Use of Defensive Weapons

Use of Defensive Weapons

Georgia Society of Healthcare Risk Management 2018 Annual Conference April 27, 2018 Security Staffing and the Use of Defensive Equipment In the Sensitive Healthcare Environment Lisa Terry, CHPA, CPP Vice President, Healthcare Consulting US Security Associates, Inc. Violence is an enormously

costly US public health problem In 2016, U.S. hospitals and health systems alone expended approximately $2.7 billion in responding to violence AHA Study: Financial impact of violence for hospitals

AHA engaged Milliman to estimate the magnitude and scope of the financial impact for HOW THE AHA STUDY IS DIFFERENT: Define violence broadly Looked at total cost to hospitals Included only unreimbursed costs of medical care for victims of violence (costs borne by the hospital as community benefit, underpayment, or bad debt) $2.7 Billion Spent in 2016 Related to Violence $280 million - Preparedness and prevention to address

community violence $852 million - Unreimbursed medical care for victims of violence $1.1 billion - Security and training costs to prevent violence within hospitals $429 million - Medical care, staffing, indemnity, and other costs as a result of violence against hospital employees June 8, 2018

Victims of Violence in Healthcare An elderly patient verbally abused a nurse and pulled her hair when she prevented him from leaving the hospital to go home in the middle of the night. An agitated psychotic patient attacked a nurse, broke her arm, and scratched and bruised her. A disturbed family member whose father had died in surgery at the community hospital walked into the emergency department and fired a small-caliber

handgun, killing a nurse and an emergency medical technician and wounding the emergency physician. Source: Centers for Disease Control and Prevention. Victims of Violence in Healthcare Just one week before [an] Oregon bill was introduced, a technician at a hospital in that state was left with a dislocated jaw, concussion and split lip.

A nurse from a hospital in New York's borough of Brooklyn had to undergo emergency brain surgery and was in critical condition....after being attacked by a patient.... In January 2014, a judge in Maine convicted a man of aggravated assault for attacking a mental health worker at a hospital.....the worker was beaten and bruised and with the point of a pen embedded in her hand. Source: Modern Healthcare. States increasingly trying to protect healthcare workers from violence. February 14, 2014. Victims of Violence in Healthcare Victims of Violence in Healthcare Thomas Robert Fredette, 38, of Santee was arrested after a stabbing attack on a nurse in Torrance on Sunday, April 20, 2014. LA5 photo source:; Thomas Fredette photo source: Violence in Healthcare 25 percent of nurses reported being physically assaulted

by a patient or a patients family member, and about half reported being bullied (ANA) Workers in health care settings are four times more likely to be victimized than workers in private industry (SIA and IAHSSF) The Emergency Nurses Association (ENA) estimates that the number of weekly assaults nationwide is in the thousands. Source: #ixzz30P8BeYCJ Source: 2018 The Joint Commission Department of Corporate Communications

Violence in healthcare 2014 and 2016: The Years of Distinction with Crime Survey Causes of the surge in crime Alert #59 Physical and Verbal Violence Against Health Care Workers April 17, 2018 Relevant TJC Requirements (Standards): 11 Environment of Care

24 Emergency Management 3 Leadership 2 Provision of Care, Treatment, and Services 1 Rights and Responsibilities of the Individual Why So Much Violence in Healthcare? Society with access to weapons

24/7 hospital open access ED Average LOS = long waits Continued increase in gang violence De-institutionalization of behavioral health

patients Continued increase in forensic patients Substance abuse and easily accessible hospital pharmacies How do we prepare for violence?

Mitigate violence while maintaining a safe and secure environment for those who seek medical care. Data driven decision-making Risk management Historical data Foreseeability of violent crime

CAP Index CRIMECAST reports Data driven decision-making Geographic location

Population served Surrounding community crime rate National, state, and local issues

Community and staff attitudes What will serve as a deterrent? Staffing and Defensive Weapons in Healthcare Once the decision is made regarding security staffing, how is the determination made to provide the officers with defensive equipment?

Is there a decision matrix utilized for assessing/analyzing workplace violence incidents? Evaluating defensive weapons Liability Benefits Risks Trends Regulatory/Accreditation Agency

View Centers for Medicare & Medicaid (CMS) The Joint Commission DNV - GL Others Once the decision is made to include defensive weapons.. The first

step? Plan and prepare Once the decision is made to include defensive weapons.. Management competency Equipment selection

**Applicant selection process Minimum State License Requirements Integrity Testing

Psychological Screening Exceed Defensive Weapons Qualifications Available training

Officer protection Continuous program evaluation Managements role Strong commitment by hospital administration for: Continuous oversight of program

Officer evaluation/Fit for Duty Continuous training Strong Use of Force policy Proactive disciplinary process Educate hospital staff Educate surrounding community Managements role + In an armed security

environment, Security supervisor should be armed in addition to officers (some organizations arm only security supervisors) + Supervisors must possess judgment, experience and ability + Supervisors must supervise Equipment selection:

less lethal weapons Equipment selection: less lethal weapons Chemical weapons (OC foam restraint) Inexpensive Lightweight and inconspicuous Less training required Effectiveness limited Some people become combative Time lag may occur Limited shelf life of OC

Equipment selection: less lethal weapons Impact weapons (expandable baton (ASP) Lightweight and durable Acceptance by individuals Offer multiple benefits Certification training programs Caution Can be used by perpetrators May cause unintended injury (liability) Retraining essential Requires close proximity to perpetrator

Equipment selection: less lethal weapons Electronic weapons Taser (Thomas A. Swifts Electric Rifle) Effective on more violent individuals Avoids deadly force Psychological deterrent Effective range of 21 feet More expensive option

Potential for causing harm, scars, sparks (See article in the Journal of Emergency Medicine 37(2)209: August 2009: Introduction of a Conducted Electrical Weapon in a Hospital Environment Hennepin County Medical Center) Equipment selection: less lethal weapons The issuance of Tasers alone (without a firearm) should not be seen as an adequate substitution for a firearm.

Other equipment selection: Handcuffs/Flex Cuffs Flashlight Key holder Radio Gloves Tablet/Other Device Body Armor Equipment selection: firearms Authorization to carry

firearms On-duty night and dayshift officers Only arming outside security officers Arming only security supervisors Equipment selection: firearms

Two critical legal considerations 1. The authority for officers to carry firearms 2. The justification to use deadly force Equipment selection: firearms Selecting firearms Caliber Ammunition Minimum penetration Limit risk of ricochet Equipment selection: magnatometers

Metal detectors Keeps weapons out Useful in Emergency Department Refusal to enter via metal detector = denied entry Augment with exterior closedcircuit television Manage exterior landscaping Consider equipping screening officers with firearms (or have armed police officer in close proximity)

Selecting qualified officers Physically capable Psychologically fit Adherence to standards of environment Positive selection criteria Selecting qualified officers Positive selection criteria Prior criminal history? Communication skills

Social skills Mental capacity Physical strength and endurance (also included in Fit for Duty standards) Selecting qualified officers Positive selection criteria Psychological assessment Integrity testing

Selecting qualified officers Rules governing armed security officers Licensure and registration Criminal history check/psychological exam Training curriculum Uniform and insignia Type of equipment and manner carried Incident reporting Certification Insurance and bonding Training qualified officers Training approach

State laws and regulations Use of deadly force Hospital policy and procedure Annual qualification of officers Quarterly or semi-annual training Training qualified officers Well-written Use of Force policy must be developed: Deadly force used only to defend human life when no other means are available to do so. In accordance with state law and

hospital policy Prohibit against an officer drawing a firearm unless in imminent danger Training qualified officers No room for error! Use of force continuum/model Training qualified officers Medical Medical aid aid

administer administer ed ed promptly promptly Training Training when when force force is

is used used Family Family of of injured injured is is notified notified timely

timely Timely Timely Use Use of of Force Force Reporting Reporting Continuous evaluation

Continuous program evaluation Act Plan Do Check Protecting officers and others OSHA Duty Clause (a) Each employer (1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees;

(2) shall comply with occupational safety and health standards promulgated under this Act. (b) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act, which are applicable to his own actions and conduct. OSHA General Duty Clause, 29 USC 65. Protecting officers & others Firearms Secure Storage Onsite Offsite lock box (when allowed) Clearing barrel

Ballistic/Stab Resistant Vests PPE Advantages Considerations Moving forward.... Evaluate the environment Consider the liability Review regulatory requirements

Research prior history Evaluate foreseeability Make the decision Moving forward.... Develop strategy Create policies and procedures Determine types of weapons/equipment Lethal and less lethal Protect officers/environment

Hire best officers for job Train and retrain Continually evaluate and improve Caring Professionals Everyday. And When Absolutely Necessary Provide Response To

Meet The Need Thank You! [email protected] 919-796-8821

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