Bolstering ER security through environmental design

Experts discuss security considerations for building, renovating hospital emergency departments


One of the biggest headaches for any security manager in the healthcare environment is dealing with risks associated with their emergency departments. Sitting in a hospital emergency room is an inherently stressful situation for most patients and their families. In fact, long wait times in emergency rooms was listed as one of the primary factors contributing to rising crime rates at healthcare facilities across the nation in a study underwritten by the International Association for Healthcare Security & Safety (IAHSS) released earlier this year. The answer to mitigating the risks found in the ER, according to experts, lies in how the facility is designed and constructed.

According to Randy Atlas, Ph.D., AIA, CPP, president of Fort Lauderdale-based Atlas Safety and Security Design, Inc., emergency departments by definition are “high risk, high threat, high asset” areas where a “high level of vigilance” needs to be maintained.

Atlas, who has an entire chapter of his upcoming book, “21st Century Security and CPTED,” devoted to hospital security, says the first step any healthcare facility needs to take when they’re either building a new emergency department or renovating one is to conduct a thorough risk assessment/CPTED (crime prevention through environmental design) survey, which will help them determine what risks and threats need to be mitigated against, as well as assets that need to be protected and  vulnerabilities that should be addressed.  “Once that is refined for the emergency room or emergency department, then it is going to be much clearer and more apparent what particular mitigation steps are needed to protect it from a critical incident,” says Atlas.

Tony York, chief operating officer of Colorado-based hospital security provider HSS Inc., and author of "Hospital and Healthcare Security, 5th edition," believes that security managers need to have a seat at the table early on with the building owners and architects of any new healthcare facility. “The principles of CPTED, which is really what we are all trying to follow, is the concept of layers of protection. We’re looking at lighting and landscaping to make it a warm, inviting and safe environment. But once inside the emergency department, it is imperative to think about the high emotional state that most people arrive in.  So the first impression is important once they arrive.  Making a decision on whether the initial greeting by a security officer or by a triage nurse or receptionist,” York says.

York, who chairs the IAHSS Council on Guidelines participated closely with the group that developed the IAHSS’ Design and Renovation Guidelines, believes that these guidelines will be a “game changer” for the healthcare industry, as many had not even considered some of these best practices in the past. “I was just talking to an architect not too terribly long ago and he said, ‘wow, I never really stopped long enough to think about designing security to this extent.’ They (architects) think about locks and hardware, but they don’t really think about how you design it from the outside thinking of a patients’ perspective on security – from being in the waiting area to the patient care room,” says York.          

Being that many people drive themselves to the hospital when they’re extremely ill or wounded, York says that you want to position emergency entrances at an angle so that a person can’t intentionally or unintentionally plow their vehicle into the facility. York also recommends using some type of barrier at the entrance of the ER, such as curbs, bollards or some other type of physical deterrent.

 It’s also vital, according to York, that workers inside the emergency department have a good line of sight to both people entering the facility and sitting in the waiting room. “What we find is that if someone is agitated, they’re usually going to start showing signs of that inside the waiting area and we want someone to be able see it,” he explained.

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