Hospital Security: The Past, The Present, and The Future, Part 2 of 2

Healthcare security consultant Jeff Aldridge examines the need of risk assessments and the hospital security management plan


Don’t forget it’s just as important to prevent unauthorized egress from the facility as it is to prevent unauthorized access into the facility. An uncontrolled, unlocked emergency exit provides an escape route for a fleeing criminal. Uncontrolled, unlocked exits also encourage patients to leave the hospital against medical advice (AMA). The National Fire Protection Association (NFPA) 2000 Edition permits door-locking devices with delayed egress in healthcare occupancies, or portions of healthcare occupancies. The code states that where the clinical needs of the patients require specialized security measures for their safety delayed egress is acceptable. The delayed egress hardware is designed to lock and alarm for fifteen seconds before allowing an individual to exit. In the event of fire the delayed egress locking system is over ridden by the facility fire alarm protection system. The fire alarm protection system has priority over all other systems and will automatically unlock all emergency exits in the event of a fire. Delayed emergency egresses serve as a deterrent to individual that may target the facility. Card access can be provided both for egress and ingress.

Camera/CCTV Surveillance

Many of the CCTV surveillance cameras and monitors in use in hospitals today are the old black and white analog systems which are not state-of-the-art products and are obsolete. Many of the cameras are not equipped with recording capability and may be positioned incorrectly. Several systems currently in use by hospitals are not monitored and are in disrepair and non-functional. In many cases hospitals do not have a Central Security location provided to monitor, record, and dispatch security response to security events that occur in their facility.

Hospitals need to replace obsolete CCTV surveillance systems and upgrade to a state-of-the-art digital, color, matrix system with digital archiving capability. Cameras should be installed in security sensitive locations such as public entrances, parking locations, entrance and exits, as well as sensitive areas such as the, Birth Center, Emergency Department, ATM Machine, Loading Docks, Cashiers, and Pharmacy. The CCTV system should also be integrated with access control through the hospitals IT infrastructure.

Photo I.D. System

A large number of hospitals still continue to use old hospital identification cards that do not display the employee’s photo. To my absolute amazement, a few are still using the plastic name tag with just the employee’s name displayed on the tag. Any office supply will be glad to sell you a bucket full with any name you would like to have engraved on the tag. More alarming is the fact that many hospitals do not enforcement the wearing of any type of hospital identification by employees and staff. Every employee and staff member, including doctors should be required to wear a tamper-proof photo identification badge, facing, forward, displaying the person’s first and last name, title, and the hospital’s name and logo.

Hospitals that fail to require all employees and staff to display a photo identification badge are exposing themselves to serious litigation. Several years ago I testified as an expert witness in a case where a hospital was sued for several million dollars because the hospital did not require all of their employees to wear Photo I.D. badges. An infant was taken from the nursery by an abductor thought to be a fellow employee by a new staff member. Photo I.D. badges were not required to be worn in the nursery because staff had complained that the I.D. badge scratched the babies when they were being held. Facilities need to replace their out-dated I.D. systems with a state-of-the-art computerized photo imaging system where the photo is implanted into the PVC plastic card.

This type of I.D. system offers many advantages. For example, this type of system archives the image so that it can be used to make a replacement badge for an employee without the employee having to leave his or her work area to have another picture taken. Many hospitals have incorporated a bar code or smart chip into the card to provide time and attendance for their employees as well as being able to restrict access to certain locations for unauthorized employees.

Emergency Department Threats

A Justice Department study reveals that hospital emergency departments across the country treat more than 1.3 million people a year for injuries caused by violent attacks, an increase of 250 percent over previous government estimates. A study by Erickson and Williams-Evans (2000) reveals that nurses are the frequent targets of assault and the greatest number of assaults (25%) occurred in emergency departments; of the 51 homicides recorded, 23% occurred in emergency departments.