At the Frontline: Healthcare security expert Steve Wilder

Earlier this year, SIW spoke with several hospital security managers following the crisis at Japan's Fukushima Daiichi nuclear plant to discuss how healthcare facilities should prepare for emergency management incidents. Sometimes, however, hospitals themselves can become the scene of a disaster.

On Sunday night, a half-mile wide tornado struck the town of Joplin, Mo., destroying or damaging thousands of buildings including the city's hospital. Six people were killed at St. John's Regional Medical Center and more than 100 people were killed by the twister overall.

In this "At the Frontline" interview, Steve Wilder, president and COO of security consulting firm Sorensen, Wilder & Associates and the former director of safety and security for Provena Health in Kankakee, Ill., discusses the steps healthcare facilities need to take to help mitigate their risks when disasters strike.

How do you handle situations in which the hospital itself is the scene of a disaster rather than treating the victims of one?

At that point, the hospital becomes a victim and their focus starts to shift. When it's an external incident and the hospital is a resource to the community, their focus is on making sure they can match the community's demand. But, when a situation occurs like in Joplin, at that moment when the hospital is taken out by a tornado, the hospital can no longer be a resource to the community and really all focus then turns on taking care of themselves. From people that I've talked to that are down there and folks that have been involved in that situation, the stories of heroics that are coming out of that hospital now are just unbelievable.

What are some things you have to take into consideration when you have a mass evacuation at a hospital?

Coming up with a menu or punch list is really hard to do. You've got to have previously done some type of a hazard assessment of vulnerability assessment to really identify what you're greatest needs are going to be. That then becomes the basis for your preparedness drills. One of the weaknesses we still see when we're visiting client hospitals is that the drills do not go to the extent that they need to. A lot of times we're still seeing drills that are being done to meet regulatory requirements as opposed to really helping to identify their level of preparedness so that when the real event occurs like in Joplin that they really have drilled for reality and not just for a passing grade on a regulatory score.

If you were a security manager of nearby hospital, how would handle the overflow of patients and visitors from the hospital that was impacted?

The first thing I would be doing is locking down my facility. You're going to have people trying to get in at every access point on the perimeter of that building. You're going to have people trying to get in through remote doors who are in need. And these, in most cases, are honest, good, salt of the earth people who are suddenly dealing with something that they could have never imagined in their lives and they're looking for answers and they're looking for help. They may be coming in trying to find supplies, equipment or things that they need for basic necessities of life at that point. So, we've really got to secure the perimeter of the building first and foremost. We've got to make sure there is one point of access into the building. Depending on the size of the building, you may designate multiple points of ingress, but in doing so you still want to make sure you've got those properly staffed and properly secured so that you're doing adequate screening on everybody that is coming into the facility.

What types of measures can you put in place to mitigate the risks posed by those that might try to take advantage of the situation?

I think locking down the facility, controlling who is coming into the building and where they're going becomes a critical part of it. Again, I look back on it and I say "ok, this being the case, how much has the hospital drilled to prepare themselves for this? When was the last time they did any type of a controlled ingress drill?" Securing inventory is another critical part. The majority of hospitals have some type of a disaster kit, which is designed to go to the scene of a disaster, but when you are the scene of the disaster, you're going to need that kit for taking care of your own casualties and your own needs. Just like many other pieces of inventory in the hospital, they are of value in the hospital, but they are of equal value out on the streets as well, so you may very well have people coming in just trying to find access to basic items. You may have them looking for household items, you may have them looking for medical supplies, bandaging supplies and all those types of things because they don't have access to them anywhere other than the streets and the streets and the community is demolished.

With emotions running high as they would be in the aftermath of a disaster, what are some of your recommendations to help keep the peace in an otherwise chaotic situation?

This is challenging because this is good people caught in an incredible set of circumstances and emotions do run high, stress runs high and we know that high emotions and stress are preceptors of physical violence. Some type of aggression management training, a healthcare-focused aggression management training that's designed specially for healthcare facilities to deal with this type of risk becomes quintessential. Beyond that, I keep going back to it, but we drill for reality and this is one of those things that your drill should encounter. Drills don't have to be these massive undertakings, but a series of small, bite-sized drills that deal with controlled ingress and hospital crowds can help us to perfect our skills at each component and each spoke on the wheel. So, when an incident happens, we've managed it in small, bite-sized pieces and now we can manage the incident as a whole.

What type of roll would security play in getting doctors and nurses safely to work after a disaster like this?

It's going to depend because security is going to be looked at to play a number of different roles. Transport may be one of them, but again it goes back to your planning. So many times we see plans that talk about the local police being called in to help out. In a case like this, forgot about the local police. They are not available to help you out. They're serving the needs of the community and they've got to prioritize for the greater good of that community. Even though your plan may say the police are coming to your rescue or that the local fire department is coming to your rescue, they're overtaxed at this point as well. Security really becomes more of a dominant figure in the hospital proper. My preference is not to take a security officer offsite to be out running as a transporter. I would be looking for others that could serve in that capacity instead. I want my security officers kept at the hospital focused on security related duties.