Use Screening Protocols to Ensure Civil Unrest Stays Out of Your Hospital

By A.J. Plunkett

When civil unrest outside your doors threatens to come inside, be sure staff are trained on screening protocols for identifying people who should not be in your facility or on your property.

Whether it’s high school rivalries, gang activity, or even political unrest, hospitals should be prepared for patients from opposing sides to be in your emergency department (ED).

Frayed nerves from the pandemic will only serve to make things worse.

The reality of local civil unrest is now all too common, says Bryan Warren, MBA, CHPA, CPOI, a longtime hospital and healthcare security professional and now president and chief consultant of WarSec Security. Warren, who responded to questions by email, is also a past president of the International Association for Healthcare Security and Safety.

“Anytime that you are as open to the public as hospitals are, plus you are dealing with people that are not entirely rational, you run the risk of one person or group not agreeing with another. This is magnified when those persons are injured or under some type of additional stress, and you see it all the time in healthcare waiting areas,” notes Warren.

That stress is seen not just in the ED, “but also in maternity units as well as ICUs with end-of-life issues and estranged family members coming together for the patient’s sake,” observes Warren.

Lessons learned

Recently, the Department of Health and Human Services’ Assistant Secretary for Preparedness and Response (ASPR) updated its Technical Resources, Assistance Center, and Information Exchange (TRACIE) site with a four-page set of lessons learned in Minneapolis during the civil unrest after George Floyd died during a police arrest, an event caught on video and widely shared on social media.

According to Civil Unrest During a Pandemic: Notes From Minneapolis, most patients arrived in the ED via local emergency medical services. However, many people fleeing riot scenes sought safety in nearby hospitals and clinics.

Keeping opposing sides apart to ensure the civil unrest doesn’t follow people inside begins at your perimeters, advises Warren. Coordinate with your local law enforcement because you may need their help.

“All healthcare organizations should have in their policies and procedures some type of screening protocol which should begin at the perimeter of the facility to identify persons that clearly have no legitimate purpose being inside the building or on the property,” says Warren.

“Appropriate screening and visitor management can also help to differentiate between patients and family members and hopefully provide some direction regarding which waiting areas they will be assigned to (should there be indications that certain patients and their acquaintances may not coexist peacefully),” he says.

“For situations in which such indicators are not readily apparent, it is also important that the facility have a restricted access process so that even if persons of differing viewpoints end up inside the same waiting area, they would not be able to freely enter patient care units or staff-only areas of the facility while restricted access protocols were in effect,” Warren says.

Coordinate with local law enforcement

“This is also an instance in which a strong public/private partnership with local law enforcement is critical so that any persons causing a disruption or negatively impacting the facility’s ability to provide patient care can be quickly removed (within applicable legal and regulatory frameworks),” says Warren.

“Not all facilities have the capability to provide separate waiting areas for conflicting parties, so the provision of uninterrupted patient care must be the driving factor in enforcing such decisions, so the hospital is not perceived as ‘taking sides,’ ” he notes.

“For long-term patients, this might result in designated times of day or even days of the week for visitation,” he recommends. For instance, group A can visit Monday, Wednesday and Friday, group B on Tuesday, Thursday, and Saturday, and so on.

“But this is not feasible for emergencies or other dynamic situations. Healthcare organizations should make every attempt to clearly address expectations of conduct to those that are becoming disruptive and then have a plan in place should their removal or relocation be required,” says Warren.

The pandemic has frayed nerves. But it also has provided at least one benefit, notes Warren: “Healthcare facilities do not have nearly as many visitors as usual for patients (even emergency departments).”

That said, “any event that occurs within the community in which people are injured or even think they are injured (the walking worried, for example, protesters exposed to chemical agents) will involve the local hospital or healthcare provider and could create potential disruptions due to rival factions all showing up for treatment or visitation at the same location,” he warns.

“This is why guidelines not only for patient surge events, but also civil unrest events and their consequences should be included in an organization’s emergency preparedness plan,” he advises.

More ASPR-TRACIE resources on civil unrest can be found at–6-1-2020.pdf.

A.J. Plunkett is editor of Inside Accreditation & Quality, a Simplify Compliance publication.