Does hospital security have a role to play in containing the threat of Ebola?

Sept. 25, 2014
Security departments at hospitals across the nation need to be on high alert

President Barack Obama on Thursday held a press conference to emphasize the threat of the spread of the Ebola virus and why it will take a global effort to stop it. The Ebola virus has five strains and the deadliest, the Zaire strain, is currently spreading through West Africa with a 90 percent mortality rate.

The New England Journal of Medicine recently released a report that stated: 

"The 25th known outbreak of Ebola virus infection is unlike any of the previous epidemics. It has already killed over 2800 people — more than all previous epidemics combined; it's affecting virtually the entire territory of three countries, involving rural areas, major urban centers, and capital cities; it has been going on for almost a year; and it is occurring in West Africa, where no Ebola outbreak had previously occurred. Above all, the epidemic seems out of control and has evolved into a major humanitarian crisis that has finally mobilized the world, with responses ranging from an emergency health mission launched by the United Nations Security Council to proposed military-style interventions and the global provision of emergency aid.

The disintegration of the health care systems in the affected countries is already having a profound impact on the populations' health beyond Ebola, as clinics close or become overwhelmed or nonfunctional. These health system effects will only worsen as the epidemic progresses."

The CDC said in a report this week that unless it is contained, "the number of Ebola cases in Liberia and Sierra Leone could rise to between 550,000 and 1.4 million by January 15, 2015, without additional interventions or changes in community behavior."

Hospitals and healthcare providers are at the spear point of the epidemic. The large predicted increase comes from cases which workers in West Africa say are still unreported, and cases that cannot be treated because there are no hospitals or clinics to record their status.

In the last week, events in West Africa have highlighted the integral role that healthcare security personnel will play in this epidemic. Clinics in West Africa have been attacked, healthcare personnel have been killed or driven out of affected villages, and healthcare delivery in these countries is in crisis.

The nature of the Ebola virus itself, where transmission comes from contact with bodily fluids of infected individuals, instead of respiratory transmission like the H1N1 virus, requires a unique and different configuration of healthcare facilities to try to contain the spread of the disease.

Many U.S. hospitals have scheduled meetings of newly formed internal groups to meet the first week of October to start preparation of emergency planning for possible Ebola cases in the U.S. Again, the method of transmission means that security officers will be integral to preventing the spread of Ebola, both to the community and also to the existing patients within the hospital or clinic.

Two separate pathways need to be established employing proper barriers, one for suspected Ebola-exposed patients, and a separate entrance for regular hospital or clinic patients. The traditional hospital emergency department should be reserved for regular patients to ensure those who may already be ill and/or have compromised immune systems, do not have any contact with the virus or the healthcare personnel who are treating Ebola patients.

In most cases, this will be a daunting task. Creating a separate tent facility in the hospital parking lot is impractical in many cases, however, temporary buildings could be brought in or there could be new pathways established for treatment of suspected cases. The CDC already has 20 centers set up throughout the U.S. to treat suspected cases.

In his speech at the United Nations, President Obama outlined additional measures to stop the spread of Ebola in West Africa, including:

  • Designation of a military command center in Liberia to support civilian efforts across the region.
  • Creation of an air bridge to get health workers and medical supplies into West Africa faster.
  • Establishing a staging area in Senegal to help distribute personnel and aid on the ground more quickly. 
  • Creating a new training site to train thousands of health workers so they can effectively and safely care for more patients.
  • Deployment of U.S. public health personnel to the new field hospitals that are being setup in Liberia. 
  • USAID will join with international partners to distribute supplies and information kits to hundreds of thousands of families so they can better protect themselves.
  • Building of additional treatment units, including new isolation spaces and more than 1,000 beds.

The effort is one that has been requested by individual countries in West Africa already overwhelmed and facing the prospect that many private airlines are refusing to fly into the affected countries, making it very difficult to deploy critical supplies and personnel.  

Security departments at U.S. healthcare facilities can look at these areas of concern, if the epidemic spreads to North America or if additional patients from West Africa are transported to the U.S. for treatment.:

  • Security will be responsible for creating and securing isolation units, walkways for regular patients and Ebola patients.
  • Security officers possibly refusing to come to work if EBOLA patients are in the hospital.
  • Security must have adequate supplies, including temporary barriers, food and water, containment and hazmat suits, respirators, etc. that should be ordered in advance to avoid possible scarcity in the future.
  • Having effective communications systems including temporary signs, electronic message boards for both internal communications within the healthcare provider, and outward to the community.

Long term outlooks for the course of the epidemic are split into two groups, one that believes the epidemic will stay on the African continent, and other that believes there is a possibility the Ebola virus will mutate into an airborne disease that could be more easily transmitted.

Currently, Ebola is only transmitted  through direct contact with bodily fluids, but some scientists have raised the point that viruses like Ebola do not replicate evenly, which means that a virus entering one person may be genetically different from the virus entering the next person. Virus researchers point out that the current transmission rate is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years.

The Ebola epidemic is an epidemic that is unprecedented in modern times, and it will have a major impact on U.S. hospitals and other health organizations, even if the world is successful in confining the spread of the disease to West Africa. Healthcare organizations can use the epidemic as a "live" emergency drill, setting up an Ebola action committee, and seeing how fast and effectively the group can set up a plan.

The CDC has also created a "Hospital Preparedness Checklist" that can be accessed at

About the Author: Caroline Ramsey Hamilton is the President of Risk and Security LLC, and consults on threat and risk assessments of security issues including hospital security, facilities security assessments, and analysis of workplace violence and active shooter.

About the Author

Caroline Ramsey-Hamilton | President, Risk and Security, LLC

Caroline Ramsey-Hamilton is a leading threat and risk assessment expert in both physical and IT security. She has developed many specialized risk and threat assessment programs for hospitals, healthcare organizations and large public and private organizations including the Department of Defense, the Department of Homeland Security, the Department of Justice, and companies like Northrop Grumman, AT&T, Parrish Medical, and Magellan Health Services, Inc. Ramsey-Hamilton also serves on the board of the South Florida Chapter of the International Association of Healthcare Security and Safety.