Keeping the Program Healthy

Winston-Salem’s Forsyth Medical Center (FMC) is the second-largest hospital in North Carolina, and getting bigger. FMC recently launched the largest healthcare capital improvement program in North Carolina history, with $247 million earmarked for

  • A new emergency department (ED) containing 81 treatment rooms, which opened in October 2004.
  • A 60-bed intensive care unit (ICU) opening later this year.
  • A 1,425-car parking garage coming in mid-2006.
  • A nine-story North Pavilion for the Sara Lee Center for Women’s Health and the Forsyth Cardiac and Vascular Center, scheduled to open in early 2007.
  • Extensive renovation of the existing third, fourth and fifth floors, to be completed in 2008.

One hundred fourteen medical-surgical beds will be added to meet the inpatient demands of the community, bringing FMC’s total bed count to 961.

Each of the new additions to our 77-acre campus has unique security requirements, from protecting visitors in the five-level parking garage to safeguarding newborn infants in the 19 labor, delivery and recovery (LDR) suites and the neonatal intensive care unit (NICU), which serves a 20-county referral area. The ED always generates the highest number of security calls in any hospital. With more than 90,000 emergency patients treated annually, FMC’s ED is the scene of frequent conflicts and disturbances that expose physicians, nurses and other employees to verbal and occasionally physical abuse.

To cost-effectively achieve the highest level of security for our new facilities, we formed a partnership early on with David McMillan, director of facilities planning, and Peterson Associates and Freeman White, project architects, to develop and implement a five-year strategic security plan. This plan includes the infrastructure for all required security systems; augmentation of public safety staffing; additional radios, vehicles and other equipment; and the revised policies and procedures needed as each new facility opens to the public.

Protecting FMC’s new and existing facilities is the responsibility of the 27-member Public Safety Team. Re-engineered from a traditional hospital security department early last year, the Public Safety Team remains small when benchmarked against comparable hospitals. However, we use the twin force multipliers of training and technology to leverage the effectiveness of our uniformed officers.

Increasing Training, Lowering Turnover
Beginning in 2003, all public safety officers (PSOs), from the newest recruits to 25-year veterans, received 216 hours of basic training.

The curriculum includes:

  • IAHSS Basic, Health and Safety, and Advanced Training Standards
  • AHA Heartsaver Course
  • ASP Baton Certification
  • CPI Nonviolent Crisis Intervention
  • OSHA Hazardous Materials Operations and Technician Level Courses
  • Defensive tactics, handcuffing and use of force training from Winston-Salem Police Department (WSPD) instructors.
  • Training required to write city parking tickets for handicapped and fire lane violations.

Once basic training is completed, all PSOs are required to complete at least 48 hours of in-service training annually. The communications technicians (CTs) who staff our new public safety communications center also complete the IAHSS Basic Training Standard. CTs then attend the APCO Public Safety Telecommunicator I Training Course (the same training given to their 911 dispatchers) conducted by the WSPD, followed by in-house training in all aspects of communications center operations. An important part of this training is walking and riding on patrol with PSOs throughout the campus, giving CTs a frame of reference when they observe various areas on the CCTV system.

Training is expensive, and the traditionally high turnover level in many healthcare security departments often makes it difficult to provide the training required for effective job performance. To both reduce turnover and encourage participation in training programs, FMC recently implemented a public safety career ladder similar to those found in many hospital nursing departments. Each rung on the career ladder requires additional education, training and experience, gives members greater responsibility; and rewards them with increased compensation.

After a PSO completes all basic training requirements and one year of satisfactory service, he or she is promoted to senior officer with a commensurate pay raise. Senior officers who complete at least 80 hours of additional training in areas like crime prevention, field training, investigations or safety, are eligible for promotion to lead officer and assume responsibility for that function on their assigned shifts. The top rung in the career ladder is the public safety supervisor. Promotion to supervisor requires completion of the IAHSS Supervisory Training Standard. New supervisors must complete FMC’s Supervisor Orientation Action Plan, including a number of courses offered by the Corporate Education and Training Department, within one year.

Communications Center Upgrade
The heart of security technology at FMC is the new public safety communications center, which became fully operational on April 1. Previously, alarms were monitored and PSOs dispatched by switchboard operators, who were not trained as emergency dispatchers and could not prioritize calls or maintain a dispatch log. FMC only had one licensed radio repeater and one simplex channel, which were used by all radio-equipped personnel. The CCTV monitors were in the old public safety office, which was staffed only during business hours.

The shortcomings of the existing system were only too evident during a blackout on August 26, 2004, when the failure of a Duke Power substation plunged the medical center into darkness. Although FMC’s emergency generators immediately went online, emergency radio traffic quickly overwhelmed our communications, and the existing emergency operations center (EOC) proved totally inadequate. The new communications center and other security improvements were already in the planning stage, but the blackout illustrated the urgency of moving forward.

The new communications center is at the center of the Public Safety office complex now under construction. It consists of a communications console and a photo-ID desk, which produces proximity photo-ID cards for employees at FMC and affiliated facilities in the region. Two copies of a comprehensive SOP manual are maintained on the console. Changes in SOPs are made by serially numbered e-mails to all CTs, which must be acknowledged by return e-mail. This process ensures that all SOPs are up-to-date, and emergencies and other calls for services are responded to in a uniform manner on all watches.

The V-shaped console has all exterior CCTV monitors on one side and interior monitors on the other. Identical sets of telephones (emergency, routine, intercom and power failure) and a CCTV controller are located on each side of the console, with computers, radio and paging microphones centered. This configuration allows up to three CTs to work at the console simultaneously during emergencies. Emergency telephone calls activate a white strobe light on the console, ensuring an immediate response.

Our systems integrator, SFI Electronics of Charlotte, NC, designed the communications center console and all access control, alarm and CCTV systems. SFI’s experience in healthcare security, their local presence, and their willingness to work within our limited budget were significant assets in getting our communications center online, on schedule, and within our cost parameters.

Secure Access Management
A GE Secure Perfect access control system, using photo-ID proximity cards and card readers, secures the medical center’s perimeter and sensitive interior areas. Forty-five card readers control access to employees’ and physicians’ parking lots, and sensitive areas such as the ED, ICU and pharmacies. Plans call for 50 to 60 additional card readers per year, besides those required for new facilities. Photo-ID badges are color coded to identify various groups—red for contractors and vendors, green for students, etc. More than 7,000 employee pictures were imported from the old card system into Secure Perfect using a JPEG file. However, employees with pictures more than five years old were required to be rephotographed. Now all employees must have their pictures taken and new photo-ID cards issued every five years.

All exterior access control points are equipped with CCTV cameras and intercoms, allowing an employee or physician who does not have their photo-ID card to contact the communications center. The CT can verify their identity by bringing up their picture on Secure Perfect, comparing it to the image on the CCTV monitor, and grant or deny them access.

Alarm Monitoring
Secure Perfect monitors all duress and intrusion alarms throughout the FMC campus. All 88 exterior doors are now alarmed. The ED can be locked down either internally or from the communications center, and future plans include the ability to lock down the entire medical center perimeter in an emergency. An alarm condition activates a red (duress) or amber (intrusion) strobe on the console to alert the CT, and specific response instructions appear on the computer screen.

FMC uses the AccuTec infant abduction alarm system to protect newborn infants in the LDR and NICU. AccuTec monitors all doors, elevators and fire stairways leading from these areas.

Over the next two years, the communications center will assume monitoring of all duress and intrusion alarms at FMC’s 32 physicians’ practices and other off-campus facilities as contracts with central stations expire. Several months before each contract expires, Public Safety will conduct a physical security survey of the facility and make any necessary upgrades to the alarm system before assuming this responsibility.

Flexible Surveillance
The CCTV system currently consists of 76 color cameras, up from 39 in the old system. The communications center will begin using laser technology to monitor 32 existing cameras at Medical Park Hospital, Winston-Salem Health Care and our administrative offices later this year.

All CCTV cameras are quad-screen monitored on 18 13-inch monitors. However, the CT on duty can change individual monitors to single-screen or sequential viewing as needed. Any camera can also be viewed on one of two 17-inch monitors. Two Bosch Allegiant controllers allow CTs to control the entire CCTV system. Our system is proactive. The console configuration enhances CTs’ ability to use the camera system to constantly patrol the FMC campus and direct PSOs to areas where problems are detected. For example, a complete vehicle patrol of roadways and parking areas takes an average of 46 minutes, while a CT can cover the same area effectively using CCTV cameras in 11 minutes. CTs also use cameras to home in when an alarm is activated or an incident reported, and advise responding PSOs of the situation.

Eight GE DVMRe digital recorders integrated with the Secure Perfect system provide motion-activated recording of all cameras and store all images for at least 30 days. Kalatel WaveReader software allows Public Safety managers and investigators to monitor any camera and retrieve recorded images on their individual computers. Images can be recorded on a CD for preservation and evidentiary purposes. I can even monitor them on my laptop from home or while traveling.

A CCTV monitor and controller are located in the emergency operations center (EOC), which is operational whenever the Hospital Emergency Incident Command System (HEICS) is activated. This allows the incident commander and staff to monitor the scene of an internal incident, or the ED and decontamination area when victims of an external disaster are brought to the medical center.

The communications center is equipped with two PCs, one for Secure Perfect and the other for Public Safety records including parking enforcement files. However, both PCs have identical software, so either one can perform multiple functions if one crashes. Several computerized dispatching and report writing systems are being evaluated by the IT Department, and one will be adopted later this year. All of the systems under evaluation are Web-based, so PSOs can use any computer throughout the medical center to write a report and forward it electronically to their supervisor for review and approval. PDA compatibility is another requirement, so PSOs will eventually be able to write reports anywhere on campus and have all emergency and operating procedures at their fingertips.

Life Safety
FMC is protected by a Simplex 4120 Life Safety System. Thirty-one separate fire alarm panels monitoring more than 3,500 fire alarm devices (smoke and duct detectors, sprinklers and pull stations) are integrated into a single, easy-to-read system, with the screen showing the actual location of all devices activated. Engineers and PSOs provide a coordinated response to all fire alarm activities.

Radio Communications
FMC’s new radio system, designed by Amerizon Wireless, consists of two Motorola repeaters for Engineering and Public Safety. There are separate simplex frequencies for Engineering, Public Safety, and the Hazardous Materials Response Team. A utility frequency is available for special projects requiring constant radio communication, so they do not tie up the other channels. All of these channels are available on every portable radio, which allows other users to contact Public Safety directly by radio to report an accident, crime or other incident. However, there is a confidential frequency installed only on Public Safety radios for surveillance and other uses. An 800 MHz radio on city and county police, fire, sheriff and EMS frequencies is located in the emergency department. Additional 800 MHz radio consoles will be installed in the communications center and the emergency operations center later this year, providing direct communications with city and county agencies during emergencies. In addition to radios, all PSOs on patrol carry Spectra-Link telephones (the medical center’s internal cell phone system), enabling them to contact any FMC telephone or make outside calls as needed.

The communications center’s console configuration is designed to permit two planned expansions within our current space, which will meet all FMC security needs during the current five-year capital improvement program.

A large medical center campus is a demanding environment in every respect with no room for error, from surgical procedures to emergency responses. Long-range strategic planning, comprehensive training and state-of-the-art technology are providing Forsyth Medical Center with a safe and secure environment for quality patient care, now and in the years ahead.

Anthony N. Potter, CHE, CHPA-F, CPP, is the director of public safety for Forsyth Medical Center and its affiliates in the Piedmont Triad area of North Carolina. He has more than 45 years’ experience in law enforcement and security, and has been in healthcare public safety since 1990. Mr. Potter received the 2003 Woody Near President’s Award and the 1992 Lindberg Bell Award from the IAHSS, and currently chairs an IAHSS special committee to develop accreditation standards for healthcare security departments. He has published more than 100 articles in professional and trade journals, and his second book, Considerations When Arming Hospital Security Officers, will be published later this year. Mr. Potter can be reached at 336-718-5537 or