By Kory L. Sandoz, CPP
A pandemic may precipitate violence as the sick and their love ones rush to nearby medical facilities. Security professionals and facility managers need to plan in advance for such scenarios. (Online Exclusive)
There is really no question about the likelihood of another flu pandemic. History shows that we have had at least ten flu pandemics in the past 300 years. What we can’t predict is when and how hard it will strike. We learned a hard lesson from Hurricane Katrina: we are on our own during the initial stages of any emergency. Local resources will have to be relied upon. Federal and even state assistance cannot be depended upon. During a pandemic these problems will be even worse. Illness will cross borders and become widespread. This could mean that assistance may never be forthcoming, which makes advanced planning that much more essential.
Many believe that the most likely virus to cause the next influenza pandemic will be the H5N1 Avian Influenza virus. This has become widely known as “bird flu.” This virus has shown the ability to kill humans. There is a concern that it could possibly evolve into a strain capable of causing a pandemic. Most governments and healthcare facilities, as well as some private companies, are drafting action plans for when the next pandemic strikes. It is essential that healthcare organizations have a plan in place for the medical aspects of a huge patient influx associated with a pandemic. But what about the security departments of healthcare facilities across the USA? Having a solid plan associated with the security of healthcare facilities and operations is arguably just as critical as the medical portion.
Americans believe that a hospital is a safe place to go in an emergency. It is a large facility that is open to the public 24 hours a day. They know there are likely to be various local officials available there in the event of an emergency. Moreover, hospitals are where people are taught to go if they are sick or injured. The unfortunate reality is that medical facilities are just not going to be able to meet the demand for services in a pandemic situation. Imagine a dozen or even a hundred sick, frightened, and increasingly frustrated people outside your doors. The potential for anger escalating to violence is a very real possibility that we as security professionals need to address.
Here are some numbers to consider when drafting a pandemic plan. The largest Influenza outbreak in recorded history is the Spanish Flu outbreak that occurred between 1918 and 1919. An estimated 500,000 people died in the United States during this outbreak. The worldwide death estimate is between 20 and 100 million people. To give you an idea about the numbers of people who will become ill in a modern day outbreak here are two examples. The State of Utah estimates 1 million ill. The State of Minnesota estimates approximately 1.5 million. It is generally accepted that once a pandemic flu strain is identified it will take 4 months or more before a vaccine is developed. Once that vaccine is available it will be in short supply.
These large numbers of people who are ill will create a variety of security concerns for health care organizations. Here are a few potential problems you may want to review. Consider if they could apply to your organization.
Staffing. Simply trying to round up enough staff to secure your facility may be a challenge. It is estimated that around 30% of the work force will be too ill to report to work. At the peak of the outbreak, absenteeism may be closer to 40% because healthy staff members will need to stay home to care for ill family members.
There is also the desertion factor among first responders to consider. Look back at New Orleans after Hurricane Katrina. Members of the departments of police and fire deserted their posts to take care of their family. You could expect similar desertions during a serious pandemic. Some people would rather take their chances with finding new employment in the future than risk catching the flu and spreading it to their family.
Another thing to consider is that security officers will also frequently have outside community commitments. Many are involved in the National Guard, military reserve, police reserve units, volunteer fire departments, or volunteer EMS units. These organizations would all be competing for the officer’s time as well. You would have to consider where to get staff from. You could try contract services but they will likely have the same staffing difficulties as you. You may have to consider some reassignment. Maybe a parking attendant could be used to check ID’s at an entrance. Maybe administrative staff could be used to staff door checkpoints.
You will want to ensure that the healthy staff members that do report for work don’t catch the virus. This means having a supply of protective equipment on hand. These items will need to be stockpiled in advance. There is likely to be a shortage of things like surgical masks and isolation gowns once the pandemic hits.
There are logistical considerations surrounding staffing that will need to be addressed as well. Your staff may need an area to change and clean up before going home. People will be concerned about bringing the virus home to their families. You may need to look at laundering uniforms on site. There will likely be a need to have food available for employees. Staffing shortages will mean longer shifts. You may want to consider advanced planning for sleeping arrangements for staff members. Staff may have extended schedules. They may be concerned about going home and giving their family the flu. There may be transportation issues if mass transit is limited due to staffing problems of their own. You may just want to have the additional staff members nearby and available rapidly if problems arise.
Escort or Transport. Medical staff could potentially face large groups outside the facility making it difficult for them to get to work. The situation may be comparable to labor-dispute picketing. You may have to find a way to ensure staff can get in and out of the facility safely. This could be something simple like crowd control at a designated entrance. It could also mean having staff members park at an off-site location and shuttling them to the campus.
Credentialing. Your regular staff probably already has ID badges, but you have to consider outsiders. You are likely to have people from numerous outside groups at your site. This could include agency nurses. It could be outside physicians who have come to provide assistance. It could be people delivering food or supplies. How will you credential outsiders who will be working at your site? You will need to have easy to identify, uniform credentials for these people. It is possible that you will have people providing access-control assistance who do not normally perform this type of task. This makes it that much more essential that the credentialing system be easy to understand.
Secure Medication Transport. You may want to consider how you will get medication shipments to the facility securely. If it is determined that anti-viral medications are effective against the viral strain, then those medications will rapidly become in short supply. Once a vaccine is developed, the initial allotments will be small. This will make these kinds of items susceptible to being stolen.
The last thing you will want to do is drive up to the distribution location in a van with your hospital’s name in huge letters across the side. That would be an invitation to would-be robbers. You may consider contracting an armored vehicle. Maybe an agreement could be reached with other area medical facilities to share the cost of this type of secure transport. Keep in mind that armored couriers will face the same type of staffing concerns that you will have. You may not even be able to get someone.
Perhaps an option would be to entrust members of your own security staff to make the pick up in a discreet vehicle. Find out in advance if any of your security staff have a firearms' permit. It is possible that an arrangement could be made with local law enforcement to assist with transporting medications securely.
Pharmacies. Pharmacies could be targeted for all the same reasons that medication deliveries could be at risk. Fixed-site pharmacies would be at risk for being robbed or burglarized or both by people trying to obtain antiviral medications, vaccines, and even antibiotics. People may try to obtain antibiotics not realizing that they are not effective against a viral illness like the flu. You will have to be creative to keep pharmacies secure so they can still dispense critical medications.
If a location has a drive-through pharmacy window you could consider using that as the only access point. Pharmacies may have to consider an armed security presence if the situation was serious enough. Hospitals with multiple pharmacy locations may need to close (at least to the public) all but their primary pharmacy (which is usually secure since it is open 24 hours).
Access Control. Access control is going to be the big issue. There are numerous access control issues and problems that will need to be taken into consideration. The first question is where to begin access control.
In a serious pandemic situation you may need to push that perimeter out. Perhaps you need to begin access control at the driveway entrances. You may need to close down all but a primary roadway and turn that into a one way with stopping only to load and unload. If the hospital is at capacity, you may need to close off all access roads completely and allow only EMS and employees into the secure perimeter.
What if your location will not allow for pushing out the perimeter? Then you will need to control access at the doors. Hospitals are notorious for having multiple public entrances that are difficult to control. You will need to close down and secure the majority of those entrances. The most logical door to keep open is the emergency room entrance, which is the entrance that the majority of people will automatically come to if they are seeking treatment. You would of course need several employees at that entrance to control access into the facility. That will be a very draining task, so frequent rotation will be important.
What about staff? You may want to consider having a second entrance open and access controlled just for employees. This will prevent employees arriving for work from exposing themselves to the sick. It will also offer them some separation from any discontented groups around the public entrance. This makes logistical sense as well. It will reduce the number of people flowing through an area that will already be overwhelmed. If your area’s climate and weather are favorable, there is the potential for medical staff to do some triage outside. Then only identified patients would be let in.
What about visitors? That will be a huge consideration. People will want to see their sick friends and relatives. You will have a facility that is already at capacity, and the addition of one or two visitors per patient would make hallways impassable. The most obvious solution is to enact a no-visitor policy. That sounds good on paper, but in reality it would be much more difficult because you would be adding all of those angry and worried visitors to the crowds of sick people trying to get in your doors.
Most hospitals have evaluated their surge capacity from a medical standpoint. They may consider using areas that are normally not associated with patient care to set up cots for triage or non-critical care. You will need to consider how to control access to those areas as well.
Crowd Control. There are several crowd-control issues that will need to be looked at. The most obvious is dealing with a group of sick and angry people who cannot get in because you are at, or near, overcapacity. You will have to consider what will work best for your situation. Will you need some type of physical barrier? Will uniformed security officers be adequate? When vaccines are ready or effective medications are identified the most likely method of distribution will be in large public groups at hospitals or clinics. How will you control hundreds of sick and scared people pushing and shoving to get their medication first?
Municipal Authorities. In the recent past, most police administrators were of the opinion that securing a hospital (especially one that is private) was solely the responsibility of the hospital's security department. They felt their role was limited to call response. That is seen differently by a lot of municipal authorities in this post-9/11 world. Police are realizing that hospitals are critical infrastructure that needs to be protected. They acknowledge that they will need somewhere to go if they become ill or a member of their family gets sick.
Consider the responsibilities that municipal authorities could assist you with. Keep in mind that they will suffer from the same staffing shortages that everyone else will face. If you were required to push back your access control perimeter to the driveway entrances police officers or firefighters could block driveways with vehicles and control access from that point. Police officers could help pick up and deliver medication allotments to ensure that they arrive at your facility securely. The uniform presence of even a single police officer at an access control checkpoint door could help maintain order.
If the situation was serious enough that a crowd would need to be dispersed, there is the possibility of using a fire hose to help with crowd control. There is the possibility of some staffing assistance as well. Firefighters usually have some traffic and crowd-control experience from accident scenes. Even if your city won’t provide any on-duty firefighters you may be able to hire them while off duty. This will offer you staff with some training and at least some level of background screening.
Drills. A lot of hospitals, especially in large cities, are holding preparedness drills. Even if your security department can’t or does not wish to participate in a full mock pandemic exercise, there are still things you could do. For example, one of your staff members could try working in a mask, gloves, and isolation gown for a few hours. This would give you an idea of the limitations they would face, such as how often you would need to rotate officers due to heat and other environmental conditions. You could go around to your exterior entrances and see just how difficult it would be to truly secure them.
Media. Security officers and police officers are all taught to give the press the old standard reply: no comment. In many cases, that is the best way to prevent any miscommunications.
In a pandemic situation, however, you may need the media to get your message out. If you are at or beyond capacity the media is a good way to communicate this to the public. If a vaccination clinic will be held, you can release those specifics to the local media. Be sure media statements are issued by a designated, responsible person.
Recovery. There are a lot of things you will have to consider even after the pandemic has eased. What do you do with staff that abandoned their post? You would save the costs of recruiting and training new people if you let them stay on. If you do let them stay on, will there be any consequences? How would you rebuild trust within your team?
There will no doubt be financial issues to contend with. You will likely have huge overtime costs that were not budgeted for. You will probably have costs for equipment that needed to be purchased or rented during the crisis. Will you be able to reward staff who took the risk and put in the extra time and effort?
What about decontamination? What equipment did you need to use during the crisis that may now need decontamination, such as flashlights, traffic vests, or any item that was exposed to sick patients? Check with your infection-control department or the department of health to find out what is necessary. They will be able to tell you how long a virus can survive and on what types of surfaces.
The intent of this article was to present you with scenarios to consider. Obviously, it can’t give you solutions that will fit every facility and situation. You have to determine what will work for your site. A lot of the materials presented here represent a worst-case scenario. It is entirely plausible that the next pandemic could be much less severe. Nevertheless, if you plan for the worst-case scenario then you know you are covered. Like the old saying goes, plan for the worst and hope for the best.
Kory L. Sandoz, CPP has 20 years experience in security and law enforcement. He currently works as a training officer for Park Nicollet Health Services in the Twin Cities of Minnesota.