Biomedical Engineering Reference
In-Depth Information
enough to cover every entrance. Imagine a contam-
inated patient entering the Emergency Department
via another hospital entrance on the other side of
the building).
Limiting access may cause a backlog of patients,
but it will allow for better triage as there will be
less of a chance of missing a patient. This process
can also allow for better patient tracking, espe-
cially when paired with only a single, controlled
exit from the department. Identifying patients is
also another issue, to which various solutions are
available. The standard hospital bracelet is a tried
and true system. Additional support can come from
the use of triage tags, bar codes on patient ID or
the potential use of radio frequency identification
tags (RFID) to track patients.
Emergency Department directors and their staff
need to be prepared for a potentially massive
influx of patients. During the Sarin gas attacks on
Tokyo's subway, there were thousands of patients
who reported to the emergency departments who
had no direct exposure to the event. They saw
what happened on television and then went to the
hospital, fearing they had been exposed. Consid-
eration should be given to how to corral these
“worried well” patients. Use of an off-site (not
in the emergency department) location may be
useful for these pseudo-patients. Critical Incident
Stress Debriefing (CISD) may be useful for them
as sometimes the “worried well” may need this
type treatment.
director, grabbed him and begged him not to let
him die. The mock patient managed to contami-
nate the physician and everything else he touched
in the hospital.
The plan for securing the ED should include
a definition of “lockdown.” Surprisingly, many
people think closing some doors is enough. It is
not as easy as you would think. Hospitals are not
designed to be “locked down”, but rather have
more points of acces than one might imagine. You
may also need to consider “locking in.” You might
need to keep people inside (i.e., quarantine). Is the
hospital ready to authorize use of force…and how
much force?
Security forces need to have an effective lock
down plan in place, to include all entrances and
exits from the building and potentially between
the Emergency Department and other departments
(besides the obvious entry points like the ambu-
lance bays and the main lobby). Thought also
needs to be given to less obvious entrances such
as the loading dock, exterior stairwells, cafe-
teria entrances and bridges or underground tunnels
between buildings. Failure to secure access can
become costly both in financial and in human life.
Caring for patients is a noble cause; unnecessarily
getting contaminated and dying from it, is not.
During the planning phase, should security need
to lock down the hospital or Emergency Depart-
ment, two questions need to be asked. How
committed should they be; is security prepared to
use force to prevent unauthorized entry or exit. Is
the hospital prepared to allow force to be used?
The second question How to obtain manpower
to adequately cover the entrances and exits? Is
relying on the local police department a prac-
tical consideration? If the event has occurred in
your city or town, they may be deployed else-
where. Many times emergency plans are written
from an independent position (i.e., the hospital's
or the city's). Each plan may require the use of
the same resources, in different places, at the same
time. For example, the hospital plan calls for the
use of local police to back fill it's own security
staff while the city plan calls for the police to be
used to close city streets, direct traffic or close
highways. (or if the hospital plans on having the
9.5 Security
Implementing a patient flow plan should be just
a small part of the overall plan for securing
the Emergency Department. The importance of
controlling access cannot be overstated. A contam-
inated patient could theoretically cause the death
of Emergency Department staff members. As an
example, at a large urban hospital in Hartford,
CT, a mock disaster victim in a drill was placed
across the street from the Emergency Department
and given directions to “get in.” He managed
to enter the hospital on the opposite side of the
building, walk through the hospital and into the
Emergency Department where he ran up to the
