• A man and woman posing as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveyors arrived at a hospital but left after they were stopped by hospital security.

   

• A man demanded to inspect a medical facility. He left the premises after being questioned by hospital staff.

   

• Three men arrived at hospital on a Friday night at 8:30 p.m. They stopped and asked a registration clerk when is the busiest time for visitors; how many beds does the emergency room have; when is its busiest time; and when do most of the staff work.

 

These are not story lines for an upcoming television movie. These events and many others like them have been occurring in healthcare facilities for the past several years. Maybe it’s a byproduct of our increased awareness since the 9/11 attacks. Maybe the people mentioned in the above examples were college students in a criminal justice or homeland security class writing a paper. Maybe they were from a news outlet doing an article on health security and emergency preparedness. Whatever the purpose of these visits, they can cause great concern for healthcare security departments.

When they occur, many security directors are confronted with the same questions they had immediately after 9/11. “Is my facility under surveillance by a terrorist cell? Could my facility be a target of a terrorist group? Could my facility be a possible secondary target?” To date, the healthcare industry has not been made aware of specific threats against it. That’s a good thing. However, it does not mean healthcare will not be a target at some point.

Here are some tools that should help you understand this phenomenon and identify, deter and prevent a suicide bomber event.

Suicide Bombers Not Deterred by Standard Security
We know from history that terrorist organizations place a high value on the use of suicide bombers. We also know the standard security precautions that have been used for years to deter crime will not necessarily deter a suicide bomber from selecting a site. For evidence of this we only have to look back to the 2005 London subway bombing. The suicide bomb attack was carried out in the daylight and in front of numerous CCTV cameras. The bombs were also not placed in a secluded location out of view (they were carried onto buses and subway trains). The terrorists were not planning on living after the attack, so standard security deterrence was not effective on them.

Suicide bombings are not intended to be part of a normal and expected armed confrontation between two parties. The people who carry out these attacks and all terrorist bombs, for that matter, are designed to (1) cause death; (2) inflect pain; (3) demonstrate that the authority is powerless to prevent the attacks; and (4) generate support and finances for the terrorist group’s cause.

Terrorist groups have said they use suicide bombing for three reasons: (1) This method does not require an army be outfitted with advance weapons and smart bombs; (2) it is a final method for them to get their views heard; and (3) according to al-Qaida leader Ayman al-Zawahiri, “is the most successful way of inflicting damage against the opponent and the least costly to the mujahidin in terms of casualties.”

Terrorist Organizations Have Multiple Motivations
The fact that bombs are relatively inexpensive to assemble make them attractive to terrorists. Additionally, terrorists appreciate the near certainty of a successful detonation and resulting injury and death of those around the bombing site. As mentioned earlier, the low probability of death or injury to other terrorists is another reason why terror organizations prefer suicide bombings. Still, there are other reasons that may motivate a group, cell or individuals to commit a suicide bomb attack.

Some terrorist and suicide attacks are linked to specific dates that are important to the group’s cause. Virtually every day of the year is linked to a date(s) that has significant meaning for some group(s). How terrorist organizations choose to celebrate or honor that date is the unknown variable for which we must prepare.

Groups may also be motivated by a public visit from a dignitary or celebrity they believe threatens or blocks their attempts to get their view addressed. There are other motivators such as political, social, religious, economic, ethnic and revolutionary to name a few.

Locations With Minimal Visible Security Often Chosen
Terrorists will select a site for different reasons. Sometimes it’s to make a statement and promote their cause. They may also select a location because they believe it to be a soft target due to there being little visible or detectable security in place to deter or stop the attack.

For example, the day after a rape of a female patient was reported, the local news claimed the hospital had not taken any steps to increase security and the public was still allowed to enter the front door unchecked. What the local news did not see was that just inside the front door were two security officers holding a written description of the suspect. They were stopping everyone as they entered and comparing them to the description.

The point is you don’t have to have an armed guard standing outside your door 24/7. Having a proactive security force and a hospital staff that is trained and involved in the facility security program who are not afraid to challenge a suspicious person will help harden a facility and make it less desirable to a terrorist.

A terrorist may also select a target because it is a symbol of what they dislike about their enemy or because it has significant meaning to their victim. Terrorists may interpret nongovernmental public sites such as movies theaters, shopping malls, churches and healthcare facilities as soft targets, depending on the deterrent steps that have been taken.

Sites with significant national meaning such as national monuments and federal and state government buildings are considered a high probability by many experts. However, as these sites become more fortified, they will become less of a target. More vulnerable locations will then move up on the terrorist’s list.

Campus Staff Should Be Aware of Terrorist ‘Dry Runs’
There are three main operational factors to a suicide bomb attack: secrecy, reconnaissance and rehearsals. Understanding these factors can help you protect your facility.

Secrecy:Secrecy is essential to plan and conduct a suicide mission. Because the bomber wants to keep the plan covert, it may appear to neighbors and coworkers that he/she is anti-social. The bomber may not associate with others except a few “like” individuals. After the fact, you may hear neighbors and coworkers say, “He/she was quiet, never bothered anyone.”

Surveillance:Terrorists must conduct thorough reconnaissance and surveillance when choosing a target and identifying its weaknesses. This is one of the key times when hospital staff has the opportunity to intervene and deter a suicide bomb event. Making a facility appear to be well protected starts with each staff person and security officer taking an active role in the facility security plan.

Rehearsals:Extensive rehearsals and “dry runs” are necessary to ensure stealth and speed during the attack. The surveillance and dry-run period is another critical time for security officers and staff to detect the presence of suspicious activity. They should be alert to even some normal activity such as someone taking pictures, a small group standing outside the facility writing or making diagrams, and questions about the busiest time of the day and day of the week.

What You Can Do to Protect Your Facility
So how do you know if your campus can be a target of a suicide bomber or other type of terrorist attack? If you have thought about it, most authorities will tell you that the terrorist has as well. To what degree they consider your industry a target is the unknown factor that you should evaluate along with other threats. Use of current weapons of mass destruction (WMD) or other types of threat assessment tools will help you.

Crime Prevention Through Environmental Design (CPTED) is the first step to hardening your facility. Making even minor changes to facility design such as the use of blast-resistant glass or film on exterior windows, aesthetically pleasing crash barriers and stops, and placing drop-off points away from main entrances are just a few ways to harden your facility and make it less desirable to terrorists.

Target hardening is an ongoing process. It is not something you do once and forget about. As your facility’s structure, workforce, product market or plan, or significance to national security initiatives changes, you will need to reassess your threats. A threat assessment should at least contain a probability ranking, potential impact to operations, and mitigating factors such as facility hardening measures.

Once these and other threats are identified, the results should be used to recommend the necessary steps to reduce the likelihood or mitigate the potential impact of such an attack.

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John Williams is the director of corporate security, valet parking and shuttle services at Prince William Health Systems in Manassas, Va., and has been involved in healthcare security for 23 years. He can be reached at jwilliams@pwhs.org.

For the complete version of this article, please refer to the September/October 2006 issue of Campus Safety Magazine.

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