Eight hospital security lessons learned in the "Pope Zone."

Hospital Safety Insider, December 17, 2015

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Sound emergency planning requires safety professionals to adopt an "all-hazards" approach to planning for events in their hospital. But the plans start with a hazard vulnerability assessment, which requires planners to think about all the things that could happen to a facility. For instance, if Justin Bieber or another well-known celebrity were admitted to the hospital, most facilities have a security plan in place to handle the media onslaught that will inevitably descend upon them.

But what happens when the celebrity is so large, and the security so big, that hospitals can't plan for everything in advance?

It happened in Philadelphia in late September, when Pope Francis visited the city as part of his first-ever U.S. visit. With more than 3 million people estimated to visit the city, security was so tight in the downtown Philadelphia area that the Secret Service closed off a three-square-mile area that became known as "the box" to emergency planners. Within that box, only pedestrians were allowed. That meant no vehicular traffic except for police, fire, and EMS vehicles would be allowed to access the five hospitals that became "trapped" within that box. Needless to say, the situation forced hospitals in Philadelphia to get creative with their emergency operations plans.

Start as early as you can.
It's been said many times that one can never start planning early enough for upcoming and anticipated events. For the hospitals in Philadelphia, their success with the papal visit was because they began to plan as soon as the Secret Service came through the door.

Know what staff are available.
Get your hands on schedules for surgeries early and often, and know what can be postponed. Determine where you will house and feed your staff who stay over. Figure out where the city will set up command centers, and make friends with the cops who will run them. These relationships made it possible for hospitals to be in constant contact with city command posts, who were able to coordinate special exceptions when traffic needed to get to the hospital, such as when patients needed to get in for important appointments, or to allow visitors with critically ill relatives to get in to visit.

Also, be ready to change your plan. Hospitals thought they were fine at first, when the city didn't expect the Pope to make an appearance. Then the Secret Service announced he would celebrate Mass. Then they closed off a large part of the city. Then they doubled the restricted area. Translation? The best plans make room for change. You may have enough cots on hand for the staff that will sleep over during a snowstorm, but what happens when that number doubles suddenly? Your plan for a large-scale event may include using the nearby parking garage for staff to park when they come to work, but what do you do when the Secret Service suddenly decides to close off that garage and use it as a command center and staging area for emergency vehicles? Always have at least one alternative plan in place.

Organize your command structure.
Hospitals in the Philadelphia area adopted (and swore by) the Hospital Incident Command System (HICS), designed as a flexible way to maintain organization during a major incident by establishing command and control and basically giving everyone a job to do. Based on the National Emergency Management System created by the government after 9/11, the principles of HICS are designed to apply to small or large groups of people; they designate groups of command structure that can help delegate smaller tasks within a large group. See page 4 for an example of a HICS command structure.

Team up with your friends.
Hospitals are realizing they can't operate in a vacuum when it comes to emergency planning. Every local facility is in an emergency together, and each should include mutual aid in its plans, and that means meeting regularly and discussing what things facilities can mutually benefit from. Many hospitals that were caught "in the box" in Philadelphia realized they did not have enough cots available for all the staff members that would be sleeping over, so they borrowed them from less-affected neighbor hospitals in other parts of the city.

Find space wherever you can.
When you've got millions of people surrounding your facility, almost 1,000 staff members sleeping over, and the need to stock your hospital with enough supplies to last a week, you're going to have to find space you never thought you had. That might mean turning a conference room into a supply closet, or using an on-campus museum or a building under renovation as a temporary staff hotel. Not enough bathrooms and showers? Rent a shower trailer.

Take care of your staff. Yes, it's your staff's job to be on their game and keep alert enough to take care of patients. But you need to remember that in an adverse weather event or other incident that requires staff to sleep over at the hospital, you are taking them away from their lives, families, and everyday activities that would normally refresh them and give them the downtime they need. Unless you help them, they are going to tire of the situation very quickly.

Officials at Philadelphia hospitals knew they were asking a lot of their employees by having two fully-staffed shifts in the building at all times, so they tried to make things as comfortable as possible. At CHOP, employees were treated to a "Welcome Aboard" event on Friday night, and throughout the weekend they were provided with clean linens, catered food, and showers in a shower trailer that was brought in. In addition, conference rooms were outfitted with amenities such as lounges, table games, televisions, and other quiet spaces to give staff a space to decompress in.

Bring senior leadership on board.
Sadly, a common complaint from safety professionals is that senior leadership does not take enough of an interest in emergency planning and security, and therefore gets surprised when safety lays out the need for big changes. When faced with a large-scale event, leadership must be involved and kept in the loop.

Include everyone. While it's important to include the senior leadership in planning meetings, it's also important to include everyone else, especially the people who will be directly implementing the security plans. UPenn formed many committees, some up to 50 people strong, and included employees from the ED as well as food services, security, and maintenance to allow them to be part of the process.

This is an excerpt from the monthly hospital safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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