The following post on self-defense and medical preparedness is fourth in a series by Pete Farmer, who holds advanced degrees in research biology and history, and is also an RN and EMT.
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In previous installments, we have examined some of the realities and challenges of self-defense and medical preparedness, including protection for your patients, colleagues and yourself, as well as protective considerations regarding your aid station, clinic, or other facility, such as location and visibility. In Part 4 of the series, we will examine additional aspects of operational medicine and security.
Having acknowledged the need for such skills, you have begun basic training in the martial arts and the use of firearms. You and your colleagues have sited your facilities using sound tactical thinking, with an awareness of your mission, operating environment, and such factors as location and visibility. Perhaps you have arranged for guards or other on-site dedicated security personnel. Your clinic has begun receiving patients and your medical staff – professional or otherwise – is treating them on an on-going basis. Let’s assume you are in a fixed facility of some kind, a brick and mortar building, such as a school. Now what? What other security considerations remain?
To answer this question, consider a modern hospital or out-patient clinic and how it is structured and operated…
Almost all modern healthcare facilities, especially the larger and busier hospitals and clinics, have multiple layers of security. Physical access – who may enter/exit – is usually controlled in some manner. These include key card-access for staff, restricting public access to guarded or supervised doorways, and issuance of visitor badges and patient ID bracelets or tags. Most hospitals now have dedicated security staff or an outside firm to handle such operations, and most use some sort of video surveillance or monitoring technology. Additionally, most facilities have a PA system or intercom to permit hospital-wide broadcasting of codes (medical emergencies), fire or disaster alerts, security lock-downs and other relevant announcements. Larger hospitals have dedicated staff responsible for the design and implementation of disaster response scenarios, including evacuation and fire drills, tornado/hurricane warnings, and the like.
In high-risk areas of the hospital, there is often additional security in place. Access to operating theaters, burn and psychiatric units, and emergency departments is usually restricted only to those who have business there. Most clinics and hospitals have detailed rules and regulations posted, which govern visiting hours, access to in-patients, and similar items.
In short, modern health care facilities can be very high-security places indeed, at least in certain circumstances. Why? The answer is somewhat complex, but in brief it is because health care professionals and organizations have learned from hard experience that such measures are necessary for patient and staff safety, as well as optimal functioning. They are also necessary to prevent theft and other crimes, such as abduction of infants or other patients. Finally, and perhaps most importantly, restricted access is critical as a means of infection control. This is one reason why open access to ICU or burn patients is restricted; such patients are often immune-compromised and/or may have drug-resistant infections such as MRSA (Methicillin-resistant Staphylococcus aureus). Controlled access is necessary to protect the individual patient concerned, as well as caregivers, family members, and other patients in the hospital.
Another aspect of security and protection concerns the physical security of drugs, medical supplies, diagnostic and other equipment, and other valuable inventory and supplies. Decades ago, hospitals, clinics, and pharmacies were much more open and uncontrolled places than they generally are today, but long experience has taught that these valuables must be secured, or they will be stolen, misplaced, or otherwise mishandled. Thus, a drug cabinet on a specific unit or floor of a hospital is inventoried at the beginning and end of each shift, typically every eight to twelve hours. Two nurses count and inventory controlled substances according to a list kept in the unit, which is signed and countersigned after being checked. The cart holding each patient’s medical drawer – with medications to be administered – is locked when not in use, and is open only when hospital staff is present. Most supply rooms are likewise locked and many have electronic inventory control and charging to the patient in question. Likewise, the hospital pharmacy is tightly controlled and physically secured. ICU and ED crash carts are locked or sealed until their use is necessary.
Controlling drugs and supplies not only aids in preventing theft and misuse, it also enhances inventory tracking and replenishment, and helps control costs.
It isn’t only physical equipment which must be accounted for; it is the patients of the hospital or clinic themselves. Unfortunately, there have been cases of patients being abducted from nurseries or elsewhere in the hospital. Furthermore, patients hospitalized for substance abuse, dementia, schizophrenia, or other mental health conditions, are considered “flight risks,” meaning that they are considered prone to attempt to leave the hospital against medical and/or legal advice or orders. For this reason, nurseries, psychiatric units, and certain other kinds of units, may have controlled access. Some psych units have controlled exits, meaning that one may not leave without a key or key card. Even for routine care, ID bracelets have become common as a means of tracking patient care, i.e. lab tests, confirming physician orders, diagnostic procedures, etc. Simply put, if you run a clinic or hospital, even a small one – you simply must keep track of the patients in your care.
The foregoing example of a high-tech, modern hospital – illustrates the kind of physical security present in such an environment today, and some of the reasons why it is necessary. In a post-disaster scenario, you probably will not have the luxury of all of the sophisticated security measures used by a modern hospital, but it is important that you devise and employ whatever measures you can, using the resources available. You most certainly will need them.
Copyright © 2012 Peter Farmer
- Self-Defense and Medical Preparedness – Location and Visibility – Part 3 (armageddonmedicine.net)