Spurred by the increase in health care epidemics, natural disasters and man-made emergencies, the Facility Guidelines Institute earlier this year gathered a 130-person Emergency Conditions Committee to develop a white paper discussing health care design best practices to help protect against these risks.

The committee’s task also included drafting a new set of guidelines breaking down these best practices into more detail. The Guidelines for Emergency Conditions in Health and Residential Care Facilities is set to publish in 2022, and a portion of its Renovation and Future Facility Design chapter specifically addresses safety within the emergency department (ED).

Guideline 2.2- (b) states that a “Means to detect weapons, such as a metal detector, shall be provided at each point of entry to the emergency department.” HFM spoke with two leaders in health care security to share their perspective on the use of metal detectors in the ED.

Paul Sarnese, CHPA, CAPM, MSE, MAS, is assistant vice president of safety, security and emergency preparedness at Virtua Health in New Jersey and current president of the International Association for Healthcare Security & Safety (IAHSS). Dan Yaross, MSM, CPP, CHPA is director of protection services at Nationwide Children’s Hospital in Ohio and serves on the IAHSS board.

Emergency departments can be a busy setting often fraught with risk. What are some strategies for keeping this area safe?

SARNESE: We have 24/7 security coverage at all of our emergency departments. We have cameras throughout the department to provide surveillance from our security command center and our ED nursing station. We have panic buttons at the registration areas, triage and the nursing stations. The panic buttons report directly to our command center. Our panic buttons are interfaced with the cameras through our access control system. When a panic button is activated, an alarm sounds in the command center on the computer screen, the location and dispatch instructions are displayed, camera(s) in the area of the panic button is also displayed to provide real-time information to our command center dispatcher.

YAROSS: Including the security department in the early planning and conceptual design stages of new and renovated facilities will help to resolve many security considerations. And those considerations will vary from project to project depending on the facility type, such as if it’s urgent care, the ED, a behavioral health clinic or inpatient facility. There are many types of safety mitigation strategies that need to be implemented, and if the security department is not brought in on the early stages of design, issues such as implementing the best way for everyone to enter into the building safely for screening can often be missed.

The new FGI Guidelines for Emergency Conditions in Health and Residential Care Facilities recommends health care facilities include a “means to detect weapons” at each point of entry to the ED. What are your thoughts on this?

YAROSS: Magnetometer operations provide comfort for our families knowing that the screening they just went through applies to everyone else entering the facility, as well. We have a laundry list of items that our magnetometer has stopped from coming into the ED. Most of the time if it is a gun, it’s someone with a concealed-carry license who forgot to leave the weapon at home or in their vehicle locked away safely. But we have been able to prevent everything from pocketknives to corkscrews from entering the facility.

A best practice for implementing a magnetometer process is to make it a minimum two-person post, and at least one of those officers should be armed. The setup should be similar to an airport security area where the visitor’s items are placed on a table and sent through an X-ray machine. We have our officers do bag or purse searches. We ask the family members to put their belongings in trays and search through them before returning their belongings on the other side of the magnetometer.

SARNESE: Each health care facility must conduct an assessment of the environment and the organization’s culture to ensure that a metal detector would be acceptable to the community and clientele they serve. If a metal detector would be a good fit, then the facility would have to most likely renovate a space for the weapons screening equipment.

The successful deployments that I have seen were all renovation projects that included the addition of weapon screening. If a facility is considering installing a metal detector, they must consult the IAHSS Security Design Guidelines for Emergency Departments and the IAHSS Guidelines for Searching Patient and Patient Areas for Contraband and Security in the Emergency Area Setting. 

What is the process for metal detection screening at your facility?

SARNESE: At a large urban facility, we have a walk-through metal detector and X-ray machine for people and weapon screening. The weapons screening station is staffed 24/7 by two officers. At the same facility will also have a k9 unit that patrols the exterior and interior of the campus.

We also have amnesty boxes where guests can voluntarily discard their weapons and contraband prior to entering the facility. Signage is also very important. Guests should be made aware that weapon screening is taking place, and the signs should be visible at all entrance paths to the ED. Signage that states that weapons and other contraband is not permitted can also reduce items from entering the facility.

YAROSS: There are two entrances from the public side to get into our ED. One is the main entrance, and the other is a squad entrance. Since this is a pediatric care facility, many times when a medical emergency squad comes in with a patient, their parents are with them, and many understandably do not want to be separated from their child who is either very ill or injured. In those cases, if we cannot take them back to the entrance to be screened through our magnetometer, we will have an officer come back and perform hand-wand screening.

We absolutely believe that because of the increase of workplace violence and violence that can make its way to a hospital’s doorsteps, this process shouldn’t be considered a luxury. It’s our duty to recognize potential dangers and develop a practical mitigation strategy to keep everyone safe.