Bolstering ER security through environmental design

Experts discuss security considerations for building, renovating hospital emergency departments


York says that chairs should be fastened together or to the floor to ensure that they cannot be thrown or used as weapon. That also applies to planters, fire extinguishers and other hard objects. Inside the patient care rooms, York says that architects also need to consider the height of things such as paintings and coat hangers, which could become hazardous in the event of an attack of a patient against a nurse or other staff member. “I think most architects are not giving consideration to what the heights of those items are. So, if you’re an average man of average height and you get thrown up against a wall because you have some majorly aggressive patient, what ends up happening? You find yourself having that thing go up against the back of your neck in a place where it could really hurt you,” says York.

York also believes that if security is present, then the security workstation should be visible by both visitors and staff members; ideally in the waiting area itself. York said he challenges leaders working in the healthcare environment that believes security isn’t important to go to their emergency room on a Friday or Saturday night and witness first-hand the issues staff in that environment are dealing with on a regular basis. “I think they’ll quickly realize that they’re not doing enough to keep their employees and patients safe,” says York.      

York and Atlas emphasized, however, that no matter what measures are in place or how much thought has been put into security design, it will mean little if it is not accompanied by thorough training of staff members.

“I think that there is a direct correlation between good design of security in these emergency departments and good training efforts that are making a difference,” explained York. “But, unfortunately, we’re talking about an industry that is just fraught with a culture of tolerance.  There are some (healthcare) organizations that are having thousands of (security) events in the course of a given year. You won’t find any healthcare security practitioner not witnessing an increase in their patient-generated violence episodes.”

Atlas says that while many older hospitals didn’t understand the importance of incorporating security into the design of their emergency departments, most modern ones are aware of how they can mitigate threats by implementing these aforementioned recommendations. “It’s getting a lot better, I think,” he says.