Securing hospitals in times of disaster

Earlier this month, thousands of people were killed and hundreds of thousands more were displaced when a tsunami caused by a massive earthquake struck the coastline of Japan. The crisis worsened in the days that followed after it was discovered that the tsunami destroyed cooling systems used to cool fuel rods at the Fukushima Daiichi nuclear plant.

The danger of a nuclear meltdown has led many lawmakers and other officials to call for a review of the safety of domestic nuclear power plants to ensure that if a catastrophe of this magnitude does occur in the U.S., that the damage and subsequent fallout can be minimized. One of aspects that has been overlooked by many in the media, however, is how equipped hospitals are to handle such disasters.

According to Bryan Warren, director of corporate security for Carolinas Healthcare System, people, even those that are uninjured, often flock to hospitals in times of crisis. It's because of this that Warren says hospital security staffs need to be prepared to handle the traffic management (vehicle and foot) responsibilities that come with the aftermath of a natural disaster.

"It's not just the injured that you are going to have to be dealing with in your hospitals and your urgent care centers," he said. "This (security issue) has been referred to as 'the worried well.' These are people that were no where near ground zero, they were no where near the actual incident yet they are going to show up in your emergency rooms and hospitals and take up valuable time and resources from those that actually need medical care."

Ironically, Warren said that Japan experienced this "worried well" issue in 1995 when Sarin gas was released on the Tokyo subway system. Although only 13 people were killed in the attack, thousands of more people jammed the hospital because they felt they may have been exposed.

"In a catastrophic incident like this tsunami and what we are going through now with the nuclear power plant there... you are going to have a lot of people coming in because they are worried they've been exposed to radiation or something else and a lot of these people simply don't have anywhere else to go," Warren explained.

As a result, Warren says that hospitals need to address traffic and access control issues for the facility's campus, making sure that people are where they need to be and that emergency vehicles can enter and exit without a problem.

Anjanette Hebert, director of security, safety and emergency management at Lafayette General Medical Center in Louisiana, says that one of the most important things hospitals can do to prepare for a disaster is to conduct a comprehensive risk assessment and a subsequent hazard vulnerability analysis. This process, which allows hospitals to rank and prioritize their biggest risks, would involve not just the facility's security director, but everyone that would be impacted.

"From a security perspective, I look at my mission of security in a disaster particularly, is to maintain the safe care environment as much as possible," Hebert said. "We are going to control the access in a way that allows people to get to the point they need to receive care, but we are not going to allow uncontrolled access that can cause chaos and disrupt the staff's ability to provide care."

Hebert said that security managers should also focus on reducing anxiety for people in times of crisis.

"Those of us that have been in security for any amount of time know that anxiety leads to more acting out," she explained. "When people are experiencing a lot of anxiety, it will increase your conflict."

Evelyn Meserve, executive director of the International Association for Healthcare Security and Safety (IAHSS) and former director of safety/security services at CaroMont Health in Gastonia, N.C., says that hospitals should also be proactive and have a plan in place to review and practice on a regular basis to handle patient surges.

"This plan should have different levels for influx of patient surge or visitor population onto the campus," she said. "Whether you are dealing with a school bus accident of 20 people or in the case of the tsunami, you are bringing in tens of thousands of people, without that practice and prior preparation the hospital is really going to be at a loss as to how to handle that."

In addition to a patient or visitor surge, Meserve says that hospitals also have to take other considerations into account.

"Not only do they have to take into consideration the additional people coming in, but they have to take into consideration what effect is the situation going to have on the hospital? If we lose power, what are we going to do? If we lose water, what are we going to do? Those are all part of the backup plans that the hospital really has to think through ahead of time and have good situational plans in place," she said.

In the aftermath of Hurricane Katrina, Hebert said the industry learned about the importance of having risk mitigation plans in place and how crucial it is to practice those plans regularly.

"Complacency is our enemy," she said. "When we don't have an event for a long period of time, planning seems to kind of wane. What we learned is that whether we have a hurricane this season or not, we continue to do that planning."
As part of preplanning for a large-scale incident, Warren said that hospitals need to designate areas for everyone that will be descending upon the facility in a disaster aftermath scenario.

"You need to have designated areas of your facilities already setup for the media and you need to have designated areas prepared for those that are looking for lost family members and make sure someone is there that can communicate with them," he said. "One of the worst things that happens, and we see this on a small scale everyday in emergency rooms across every country really, is when people come to the emergency room to be treated or to visit someone, one of the worst things is not getting any information at all because the mind tends to go to the worst case scenario and the imagination turns into a 'well this has to be bad or they would be telling me something.' We need somebody to give information even if it is simply 'we don't have the details now, but we are working on it for you.'"

Warren added that it is also imperative that hospitals develop relationships and have memorandums of understandings with local authorities so that they will know what the facility's control plans are for a disaster situation. Despite these additional challenges created by natural and unnatural disasters, hospital security managers must still focus on normal day-to-day security tasks to ensure that the facility's employees and patients are safe.

"Unfortunately, there is always opportunity in chaos," Warren said. "There is potential for looting and there is potential for other criminal activity because police are otherwise involved in life saving or more important things at the time rather than crime prevention efforts. I think you have to be ready, not only for the surge event and the emergency management aspect, but you also have to be very vigilant about people taking opportunity to take things, to sabotage things at your facility that might impact your ability to provide medical service. I think it's tough because you have to switch your focus to the emergency management aspect, but you can never let the security of the facility go astray."

When it comes to biological, chemical or radiological incidents, Meserve says that most hospitals have programs in place to handle them and many have used grants to fund the purchase of protective gear. She says, however, that a facility's ability to effectively handle these situations goes back to their teamwork initiatives with local first responders.

"The key in one of (those incidents) is early communication," Meserve said. "If it is identified early, you can setup and prepare for it, but the unfortunate truth is that a lot of times someone is going to be in the emergency room before you realize what you have got and then you have to implement steps after the fact to try and shut down and prevent that incident from spreading to different locations in the hospital."

Hebert said that isolating patients presents a huge challenge for many hospitals.

"The biggest issue I see from a non-clinical perspective is having enough isolation rooms," she said. "Most hospitals that I've encountered have a limited number of rooms that are equipped to do isolation. There is portable equipment that can be used with the help of your facilities department to create a temporary isolation room and you can even use it to take a whole wing or hallway and create an isolation space."

During the SARS outbreak several years back in Canada, Warren said hospitals there setup a triage unit in the parking lot to prevent cross contamination and also handed out the proper protective equipment to people.

The utilization of various communication methods can also be a big factor in notifying a hospital's staff about an impending emergency and getting them into the facility. While mass notification solutions are an option, Hebert said that mainstream and social media can also help get the word out to doctors and nurses. Having staff members provide their cell phone numbers to the hospital's command center is another option, according to Hebert.

If the hospital itself is damaged during a disaster, Warren says it's imperative to have good relationships with both in house resources and emergency responders.

"That's where that preplanning is so crucial. You need to have a secondary treatment site already identified that in a perfect world, you would be able to flip a switch and everything we did at the hospital we can do over at the secondary site," he said. "That is why it is so crucial that you practice, you do tabletops and you do drills."

Hebert said that this was also another valuable lesson learned by the industry in the wake of Katrina.

"The mitigation for the structure was by far the biggest lesson, in my opinion, that we learned," she said. "There are ways that you can shelter in place, but you have to make the investment in the building and in the stockpile of supplies or caches that you have in order to fulfill your mission in times of disaster. And that takes planning."