Now What?

By Linda Chaff

America has been thrown into a new era. We are treading on ground that we have never been forced to walk at any time in our history. We grieve, we provide mutual support, and we have joined in a unity that has not been seen in most of our lifetimes. When the occasion permits we also celebrate. Since the September attacks, the healthcare system has been generally untouched by the destruction, which has stricken this nation.

Now What?

Can we expect things to remain as they presently are, or will the next blow be delivered against the healthcare system of this nation? Have your security practices been closely examined, or is it business as usual at County General?

As a result of recent events, we decided to conduct an exercise in espionage and sabotage within our facilities. The final results were discouraging. WE FAILED OUR OWN TEST! An outside consultant was retained and instructed to gain access to as many areas at our campus as possible. No area within our physical plant was denied entry to our “saboteur.” In some areas, employees were so pleased to be of assistance that they posed for pictures in front of equipment, which would be ideal targets for persons intent upon death and destruction.

I realize we all have written programs and plans. I realize we all conduct drills and instruct staff on the proper procedures to insure the physical integrity of our operations.

I now also realize that each program and policy should be tested in order to insure compliance by all staff members. These procedures also allow individual facilities to determine if their policies and procedures require a new look and a renewed dedication by the staff.

Security devices are only as good as the personnel on the premises. We have time locks in nursery areas, we have security cameras and many facilities have armed and unarmed guards. Are these people properly instructed in their duties and the limits of their authority? Do employees by pass locks for their own convenience when they’re only going to be outside an area “for a minute”? Are cameras continually monitored for area of surveillance and proper operation? Are tapes changed on a regular basis? Does staff provide code access to others for convenience? Virtually any hospital I have visited has to admit that staff entrances are used by non-staff individuals because someone has supplied the proper codes to save time for the unauthorized persons.

Now What?

Is your emergency staff fully prepared for potential epidemics? The healthcare section published a series of articles early in 2001 dealing with terrorist bio-chemical threats. Unfortunately these were printed long before the bombings of September 11th, yet were probably ignored by the majority of readers as an apocalyptic myth. Many in healthcare have recognized for a long time that such attacks could paralyze healthcare delivery nationwide. Some have echoed their concerns to the highest levels, but their cries for action have generally fallen on deaf ears. It may take up to five years to produce enough smallpox vaccine to immunize the American public. The world stands in wait for us to lead. How long will it take to protect other countries that may experience similar hazards?

We have had anthrax pushed to the forefront of every breaking news story. Anthrax is not new, nor was it unanticipated. When the first exposures occurred, we had a minimal supply of vaccine available, which is generally reserved for the military, and supplies of antibiotics were woefully lacking.

Now What?

Aside from domestic baby abductions, are we prepared for bomb threats? Does your policy advocate evacuation for bomb threats, or does your staff stay put? Are you prepared for assaults in the emergency room. Are all staff members adequately protected? Some hospitals feel bulletproof glass conveys a feeling of detachment, unfriendly surroundings and mistrust. As a result, many hospitals continue to have an open atmosphere for the general public. All too often the open atmosphere leads to another newspaper headline of violence and death in a hospital.

Is your staff willing to make exceptions on some visitors just because they have a “good speil” regarding their need to be in an area? Those with the best and most reasonable stories are the ones most likely to have alternative ideas once they gain access. Are parking lots properly patrolled in dark periods and inclement weather? Parking lots continue to produce victims and headlines continue to proclaim weaknesses in the system. A great number of the larger metropolitan facilities have taken many of the steps that should be basic and mandatory. Unfortunately many rural and small town hospitals continue to trust the home folks. I have seen small facilities located within convenient walking distance of an Interstate highway that continues to leave rear doors unsecured and unsupervised. The hometown folks can’t help, because it will be too late. Ultimately a lax attitude will result in a disaster that will adversely affect facilities for many years.

Are flammable gasses monitored and other compressed gasses such as nitrous oxide properly secured? Some doctors continue to insist that these gasses be portable, convenient and openly available for their use during their hours in a hospital. I have also seen nitrous oxide disappear and not be available for staff use because it was too available for public procurement. “Where’d the gas go?” is a common cry.

Each of us should take the time today and inspect our policies, and then follow that inspection with unannounced testing of the staff. Your community depends upon a quality healthcare system. We cannot afford to provide anything less.

The healthcare section will be submitting articles in the area of security and chemical and biohazard concerns in the coming issues. Our focus will change dependent upon the developments that occur as a result of September 11th and beyond. If you have issues that you feel are pertinent or questions that need answers, the healthcare section is available on the internet through this publication. In addition, the Healthcare Section has decided to devote special sessions during next years’ National Safety Council Congress and Exposition entirely to terrorist activities and security in the healthcare setting. Plan on joining us in San Diego in 2002.