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When the shooting starts.

When the shooting starts

The need to provide a secure working environment for health care facilities during emergency situations is greater today than ever before. Violence perpetrated by criminals or psychotics, natural disasters, and accidents cause deaths and injuries, disrupt services, and expose health care facilities and businesses to civil and criminal liabilities. Effectively anticipating and preparing for potential disasters requires that viable security and emergency response plans be developed specifically for each organization and implemented by well-trained personnel.

The number of criminal incidents at health care facilities has risen consistently over the past three years. In recent months several hospitals have had staff and patients wounded or killed by crazed gunmen. Such violence is often drug related or perpetrated by patients or family members reacting violently to perceived inadequacies in health care services.

Incidents most commonly occur in hospital emergency rooms. In one recent tragedy, a quiet, middle-aged man calmly walked into a hospital emergency room and started shooting. The gunman was not looking for any particular person but was venting anger and frustration over the loss of his father, who had died on an operating table earlier that morning. The emergency room was targeted because the man felt its staff had not given his father adequate care.

The gunman was well-known to hospital personnel, did not fit any potentially dangerous profile, and had given no indication of his violent intentions. When informed of his father's death, he displayed no outward signs of distress. He simply left the hospital, only to return a few hours later with a loaded pistol and start shooting. When he walked out of the hospital, a nurse and a trainee lay dead and two others were seriously wounded.

In many instances, hospital personnel cannot reasonably foresee or prevent such tragedies, especially in hospitals located in low-risk, stable, urban areas. The perpetrators often display no warning signs of psychosis or violence.

Unfortunately, similar tragedies can occur in any hospital, nursing home, or business organization. Hospital administrators and business managers must assess their current security procedures to minimize exposure to such tragedies. They must also evaluate their organization's ability to limit the consequences when such disasters do occur. In most instances, however, they do not have the qualified and experienced personnel necessary on staff to make such evaluations.

A thorough, comprehensive plan that systematically addresses overall security is essential to developing an adequate security program. The security plan must include a variety of emergency response procedures designed to meet an organization's needs. Unfortunately, the great majority of hospitals and businesses have incomplete or inadequate plans developed in bits and pieces by an unqualified, overworked staff. Worse yet, a significant number of organizations have no plan at all, which invites disaster and potential civil and criminal liability that can be costly in the long run.

The administrator of any hospital or business that fits either category should immediately develop a master security and emergency response plan - a task best accomplished by a qualified security specialist. Development should occur in five consecutive phases: risk analysis, countermeasures, emergency response planning, personnel training, and system testing.

Risk analysis. This first phase must include a thorough evaluation of potential threats as well as the probability and impact of an incident. Gathering the information essential to developing an effective plan requires a detailed audit of current security policies and procedures, physical security, local crime, and personnel security awareness and training.

To achieve the highest degree of reliability, an analysis should define problem areas, identify weaknesses, and allow for the timely implementation of appropriate countermeasures. A risk analysis of the hospital mentioned earlier may have predicted the type of incident experienced but would also have shown a low probability of occurrence.

Countermeasures. The second phase often involves equipment purchases and policy changes. Many organizations mistakenly purchase expensive security equipment to counter an identifiable risk without first evaluating the equipment's effect on security and operational systems.

Simple security countermeasures include equipment and devices such as CCTV, alarm systems, safe rooms, and locks. A guard force should also be considered, although it is unnecessary in many instances.

A CCTV system is perhaps the most effective means of monitoring a large and diverse area. The initial purchase and installation is relatively inexpensive, use is continuous, and the system requires little maintenance.

Had the hospital involved in the shooting used a CCTV system, personnel could have rapidly identified the security problem, initiated appropriate security alarms and devices, and summoned law enforcement. CCTV could also have provided continuous information on the nature, location, and movement of the gunman. Videotape of the incident could then have been used to identify and prosecute him.

Alarm systems are another excellent means of protecting low-use or restricted areas. An alarm system with a silent duress button provides immediate notification of a dangerous security situation in a high-risk area. However, an alarm system is effective only when backed up with a well-defined response by trained personnel.

A safe room provides a protected environment for personnel during a perceived or actual life-threatening emergency. It should be large enough to accommodate the number of people reasonably anticipated to be threatened. Safe rooms should be constructed of bulletproof glass and similar materials and equipped with a communication system. If possible, they should also include an escape route. Safe rooms should have one-way glass or other devices that allow protected personnel to view the threat area without being observed by the perpetrator.

While locks are an inexpensive form of protection, they are best employed in conjunction with other security elements - such as officers and CCTV - to limit access to controlled areas. Often, however, employees bypass locks or prop doors open after the initial fear or threat awareness dissipates. Also, locks are not conducive to the open, comfortable, welcoming atmosphere most hospitals and businesses in low-risk environments desire.

The primary mission of security officers at most hospitals in low-risk areas is to provide a deterring presence, give advance warning, and protect assets.

Most unarmed officers do little more than stand watch and are usually not trained to respond to serious or life-threatening situations. If your risk analysis indicates a need for armed officers, ensure they are thoroughly trained and their duties well defined, especially regarding the use of deadly force. Armed or unarmed, security officers are a high-priority target for intruders and psychotics. Had an officer been in the emergency room when the shooting started, he or she may well have been the first victim.

No single countermeasure is designed to stand alone or is adequate for every organization. Each one must be evaluated separately and incorporated into an overall security system. Each must also be supported by a comprehensive emergency response plan, the most effective protection you can provide for your organization.

Emergency response planning. While the chance of stopping a dedicated gunman or terrorist is small - even with extensive security measures - a good response plan isolates and controls the situation by providing a rapid and coordinated response. Response procedures must specify personnel responsibilities and actions and coordinate available resources. An emergency response plan must be tested, evaluated, revised, and updated regularly to ensure its effectiveness in actual emergencies.

Personnel training. Continuous training is critical to the effectiveness of any plan or countermeasure. Personnel must be able to identify emergency situations and respond according to established policy. Most disasters leave no time to think, and well-trained employees can respond quickly and automatically and assist others.

System testing. An integral part of personnel training is testing the plan through a variety of situations. Practical exercises and drills during training help uncover problems in the plan and procedures that can be corrected before an actual emergency.

While applying these concepts may not prevent shootings, it lessens the confusion and trauma of such tragedies. The major lesson to be learned from recent violent incidents and disasters is that every organization must have a plan that provides systematic and organized responses to a variety of emergencies. The plan must be user-friendly, which means it must be well organized, clearly written, and easily accessible in a crisis.

Recognizing and resolving security problems requires not only common sense, but also the skill of an experienced professional capable of evaluating security needs, formulating sophisticated plans to meet those needs, and training personnel in implementing them. An appropriately implemented emergency response plan assures personnel and clients of the best possible protection.

James F. Neal is a retired career US naval special operations officer with extensive experience in developing disaster and contingency planning and emergency preparedness programs. As president of Security Concepts International, Neal has headed the development and implementation of numerous emergency preparedness programs now in use at major medical centers, corporations and military installations throughout the United States. He is a member of ASIS.
COPYRIGHT 1991 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:security and emergency response plans
Author:Neal, James F.
Publication:Security Management
Date:Jan 1, 1991
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