According to the U.S. Bureau of Labor Statistics, healthcare is the country’s largest industry and is expected to generate more jobs over the next few years than any other field. Seven of the 20 fastest-growing occupations are healthcare-related. The explosive growth in this area will require extra attention to security in order to the meet the special needs of hospitals and medical centers.
A typical medical center is likely to share many of the same safety concerns — transportation, parking, crowd control, theft and violence — that a small city might face. There is a need to maintain a constant safe and secure environment at the center to help protect a population that includes doctors, nurses, staff and hundreds or thousands of patients and visitors moving in and out of the facility each day.
All of those people — many of whom are under stress — can create volatile situations. The federal government has reported that hospital workers are four times as likely to be assaulted on the job as compared to those in other private-sector jobs. This high-stress environment, concentration of diverse population groups and abundance of high-value assets create special challenges for the security professionals charged with providing a safe and secure environment for the property owner, employees and others.
Start with the Perimeter
One good way to create a tight security plan is to start with the outdoor perimeter. Most people’s first impression of a hospital or medical center is likely to be the parking areas. Most centers will have uncovered lots, a parking garage and special areas for doctors, employees and emergency vehicles. Low-tech methods, such as crime prevention through environmental design (CPTED), will require that foliage be kept cut back and not blocking views of security officers into parking areas. As hospitals are active both day and night, bright lighting in all parking areas is vital.
Video surveillance systems also play an important role. Cameras need to be placed properly and in sufficient quantity to reasonably cover all parking spaces. Parking lots and garages offer potential attackers many ideal places to hide in wait of a victim or to avoid detection while waiting for an opportunistic crime. Cameras enable security personnel to provide a video escort for hospital employees coming and going during night shifts, freeing security officers from this important but time-consuming task. Video can also help to review incidents, such as when a visitor claims to have a slip-and-fall accident or damage to his or her vehicle while in a parking structure or lot.
Communication kiosks can be a great complementary addition to video surveillance. The kiosks should be prominently located in easy-to-find spots throughout parking lots and garages to help guests summon help if a visitor or employee feels threatened or should someone need immediate medical assistance. Wireless and cellular technologies increase flexibility of these kiosks, making it possible to install them virtually anywhere on the medical center property. Some kiosks can even use solar power, reducing energy costs and enabling a further variety of installations. Cameras can also be integrated with these devices to provide a single point of communication and surveillance.
To address potential privacy concerns and create a deterrent effect, ample signage should warn visitors and would-be criminals that they are under surveillance. Additionally, advanced video technologies, such as video analytics, can automatically monitor camera data and alarm on predefined conditions. Analytic profiles can alert security officers to a vehicle blocking the ambulance parking zone, loitering persons or unattended parcels left in an unsafe or suspicious manner. Analytics can also be used help monitor parking areas for people crouching behind objects or cars, unsafe traffic movement or illegally parked vehicles.
All perimeter entries to the hospital should be under video surveillance. Clearly visible monitors should also be mounted just inside each major entry to let people know they will be monitored while in the facility. This will help to act as a deterrent to someone planning illicit activity, and can comfort those whose most valuable assets, their loved ones, are entrusted to the facility.
The emergency room can be a hospital’s most challenging and dangerous area. Most emergency rooms never close and they serve as the treatment center of choice for many ill and injured people. Gang violence that begins on the streets may spill into the ER, where injured gang members are taken for treatment. Cameras are critical for monitoring the entrance, waiting room and non-treatment areas of the examination space.
Most new hospital layouts have designed emergency rooms to include a security station with a constant guard presence in order to enforce access control procedures. Previously, many security stations were located deep within the center of the hospital. Having security personnel closer to the action can help diffuse problems as they arise.
No one should be allowed to pass from the waiting room to the examination space without first checking in with a receptionist, who should have the ability to electronically unlock the door separating the two areas. Bulletproof glass is often a good idea to serve as a barrier between treatment areas and public spaces, and whenever possible, non-medical personnel should be escorted into the area.
Obviously, medical personnel and emergency responders with ill or injured patients need immediate access to the ER, and a separate entrance for these people is always a good idea. Those with a need to enter the ER on a regular basis can be issued an access card, enabling speedy access for patient care while maintaining a high degree of control.
Pharmacies are another area in a hospital that require a high degree of security and accountability. Stocked with many valuable and life-saving drugs with high street values, pharmacies and their inventory can be a target of theft and manipulation. The pharmacy needs to balance flexibility and easy access with strict control of who is permitted access to the pharmacy and its contents. Access to the pharmacy should be kept to a minimum and each should have a card reader to allow access only to authorized employees.
The access control system will provide an audit trail of who entered the pharmacy and when. Video surveillance is also essential and may deter abuses of pharmacy resources. Cameras should be mounted to monitor the work areas and entries. In addition to standard access control and security technologies, advanced inventory management applications are available to not only restrict access to controlled substances but also provide patient accounting and medical records management.
Other critical areas that require video surveillance are elevator banks, waiting rooms, hallways in public areas, nurses’ stations on each floor and entries to areas such as surgical suites and the nursery. All video should be transmitted to a central security station, where it will be recorded for investigative purposes. The station should be staffed at all times in order to respond immediately to alarm situations. By monitoring live video during a crisis, the attendant can help direct fellow security and law enforcement officers during the emergency.
Protecting Patient Information
A host of state and federal laws and regulations now require careful protection of private patient information. Data centers and record rooms should be treated much like a pharmacy — with limited entries, access control and cameras mounted to see who comes and goes. There are numerous regulatory and technology initiatives to convert hard copy patient information to data, making the convergence of physical and logical (data and network) security not only desirable, but a necessity. The “file room” of days gone by will become the computer workstation or handheld computer in the future, making data more readily accessible and making security and protection of medical records a united effort of both security and IT professionals.
Integrated Access Control
All employees, doctors and long-term contractors should be issued an access credential that they are required to display at all times, with the credential also serving as a visual photo identification badge. In addition to the previously mentioned use in pharmacies and patient record areas, an access control system can be deployed throughout the facility for control and management purposes. Each user should have customized access only to those areas required for them to complete their current assignment. For instance, doctors may be allowed to access elevators to surgical suites and any other patient care areas, while a maintenance worker’s card may not allow entry to the data center. The system should allow access to be coded not only for individual location, but also by day and shift, job classification, certification currency, etc. The system may also be integrated with time-and-attendance functions, parking access and logical access functions for computer sign-on.
A highly integrated access system may help to track the movement of employees or other vital medical personnel. In an emergency, it would be helpful to know if a doctor had arrived at the hospital and in what department he or she is currently working. RFID-based tracking systems are also helpful for monitoring wandering patients, infants and portable equipment.
Stories of newborn babies being taken from a nursery make national news. That is the type of publicity that no hospital wants. RFID tags can be fitted to an infant’s ankle. Readers placed at the perimeter of nursery or maternity ward will set off an alarm if anyone other than an authorized caregiver tries to take a baby past that point. A tag can also set off an alarm if anyone tampers with it to remove it from the infant.
The same type of RFID tag and reader system also can work in geriatric or head trauma areas, where patients suffering from dementia or other impairment may try to wander from a controlled area, placing themselves into a dangerous situation.
A similar RFID system may also be used to track equipment throughout the hospital. Expensive equipment, such as portable X-ray machines and crash carts, can be moved from room to room or even to a different floor. By applying an RFID tag to the equipment and mounting readers on entry and exit portals, it is possible to locate the equipment when it is needed. From a business perspective, proper management of expensive assets enables the facility to have the equipment when and where it is needed for patient care without excess inventory or unnecessary delay.
Infrastructure costs to effectively use asset-tracking systems are still substantial; however, technology costs are decreasing, ensuring hospitals will be deploying more of these systems in the future.
Ongoing Risk Assessment
As with any type of facility, a hospital or medical center needs a regular risk assessment to make sure that its security program is up to meeting the challenges it faces. An experienced systems integrator will be able to assist with such an assessment, balancing the unique needs of a specific facility with available and reliable technology from respected manufacturers. Highly integrated systems enable modular expansion as new applications are identified or funded. Additionally, a single-operator interface into multiple subsystems (access, alarms, CCTV, intercom, etc.) can actually reduce manpower and operational costs while improving the timeliness of the response to any security situation.
Any time there is new construction — a parking garage, offices or a maternity center, for example — it is important to consider security from the beginning planning stages. It is always easier and less expensive to run cables during the build phase than to create construction havoc to patients and staff during a retrofit.
Medical centers and hospitals have security concerns that go above and beyond what most other organizations need to consider. These large, city-like facilities need to integrate video and access control with new technologies and other low-tech solutions to keep their employees, visitors and some of the most vulnerable among us safe. It is a huge challenge that takes careful planning and implementation, and the experience of a qualified systems integrator can be a valuable asset for a successful outcome.
Bill Savage is the president of Security Control Systems Inc., with offices in Houston, Dallas, Austin, Texas, and New Mexico. Savage is also a founder, past president and current member of Security-Net, an international network of 24 leading independent systems integrators.