Hospital Security Planning: Operational & Technological Considerations

Workplace violence, angered patients, and/or families frustrated by long waits to be seen – these and other psychiatric aspects of illness and injury are all too common to hospitals, and to their Emergency Departments in particular. These issues, along with the threat of terrorist attacks similar to those seen in Mumbai in November 2008, have significantly increased the importance of hospital security practices.

To improve individual and collective hospital security in District of Columbia hospitals, funding   received from an HHS (U.S. Department of Health and Human Services) Coalition Partnership grant has been used to perform individual security-risk assessments of all hospitals in the D.C. area.

During those assessments, facility architecture, security operations, and technological security measures all were reviewed at each facility by a consultant with expertise in hospital security. The results were then shared with each facility in individual reports. Prior to final submission the results and accompanying recommendations were reviewed with key facility officials in a separate meeting. Following the completion of all of the security-risk assessments a comprehensive report – Summary Recommendations on Hospital Security Best Practices – was written and discussed at a day-long Hospital Security Best Practices Seminar during which hospital security personnel and law-enforcement officials discussed the common findings and strategies to combat the issues. Best Practices Times Three A previous issue of the DomPrep Journal (December 2008) discussed the best-practices architectural recommendations. However, the architectural design of a security system, important though it may be, is of little practical value unless it is complemented by comprehensive and effective operational and technological security practices.

The architectural design of a security system is of little practical value unless it is complemented by comprehensive and effective operational and technological security practices

Among the most important Operational best-practice recommendations presented at the seminar are the following:

  • Train and certify security officers as Special Police Officers – armed with the  authority needed to make arrests;
  • Ensure that the security staff is able to participate in emergency response plans and operations;
  • Maintain comprehensive security policies and procedures, updating and revising them when and as necessary;
  • Institute an annual review-and-certification process for all written security policies and procedures;
  • Minimize security staff turnover by providing acceptable working conditions and requiring the direct hiring of employees;
  • Promote professional development and education in every way possible, including the provision of financial assistance to offset the costs involved in achieving higher levels of education; and
  • Ensure staff familiarization with the particulars of both the National Incident Management System (NIMS) and the individual hospital’s own incident-management team design, including specific details about the hospital’s own security policies structure.

Among the Technological security recommendations presented were the following:

  • Use closed-circuit television (CCTV) surveillance systems to extend security-force effectiveness – and complement that capability whenever possible with digital-recording technology;
  • Install and use electronic access-control and alarm-monitoring systems;
  • Integrate the CCTV surveillance and access-control systems to ensure that security personnel monitoring the system are optimally effective and efficient;
  • Install and use an electronic-security guard-tour system to monitor security officers’ performance of their checks and rounds;
  • Use two-way hand-held radios to ensure that continuous communication is available between and among security personnel, facilities personnel, and senior hospital management staff;
  • Install infant-abduction prevention systems when care is provided to birthing and pediatric patients; and
  • Ensure that a mass-notification capability is available in all hospital facilities to provide zoned and “all-call” capabilities.

To briefly summarize: Hospital security has never been more critical than it is now. To upgrade security to the highest degree possible, architectural design must be complemented by operational policies that address such needs as staff selection, training, and certification maintenance, along with their integration within the hospital incident command system. Suitable technology – including but not limited to CCTV surveillance, digital recording, radio communications, and visible as well as audible alarm systems – must also be available for use in strategically important areas. Only through effectively addressing its fundamental architectural, operational, and technological needs can a hospital meet today’s growing security challenges.


For additional information: On the 2001 DOJ report, see Violence in the Workplace, 1993-99, by D.T. Duhart;

On the 2008 survey discussed in the Journal of Emergency Academic Medicine, see “A Survey of Workplace Violence Across 65 U.S. Emergency Departments” (by S.M. Kansarga, S.R. Rao, A.F. Sullivan, and J.A. Gordon, et al. 

On Hospital Security: An Age-Old Problem Becomes Increasingly Important – /site/assets/files/5261/dpjournaldec08.pdf

Craig DeAtley

Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.



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