A soaring three-floor atrium, with two walls of windows that flood the area with natural light provides a soothing transition from the outside. Comfortable, carpeted waiting areas flank the two walls of windows. With abundant plants and plush set-tees and chairs, the area has the welcoming ambiance of a hotel lobby. In fact, this newly renovated lobby is part of a large suburban hospital complex that was designed to welcome visitors and provide patients a feeling of reassurance and well being. As part of an effort to be more competitive, some hospital administrators are trying to break the typical stereotype of the dark, gloomy, smelly hospital by creating a more open and inviting environment for their patients, employees and visitors.
In order to keep up with those trends, hospital security strategies have been changing as well. Security officers dressed in formal police attire and stationed at various posts within this environment may look out of place. Dressed in "concierge" type blazers, the security officers have become public relations representatives of the organization since they are frequently the first contact a patient or visitor has with a hospital. In addition to their normal duties of monitoring and controlling visitors, the officers are often required to be a source of information, directing visitors and patients to their destinations.
Hospital facilities are usually comprised of a number of buildings with many entrances, rooms, areas with high-value equipment, supplies, drugs and a variety of people - patients, visitors, staff and vendors - with a need to move about freely. Controlling this environment from a security perspective requires knowledge of current and future physical and logical access needs, coupled with an understanding of the standards and regulations facing today's health care practitioners. As part of physical security, health care security practitioners are implementing the latest state-of-the-art security systems for access control, video monitoring and communication, which will also improve their staff's productivity.
Points of Entry
Visitor control in this type of environment for the hospital security practitioner is one of their most difficult tasks.
As part of controlling patient visitors, some hospitals have implemented a visitor management system which enables security officials to track who is in the building and ensures visitors are only allowed access to certain areas of the hospital. Hospital security staff and/or volunteers can scan the visitor's driver's license. The visitor's information is automatically entered into a database and a visitor pass is printed on a label, which is then worn by the visitor for the duration of their visit. The system can also be integrated onto the hospital's network for continual update with the patient data system to verify that the patient is registered. Some children's hospitals have implemented a feature that checks a visitor's name against the national sex offender registry.
Video cameras should be located in the immediate lobby areas and typically include the gift shop. They provide the security officer the ability to view and assess a potential security issue on video monitors or video workstations that may be located at the concierge/security post. All video cameras throughout the hospital facility should be recorded at all times.
Respective community crime factors and quality-of-life issues are mirrored within each hospital environment and are most evident in the ER (emergency room) waiting area of urban and inner-city health care institutions. It is not uncommon for ER staff members to be subjected to verbal and sometimes physical abuse that may arise from domestic conflicts, child custody disputes, gang violence, drug users and psychiatric patients.
Triage staff members, in particular, are usually the target of verbal abuse - particularly by patient family members. In response to that potential event, each triage station should be provided with a duress device or personal alarms that summons the security officer. Proper deployment of video cameras in the ER should ensure that these stations are also within camera view. The ER pedestrian and ambulance entrances, the waiting room and the psychiatric observation rooms are areas where cameras should also be deployed.
Since emergency rooms in hospitals operate around the clock, most institutions will provide continuous security personnel presence in the area. The officer is normally positioned at a fixed post that has sub components of the facility's security system which provide the ability to monitor ER alarms, view all ER cameras and remotely control the operation of doors in the immediate area.
Using card access-controlled doors between the waiting room and the ER treatment area can be very useful in limiting patient visitors and eliminating unwanted and distracting pedestrian activity between the two areas. Card access control may also be applied at the ambulance and pedestrian entrances as well as entrances leading into the ER treatment area from other areas of the building.
During certain periods - typically on weekends - some hospitals will deploy magnetometers to scan individuals who seek treatment in their ER.
Common Areas of Security Concern
Access Control: The application of access control can be one of the most important elements of a hospital's security solution. Access control refers to managing who is allowed to enter where and when, including limiting access to people, places, and things and - via an audit trail - having the ability to track and monitor individuals and assets. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), one element of performance by which a hospital's environment of care is measured is that "the hospital controls access to and egress from security-sensitive areas, as determined by the hospital."
A high level of security is required for areas such as operating theatres and diagnostic suites, to ensure entry by authorized staff members only. Card access control devices for these critical areas need to be reliable, fast, hands-free and easy to use.
Material Storage: A primary problem with loading dock and material storage security is that most hospitals lack permanent security supervision in these areas. Add to this the sometimes relaxed attitude of the shipping and receiving operation by leaving doors open or the area unattended, and many hospitals are left dangerously vulnerable to theft.
Proper loading dock security starts with comprehensive policies and procedures for shipping and receiving operations. Card access control on doors, asset management systems, inventory management systems, intelligent video management and advanced integration of these should help in limiting the losses.
To minimize pilferage of foodstuff, dietary services departments should use card access control combined with video cameras in their food storage rooms as well as walk-in refrigerators and freezers.
Compliance: To maintain compliancy with HIPAA regulations, some healthcare organizations are combining smart card technology with biometrics for access to patient and employee records as well as pharmacy access control.
Infant Protection: A hospital administrator's biggest concern is the fear of litigation and a potential incident that would damage the institution's image. The abduction of an infant from the hospital's maternity ward would probably lead to both. To prevent such an incident, many hospitals that provide birthing centers with maternity and pediatric wards have installed infant monitoring systems.
An infant protection system is comprised of a small, tamper-proof tag that is placed on the infant's ankle or wrist immediately after birth. Should an infant be carried toward an exit door, the system will automatically set off an alarm with video at the local nurse's station and at the central security room, activate door locks including stairwell exit doors and hold selected elevators. These systems will integrate with access control systems, video cameras located at the various doors, public address systems, pagers, fire systems and other security alarms. Some systems also have the ability to automatically confirm that the right baby is with the right mother by providing an audible signal when the infants and mothers are correctly matched.
Terrorism: Large medical centers with research facilities may be using Cesium 137 Blood Irradiators. Recent world events have raised a concern that the radioactive material in them could be used by terrorists to construct a so-called "dirty bomb."
The NRC (Nuclear Regulatory Committee) has mandated strict requirements - some of which include biometric access controls with alarm detection and video assessment, background checks for personnel with access to the materials, assessment and response capabilities; transportation controls; and Information protection.
Laboratory Security: Hospitals with research capabilities will probably also have laboratories and vivariums that house the animals that are used as part of their research. These areas also require stringent access control not only from a security perspective but also to ensure that these areas are maintained within a controlled environment.
Card Access Solutions
As one of the most common card technologies, the magnetic stripe has been in use for many years in the healthcare environment due to their relatively low cost. Today, with higher associated maintenance costs, many healthcare campuses are installing new proximity card readers that provide more functionality combined with less maintenance.
Proximity cards are read rapidly and easily by simply presenting the cards within a prescribed distance to the reader. Magnetic stripe cards require the motion of "swiping" or insertion, which at times necessitates several attempts for a valid read. In vital applications such as in a hospital - where time to access an area could involve a life-and-death situation - the proximity readers certainly provide the superior functionality.
For hospitals contemplating a switch to proximity, dual-technology cards (magnetic stripe and proximity) would provide a solution during the transition period to support the older technology while moving to the more reliable, higher functionality.
For years, many healthcare facilities have relied on multiple card credentials to fulfill different tasks. It is still not unusual to enter a hospital and find staff members wearing multiple badges for various reasons. Many hospitals are contemplating and switching to a smart card to create a one-card solution. Using both contact and contactless smart chip technologies, a single credential can handle a bar code for inventory control, a photo of the employee for identification, a dollar value for use in the cafeteria, a biometric template for data protection in the IT department, and proximity technology for access control.
The application of video cameras in most healthcare facilities is used primarily as an investigative tool to assist in the review of an incident that has occurred. Video cameras provide additional and remote "eyes" that enable minimal security staff to observe multiple remote locations, either in real-time or recorded for future review. They are also an overt reminder that a security system is present. Where possible, camera views should be associated with alarm conditions to assist in alarm assessment. For instance, upon an alarm condition on the infant monitoring system, associated camera views can automatically be displayed at the pediatric ward nurse's station, the lobby security post and the hospital's security response center.
Healthcare facilities typically record and store camera views on computer hard drives for at least 31 days. These computers or digital/network video recorders have the capability of residing on the hospital's IT network or on a private network dedicated to security.
Unlike analog video cameras that rely on point-to-point cabling, IP or network cameras are designed to transmit over a network where video signals and power are transmitted on the same cable. IP cameras are becoming a popular and an important part of the healthcare security infrastructure due to their cost-effective ease of installation.
Video Analytics is a fairly new technology which has been applied in the healthcare environment. Examples of video analytics applications include: counting the number of people entering a hospital's lobby door or vehicles entering a hospital's parking lot.
Video analytics can also be used to generate an alarm when individuals attempt to enter a restricted or closed off area of a hospital. It can also determine the location, speed and direction of travel of pedestrians and vehicles and can be used to identify suspicious behavior of people.
Today's ever-changing and evolving health care facilities and hospitals present unique challenges for security. Security practitioners need to be proactive and adopt a non-conventional approach to maintain that same pace.
Fred Miehl is a Certified Protection Professional with the consulting firm Aggleton and Associates. He is a member of ASIS, and a past member of its Standing Committee for Banking and Finance; he is also a member of the International Association of Professional Security Consultants (IAPSC).