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Securing hospital halls.

Remember the good old days when you could expect to receive medical treatment in a safe and secure atmosphere? Welcome to the 90s. On a daily basis we read or hear of violence in hospitals in the form of infant kidnappings, bomb threats, assaults, robberies, rapes, and murders.

In a 1987 survey conducted by the International Association for Hospital Security, most hospitals reported the annual occurrence of one or more violent incidents, meaning extreme, sudden, unjust, or improper force exerted so as to cause damage, abuse, or injury. Of the hospitals polled, 99 percent reported thefts, 58 percent reported assaults, 52 percent reported bomb threats, 29 percent reported suicides, 12 percent reported armed robberies, 8 percent reported rapes, 7 percent reported arson incidents, and 4 percent reported kidnappings.

Hospitals are not sacred ground, nor are they immune to the aggressive nature of people. The health care industry faces the dilemma of providing an environment open to all types of people, where patients can receive quality care-and at the same time providing a protective atmosphere.

The security management staff should examine problem areas, taking into consideration people's unpredictable nature, and develop a plan to prevent or deter violent occurrences. They should practice the techniques involved in carrying out the plan and communicate the plan to all staff members. Some of the main concerns for those responsible for preparing such a plan follow.

Families. Domestic disputes rank as the top source for generating violent situations. Families and loving relationships sometimes fuel the most violent acts documented by security personnel. Properly trained personnel can sometimes detect a domestic problem brewing before it escalates into an act of violence. Since nurses must deal daily with strongly emotional individuals, they must be taught to have a keen awareness of how to detect emotions growing uncontrollable.

The management of hospital security is a unique field, quite different from public law enforcement. When the law is violated in the public sector, the individual is arrested and charged. But in a hospital, based on the severity and type of offense, individuals are generally not charged when an incident involves a patient or patient's family member.

For example, a nurse is slapped by a family member who was just informed of a mistake made with his or her relative. Should the security manager have the family member arrested? In most instances, it would probably be best to defuse the situation and handle it through administrative channels.

Even if a family member actually attacks a nurse, in most cases the hospital's administration would not file criminal charges against the individual, nor would an employee be encouraged to do so. When an employee signs criminal charges against someone, he or she is acting as a representative of the hospital and involves the institution in any further legal action. Since a criminal conviction would only result in payment of a fine, the hospital may choose instead to obtain a restraining order or pursue civil action.

Patients. Agitated or angry patients can be annoying and disturbing. Violent patients, on the other hand, are destructive and harmful. Fortunately, impending violent behavior can usually be detected and prevented. The following steps can help in dealing with patients before they become major problems:

* Identify high risk patients. Special precautions and alertness are necessary when dealing with patients who have a history of violence. When the stress of hospitalization exceeds their coping capacities, such patients may experience an acute reaction that manifests itself through anxiety or rage. Arguing or debating with these patients from a position of superior knowledge can provoke verbal abuse or physical violence, and often the staff member feels threatened. If this situation occurs, an existing plan designed to deescalate the situation should be implemented immediately.

* Recognize precursory violence. Patients who are about to become violent often act aggressively by pacing in an agitated fashion, advancing on and then retreating from staff members, and expressing irritation. They may clench and release their fists or facial muscles, challenge staff authority, or make accusations of mistreatment or ill will.

* Rapidly confront the situation. After detecting a potentially dangerous patient, the staff must immediately confront the situation, not avoid it. Ignoring aggressive behavior often leads to its intensification. The patient may perceive staff withdrawal as confirmation of paranoid feelings that something is going on behind his or her back. The patient whose anger is getting out of control may interpret withdrawal to mean help is unavailable, and become anxious and more aggressive. The patient who feels lonely or frustrated may see staff avoidance as punitive.

* Implement a plan. Successful intervention to prevent violence depends on a coordinated plan. Developing such a plan requires effective communication between the nursing staff and other employees who will be involved in responding to violent incidents. Management should identify and analyze locations where incidents might occur and review the frequency and types of incidents that have occurred. Management must then decide who is going to respond and how.

Visitors. Many of the same techniques used to deal with patients apply to violence caused by visitors as well.

If a visitor rapidly gets out of control and verbally abuses other staff members, security staff called to the scene should talk to the individual and find out what is causing the disruptive behavior. The individual should not be crowded or approached unless the chance of immediate danger exists. He or she may be using loud and abusive language, but this is certainly preferable to physical violence.

Robberies. Discretion is the better part of valor in a robbery situation. As long as the suspect's demands do not involve human life, the suspect should be given what he or she wants. Staff members should obtain a good description of the suspect and any vehicles, note the suspect's direction of travel as he or she leaves the facility, and pass this information on to the police.

If a hostage is taken from the hospital premises, the probability is high that the hostage will be killed, so preventive steps should be taken. If it appears the robbers intend to take a hostage, change their plans and force their hand. This advice is specifically addressed to security management staff who are experienced in handling hostage situations; employees in general should not place themselves in a life-threatening situation or act without the proper training and experience.

Bomb threats. Hospitals are not exempt from bomb threats, so they should be covered in internal disaster plans. No one plan can deal with every possible scenario. but the following basics should always be included for the recipient of a bomb threat call:

* Signal someone that you have this caller on the line.

* Contact a predesignated administrative person.

* Obtain all the information you possibly can.

* Be very attentive to all noises associated with the call.

* Alert only those individuals specifically designated in the internal disaster plans.

Hospital security plans should address what actions will follow the threatening call, which staff members will participate, and how the search will be conducted. Responsibilty for evacuation and notification of authorities should rest with administrative personnel.

Kidnappings. Since infant kidnappings from US hospitals have increased in recent years, it would be wise to prepare contingency plans for responding should such a situation occur. The procedures to be followed should be communicated to all personnel working in areas where infant kidnappings are possible. Nurses' keen perceptions are vital in preventing kidnappings. Restrictions on visitors should be imposed if hospital policy allows.

Emergency department. The emergency department or room is always a primary area for violence, and security personnel may spend more time here than in all other departments combined.

One style of aggression that displays itself in the emergency room occurs after one spouse has tried to kill the other and failed. Just as the physician is attempting to save the life.. the perpetrator may rush in to finish the job. Security staff should be called in quickly. They should pay particular attention to any weapons and keep distance between the two people. Security personnel should always attempt to keep the aggressive one away from everyone else. Quick response and control by in-house security staff is vital in these incidents.

THE BEST TIME TO ESTABLISH A SEcurity plan addressing violent actions is before an incident occurs. Unfortunately, all too often a plan is not discussed until a serious event occurs, leaving the hospital staff unprepared. In hospitals employing a full-time security staff, the respondents to calls for help may all be security personnel. In most hospitals, however, personnel from other departments are involved in security efforts. Having a plan, with one member of the interdepartmental team actin, as spokesperson, ensures individuals will know how to work as a team, what action is to be taken, and when.

Allowing several staff members to talk to a violent individual at once only complicates any situation. It also shows a lack of coordination and leadership, giving the impression no one is in control. In a situation where one staff member has been engaged in conversation with the disturbed person prior to security's arrival. he or she should remain the spokesperson.

Staff from different departments, which may include maintenance. environmental services. construction services. and nursing services. should be called on to be part of the team. Personnel must be trained together and practice procedures together if they are to function as a team and be prepared when the time comes.

It is important to plan at what point physical intervention will occur and what signal will be given to team members. Since attention will naturally be focused on the subject, eve contact between team members is essential. A prearranged signal should be used to escalate the confrontation automatically from verbal to physical. At this point, members must move in simultaneously to take control of the situation, taking care to avoid injuring the individual or team members. Team members should never underestimate the unpredictability of any incident.

Some issues to consider when establishing a training program are the qualifications of the instructor, ways of assessing a "trained" status, documenting the training, and documenting the incident.

Most health care institutions have staff who are trained and experienced in handling disruptive behavior. Generally, these individuals are capable of training the staff, discussing potential situations, and analyzing options for action. Documented classes and exercises have proven to be a valuable defense in legal actions as well as an excellent way to develop methods for handling incidents with as little physical intervention as possible.

If an incident occurs, all team members should be involved in a critique of the situation, since many new ideas can evolve from follow-up discussions. Others should be invited to your critique sessions as well; input from the medical and legal staff usually proves to be worthwhile. Arming the hospital security staff is a concept that has become far less controversial in recent years. Before allowing firearms on the premises, the security manager should consider these questions:

* Who are the officers going to shoot?

* What incident would warrant the

use of firearms in a hospital?

* Are the staff trained and qualified to carry weapons?

* What about hospital, supervisor, or individual liability?

* What about high-pressure gas lines in the walls? The only advantage to carrying a weapon, in my opinion, is the psychological effect, which may be far outweighed by potential problems if the weapon is used. No matter what situation arises in a hospital, discharging a firearm is probably not the answer. However, some hospitals may be able to justify having security personnel carry sidearms, and it's up to the individual institution to make such a decision. It is my opinion that employment of unarmed security personnel is the wave of the 90s for hospitals and other businesses. I researched the 30-year history of firearm use at a large hospital in the South. I found the only incident involving a firearm occurred when a deputy sheriff was wrestling with a patient in the emergency room and his weapon discharged accidentally, striking a physician in the foot. To be prepared for an eventual violent situation, the security management staff needs to be aware of its role and plan its actions for deescalating an incident. A commitment to emergency preparedness and action needs to be communicated to all staff members who will be involved when violence occurs. Security managers should talk to staff, plan their actions, and understand the purpose of the team and motivations for team members. They should train house staff to understand their function and security's expectations. Hospitals of the 90s should provide safe and secure treatment. About the Author . . . Anthony L. Best is director of protective services (safety and security) for the Mobile Infirmary Medical Center in Mobile, AL. He is a member of ASIS. Dealing with a Disturbed Person W" FOLLOWING FACTORS SHOULD I be considered when dealing with a disturbed patient, family member, or visitor:

* Staff members often become nervous and anxious when confronted by a potentially violent situation. Sometimes their actions further agitate the person. Staff must be trained to treat the individual as they would like to be treated themselves and to take time to determine if a legitimate reason incited the behavior.

* While concentrating on the disturbed individual, staff members should quickly assess the physical surroundings. They should locate objects within reach that could come weapons, locate possible exits, identify patients in vulnerable positions, be prepared if a is taken, and determine if die individual has a weapon.

* Staff members who intervene should attempt to gain the suspect's confidence and be sincere with all comments. Often these individuals are hypersensitive and can easily determine if inexperienced staff are trying to trick or mislead them.

* Security personnel should not lose patience and be too quick to end the confrontation. They should spend as much time as possible talking to the individual.

* All staff should be calm, cautious, courteous, and consistent in their dealings with an agitated individual.
COPYRIGHT 1990 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes information on dealing with a disturbed person
Author:Best, Anthony L.
Publication:Security Management
Date:Aug 1, 1990
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