Managing Aggressive Subjects Who Might Have Ebola

Current concerns about Ebola should remind security and law enforcement departments to review and revise their precautions for controlling potentially infectious subjects and patients.

The recent Ebola issue has received a lot of press and has created quite a bit of concern within the healthcare community. One result has been the establishment of safer methods for interacting with suspected or confirmed viral hemorrhagic fever (VHF) subjects that present for treatment at hospitals and healthcare facilities. While planning for such contingencies, many healthcare organizations, particularly security personnel, may have overlooked an important aspect of such an issue. How can you safely deal with an aggressive subject that may have an infectious disease (particularly those that are easily transmittable) when they are exhibiting violent behavior?

While healthcare workers are being trained to don appropriate personal protective equipment (PPE), few security and law enforcement personnel have immediate access to such protection. Even if they do, the dynamic nature of violent encounters rule out the opportunity to effectively suit up before stopping an assault in progress. This may result from having to enforce an official order of isolation or quarantine from local health authorities in the event of a pandemic situation or simply preventing an “at risk” patient from harming healthcare clinical staff.

With such incidents well within the realm of possibility, mitigation strategies should be considered by security and law enforcement agencies now so that if such a situation arises, officers are better prepared to respond and protect themselves and others both from the aggressive behavior as well as the transmission of a dangerous disease (one existing reference is OSHA # 3335 – Preparing and Protecting Security Personnel in Emergencies:

Review Your Policies Now
Agencies should review their current use-of-force, arrest and detainment, patient restraint and similar existing policies and procedures to determine which will need to be modified when dealing with a suspected or confirmed highly infectious or contaminated subject. Any techniques or tactics that have traditionally called for direct contact and a “hands on” methodology need to be carefully considered, especially if appropriate PPE is not readily available. Even if PPE can be obtained and donned quickly, will the actions required by existing policy and procedure be effective while simultaneously protecting the officer? Many items of PPE cannot withstand even moderate stress, such as physically trying to restrain a resistive subject. If the PPE items cannot, then methods that use greater distance during control should be considered.

One such option that many security and law enforcement professionals have had for some time is that of Oleoresin Capsaicin (OC or “pepper” spray), CS, CN or other less-than-lethal self-defense gases, liquids and foams. Typically when used on a subject, these agents can cause temporary blindness and an inflammation of the subject’s respiratory system and thus decrease their ability to effectively fight, making them easier to control.

One such option for controlling and immobilizing a subject from a safe distance until appropriately equipped backup can arrive is that of an electronic control device.

In the case of a subject with a highly infectious disease however, the use of such agents should be avoided since subjects exposed to a lacrimation or inflammatory chemical agent produce excessive mucous, coughing, upper body spasms and other effects that dramatically increase the likelihood of contamination of the officer and bystanders through bodily fluid and droplet expulsion. Most policies regarding the use of pepper spray or other similar agents require the officer using them to decontaminate the subject prior to then transporting them to a local healthcare facility for evaluation and medical clearance. Any highly infectious subjects that have been exposed to a lacrimation or inflammatory chemical agent should be treated with extreme caution and only transported if the law enforcement or security agent possesses the appropriate PPE prior to attempting such procedures.

Consider Using Electronic Control Devices
Should use of force become necessary to control such a subject, traditional models may have to be modified based upon the threat caused by the potential for disease transmission to the officer and bystanders. One such option for controlling and immobilizing a subject from a safe distance until appropriately equipped backup can arrive is that of an electronic control device (ECD), such as a Taser.

An ECD can be deployed from a safe distance in order to rapidly and effectively immobilize the subject until such time as adequately equipped and properly attired personnel can move in to affect a more appropriate type of physical restraint. Based upon the circumstances, an ECD may be the quickest and safest alternative to reduce the likelihood or possibility of more serious injuries to the subject and potential contamination to the officer.

Use of the drive-stun mode (in which the ECD is used as a physical contact pain compliance device) should not be considered when dealing with a suspected or confirmed highly infectious subject. Probe deployment should always be used in such cases. The ECD use should be limited to the minimum number of cycles needed to bring and keep a contagious subject under control. When reasonable, the officer should issue verbal commands between each cycle, and additional cycles should only be applied when the subject is actively resisting. Removal of ECD probes should be performed only by personnel using appropriate PPE and other precautions based upon the hazards surrounding the suspected or confirmed pathogen. ECD probes that have been removed from skin should be treated as sharps and potentially infectious hazardous waste. 

Adopt a ‘Universal Precautions’ Approach
Violent subjects have always created a special concern for security and law enforcement officers who must control these individuals with the least amount of force while not being harmed themselves. This is particularly true when dealing with a highly infectious or contaminated person. Only through careful planning and adopting a “universal precautions” approach with these types of subjects can security and law enforcement officers achieve safer results for everyone involved.

Bryan Warren is the director of corporate security for Carolinas HealthCare System. He would like to thank Carolinas HealthCare System’s investigators and training division for their contribution to this article.

Photo: ThinkStock

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