with the media. "We've had a lot of VIP visits," explains Fingerhut. The hospital attracts many dignitaries and celebrities, both as patients and as visitors who come to entertain the sick children. Among the more well-known recent entertainers have been Michael Jackson and Harry Connick, Jr. Willard Scott broadcasts a Today Show segment live from the hospital once a year. Crowd control is the biggest concern for guests like Jackson, who want to spend time with the children, rather than giving autographs to visiting adults.

The hospital closely guards the privacy of those who come for treatment. "We will give them a different name on the hospital computer and charts," explains Fingerhut. Only the doctor will know the real identity. Security will be told that the individual is a VIP. This procedure is also followed for victims of violence who might fear a visit from an attacker or abusive spouse or parent.

A security officer escorts high-profile or high-risk patients from department to department, makes sure that they have unmarked parking, and that crowds are kept away. If necessary, the doors to their unit, normally open, are secured to keep out the curious.

The press must have a security escort to enter the hospital, and, if a particular station's reporters get a reputation for being too aggressive, security is alerted to make sure that they do not gain unauthorized access.

Additional training covers helicopter safety, aircraft safety, abduction prevention, legal and policy updates, use of electronic security equipment, and general security techniques. Training is reinforced regularly with annual refresher courses. With the exception of the department shift supervisors and investigators, the entire force receives the same instructions and rotates duties. "All of our officers have to do the same work, so that if we're short or someone is out, they are all cross-trained," explains Fingerhut.

Although officers do receive weapons training and take an annual pistol range qualification test, the force is not armed. "Without firearms," explains the security director, "officers have to depend more on their ability to solve problems by using their intelligence." In response to the rising number of violent incidents in emergency rooms across the country, however, the hospital is exploring the British approach, which is to train a special group of on-staff officers as a strike force ready to respond to armed situations.

When an officer is first hired, he or she works for thirty days on a probationary basis without donning a uniform. In addition to the training already discussed, officers spend time on each floor of the hospital to learn procedures and locations. They must memorize the names and functions of every activity in the hospital, from otolaryngology (ear, nose, and throat procedures) to gastroenterology (disorders of the stomach) to hematology oncology (the cancer unit). Officers must master what these procedures are, where they are, and how to pronounce them.

At the end of the thirty days, they are given a 100-question exam. "We have had several officers fail during their probationary period, so it's not automatic," notes Fingerhut.

High visibility and quick response time are continually emphasized by the department. This philosophy is applied to everything from a serious emergency call to a minor flat tire repair. While fixing a tire or jump starting a car might seem trivial, Fingerhut notes that parents leaving the hospital can be very stressed out after several days with a seriously ill son or daughter. Car trouble may be the last straw. "We can respond in two or three minutes, which really enhanced our reputation," he says.

For visibility, the department builds on the concept of the neighborhood beat. Officers walk the halls, where they are encouraged to take time to play with the young patients and to get to know visiting family members. They carry a data recorder and check in at 100 stations a week. "We virtually hit every unit in the hospital, every location, every forty-five minutes," says Fingerhut. "It gives parents a feeling of security and well-being to see an officer at least once an hour," he notes.

Emergency room security is given extra attention. Seven data stations ensure that officers make regular patrols through the waiting room, and one officer is assigned to the area around the clock. If an incident occurs, additional security arrives in force. "Usually, no matter how tough someone thinks they are, when four to six officers show up, they tend to calm down very quickly," says Fingerhut.

At night the emergency room door is now locked for added safety. The emergency room officer was always able to visually inspect visitors, as the guard desk is just inside the door. An emergency room speaker has been added at the post so that the officer may also speak with visitors before releasing the lock. "If anyone shows up with a child, we open the door, but if an adult is there and it is not clear what they are doing, we don't let them in," explains the security director.

The entire building is secured with a proximity card access system, chosen to replace a more limited magnetic stripe card system about two years ago. Fingerhut explored several options before deciding on the proximity card. The hospital setting eliminated some possibilities. He tested a visual recognition system, for instance, but he notes, "the designers forgot that everybody who enters an operating room has on a scrub hat and mask and all you can see are the eyes."

The access card system is supplemented by keypads for security research labs that work with infectious materials and other areas that demand extra security. Eleven panic buttons are installed in high-risk locations, such as the emergency room, the pharmacy, the information desk, the cashier's office, the gift shop, and the human resources department--all monitored from the central command post.

Remote sites automatically unlock during business hours. "At night, we can electronically secure most of the hospital, including the loading dock area," notes Fingerhut. "We also have emergency lock-up procedures. Should we have a problem we can secure all perimeter doors in five minutes and have security staff at all open locations. We can do all of that from our security base."

High-resolution, low-light, pan/tilt cameras and passive infrared motion detectors are located in all hospital stairways, in elevator lobbies, at outside entrances, in the four-story parking garage, and around the loading dock. At night, the loading dock is electronically controlled. When there is a nighttime delivery--a common occurrence for linens and other supplies--four cameras zoom in on faces, license plates, "whatever we need," says Fingerhut, who notes that the equipment can read a license plate seventy-five yards away. An officer can unlock and relock the loading dock doors to permit deliveries without leaving the central command post.

If someone comes or goes in any area monitored by cameras and motion detectors, the alarms automatically activate cameras and recorders, and the activity comes up on the main monitor in the control room. A printer can provide still photos of scenes captured by the surveillance video.

Children's learned the hard way how the system worked when a kidnapping occurred in its employee parking garage in April 1992. At 1:00 a.m., the hospital's security department was informed by police that one of the staff's physicians had been abducted from the hospital's parking garage a few hours earlier, around 6:00 p.m. She had been approached by two armed females and required, at gunpoint, to use her access card to get them out of the lot in her car. When the abductors realized that the car had manual transmission, they demanded that the doctor drive them to another location and teach them to use the stick shift. After several hours of unsuccessful lessons, they forced her to drive them to Union Station and rent them a car. They then released her.

Once free, the doctor contacted the police, who passed the information on to the hospital's security department. "Our night supervisor immediately went to the computer to determine when she left," says Fingerhut. The computer indicated that she had used her card to leave the lot at 6:05 p.m.

Using the access card system's audit trail, the night officer then ran a list of people who had been in the garage thirty minutes before and after the abduction. Seven people were identified as possible witnesses, and at 8:00 a.m. the following morning, the department's three investigative officers began questioning these individuals. The investigation was aided by the fact that the doctor had been with her captors for several hours and was able to provide a detailed description of the two girls. "We also videotape the lot, so about the same time that we identified witnesses, we also came up with videotapes of the suspects, coupled with pictures," explains Fingerhut.

Of the seven witnesses, three remembered that the girls had been in the garage. The witnesses said they had seen two young girls sitting on a railing in the parking area. At the time, they had assumed that the girls were the children of employees waiting for their parents. One witness thought she recognized the girls as patients from the hospital. Security started questioning other hospital staff members to see if they recognized the abductors as patients. "One of the clinic employees recognized them, so we were able to obtain their names, addresses, phone numbers, and entire history," says Fingerhut. By the time the city police arrived to discuss the case at 10:30 a.m., we had already solved it," says the security director.

The electronic security system's effectiveness is evidenced by the decreasing number of incidents of theft and vandalism in the garage. Problem cases have gone from a high of one a week in 1988 to only one incident in an eleven-month period in 1992.

Parking garage patrols supplement the physical security equipment. Again playing on the importance of visibility, officers make the rounds in security vehicles with yellow lights flashing for enhanced pedestrian awareness. Contract patrols assist the regular parking garage force during high traffic times of the day. Several years ago, security also brightened the space by adding 1,500 fluorescent overhead lights and painting formerly grey support posts throughout the garage a bright white.

Parking garage security was further enhanced when separate areas were provided for public and employee parking. Executive parking places are unmarked and randomly assigned. Security is aware of the assignments, but most employees are not. The philosophy is not to advertise your vulnerable points, explains Fingerhut.

A similar approach is used for other potential hot spots, like executive offices, the credit union, and the pharmacy. None of these locations bears a sign. The cashier's window and pharmacy window are both additionally protected by bullet-proof glass. These areas are locked twenty-four hours a day. Pharmacy access is strictly limited. Even security is denied clearance, except in an emergency. "We've also arranged cleaning schedules so that the area is only cleaned when employees arc there," notes Fingerhut. "As a result, we have no problems with our pharmacy."

The hospital's unique approach to family interaction creates a special challenge for security. The center has parent beds in each patient's room and allows parents to stay overnight with their children. At any one time, 200 or more parents may be in the building when it is otherwise closed to the public. A temporary badging system provides parents with limited access. Parents who stay the night get a twenty-four hour badge that allows them to be on the patient floors and to go to the snack bar.

Allowing parents to sleep in their child's room is just one of the hospital's attempts to make the environment a friendly one for its young charges. Each floor has a playroom for recovering toddlers, and the walls of the hospital are decorated with everything from carousel horses to trains. Security does its part by giving teddy bears to lost children. With a couple thousand visitors a day and parents focused on an injured child, a few of those who are told to sit in the waiting room tend to wander off and end up in security's custody, explains Fingerhut.

The focus on the children's welfare pervades the hospital. While the physical security system is thorough, the department may owe part of its success to this attitude. "We don't have a lot of reports of thefts," says Fingerhut. "I think most people realize, if they take something, they are really taking it from the kids."
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.

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Author:Harowitz, Sherry L.
Publication:Security Management
Date:Aug 1, 1993
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