Hospitals that only a few months ago were hosting kidney transplants and mending accident victims are now full time Covid-19 triage and acute care centers. Medical centers as perhaps never before are on the forefront of a global battle.
Frustrated, overworked personnel are being forced to make hard decisions about distribution of limited resources. The situation is ripe for anger and conflict. That conflict can come in the form of a disgruntled employee, family member or, as if we didn’t have enough to worry about, criminals and terrorists.
In Missouri this week it came to light that 36 year old Timothy Wilson had been planning a terrorist attack for months. Motivated by extremist racial, religious and anti-government animus, he had been considering various targets. His weapon was going to be a vehicle-borne improvised explosive device. In the end, his chosen target was an area hospital “in an attempt to harm many people, targeting a facility that is providing critical medical care in today’s environment.” Indeed, an attack on a hospital would be a bonus, a chance to kill hundreds but also wreak extra havoc, from his point of view.
We think of hospitals as safe havens, as well they should be. But that very sentiment makes hospitals and emergency responders targets in the minds of the enemy. Another example is that of Wafa al Bass a Palestinian woman from Gaza who in 2005 was receiving specialized medical care at the Soroka Hospital in Beer Sheva, Israel’s second largest medical center. En route to one of her care visits, she was stopped by border police who found her suspicious. A security check revealed that she had a 20 pound explosive belt under her clothing, which she tried unsuccessfully to detonate.
In many cases, access control at hospitals has not historically been a critical consideration. Security levels differ from location to location, dictated in many cases by culture and community norms. Under the best of circumstances, being hospitalized is stressful. Protocols for visitors be they family or friends take that into consideration. My personal experience at large and small hospitals in Southern California has been that there are plenty of loopholes. A security officer is off post. Blank badges are left out, and doors are left unlocked. And a little social engineering goes a long way. The main goal – as it should be – is patient well being. Security has been a secondary concern. In this pandemic, monitoring access to the hospital is a public health priority.
The last months have demonstrated how quickly things can change.
It’s worth noting the difference between the kind of access control with which we are already familiar at hospitals versus access control measures for security. For example, hospitals try to keep folks out of restricted areas of the hospital to prevent them getting in the way of medical personnel doing their jobs, to keep hallways clear and quiet. However, “Patients Only” or “No Visitors Allowed in this Area” signage may work well enough to control the good guys, but not so much malicious adversaries.
There are instances where an ambulance has been used to perpetrate an attack or serve as getaway afterwards. For a criminal, nothing is sacrosanct.
- Extend perimeters outward – campus entrances and checkpoints should be as far from the hospital entrance as possible to allow for screening of arrivals at a safer distance from the protected environment.
- Security patrols along perimeters are another way of supporting the effort of adding security rings.
- Most hospitals are as open and accessible as hotels. Anyone can enter the lobby. Where personnel resources allow, consider escorting patients into the facility, versus having people be screened only after entering. Currently, common protocol for discharge has a patient wheeled out the door so escorting is already in use.
- Make sure personnel are aware of social engineering methods an adversary would use to infiltrate the hospital.
- Reach out to local police for assistance patrolling hospital perimeters and adjacent streets in the neighborhood.
- Make sure all staff are up to date on access control procedures.
- Establish communication with Security Managers at other hospitals in the area to share information and intelligence on situations and threats they are facing.
- Make sure security personnel have proper protective equipment, as they may be the first individuals to interact with patients, staff and visitors coming into the hospital.
- Set up an area off site where media briefings can be held.
The good news is that putting more stringent access control in place, and training people on proactive procedures will have an immediate effect. Ramping up security takes thought and discipline but in the larger scheme of things, is easier than many of the other battles we are fighting.
We would like to hear your comments and ideas for improving hospital security in this time of crisis.