Combatting Healthcare Workplace Violence with People and Weapons Screening
Here’s how one New Jersey hospital emergency department uses metal detection, an amnesty box, signage and policies to keep patients, staff and visitors safe.
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Healthcare campuses are confronted with the potential of workplace violence on a daily basis. Fortunately, there are many evidence-based practices that can combat violence. One strategy is to implement a people/weapons screening process to prevent illegal or prohibited items from entering the facility. There are many factors that must go into the decision to install metal detection technology, and to develop and implement the processes.
People screening is the practice of searching people and their belongings before allowing them access to a secure area. This approach is already in use at facilities like airports, court houses, museums and prisons. Screenings are used to detect concealed weapons or other contraband, without a physical pat down.
Walk-through metal detectors (WTMD) allow for the quick screening of all persons entering the facility. WTMDs have two categories of detection: single zone and multizone. Single zone WTMDs will identify a metal object on a person but will not show its location. Multi-zone WTMDs have multiple transmit and receive indicators that detect where the metallic materials are located. They will indicate if the items are on the left or right side of the body.
If a person entering the facility sets off the WTMD, there should be a secondary screening procedure. In most cases, the secondary screening procedure includes hand-held metal detectors (HHMD). HHMDs could also be a primary screening option for those with special considerations such as implants, prosthetic limbs, wheelchairs and walkers, or for guests who are unable or unwilling to walk through the WTMD.
An x-ray machine uses a conveyor belt to move objects through the machine. Items that pass through the machine absorb radiation differently. Each type of item (organic, inorganic or metallic) is color-coded. The operator can zoom in and filter his or her view to make identifying an illegal or prohibited object easier.
The Patron Screening Best Practices Guide published by the U.S. Department of Homeland Security suggests that an amnesty box be placed near the entry of the facility. An amnesty box is where individuals can put illegal or prohibited items prior to entering the facility. The types of items allowed in the box are at the discretion of the campus. The security management team should check with local law enforcement to determine the best location for the amnesty box.
How Virtua Camden Utilizes People/Weapons Screening
The Virtua Camden emergency department (ED), located in Camden, N.J., was scheduled for renovation, and planning was underway to redesign the ED triage and waiting areas. This facility is part of Virtua, one of New Jersey’s largest, non-profit health systems. The organization provides comprehensive healthcare services through the Virtua Medical Group with 500 physicians and other clinicians. It is comprised of urgent care centers, hospitals, ambulatory surgery centers, health and wellness centers, fitness centers, home health services, long-term care and rehabilitation centers, and a paramedic program. The Virtua Camden satellite emergency department treats more than 38,000 patients per year.
We began to investigate designing Virtua Camden’s ED to accommodate a people/weapons screening area.
We utilized the International Association for Healthcare Security and Safety (IAHSS) guidelines to develop our program’s objectives. Two IAHSS guidelines we utilized: Searching Patient and Patient Areas for Contraband and Security in the Emergency Area Setting. (The IAHSS guidelines are designed to be applicable to all healthcare facilities, are available to members and can be purchased at www.iahss.org.)
Additionally, through the contacts we made through IAHSS, our security leadership team was able to visit several EDs in New Jersey and Pennsylvania. We met with the other security leadership to share lessons learned and best practices. We evaluated the type and placement of equipment, the space that supports the weapon screening processing, staffing, signage, training, property management and the process for confiscating illegal weapons.
We determined the best staffing mix for our organization was having two security officers deployed 24/7. A single officer could easily be overwhelmed if several guests entered the ED simultaneously. One officer can provide guidance for guests entering the ED and to conduct secondary screening with the HHMD. The other security officer can operate the x-ray scanner and manage the overall people/weapons screening process. Our security officers are not armed.
The Patron Screening Best Practice Guide recommends the use of amnesty boxes to allow patients and visitors to voluntarily dispose of illegal or prohibited items, like illegal drugs and weapons. We could not find any research about the use of amnesty boxes at U.S. hospitals. However, we did find that amnesty boxes have been used in Europe for large outdoor concerts and events. We discussed testing the amnesty box with our leadership and received overwhelming support to deploy a box at Virtua Camden. We then met with the Camden County Metropolitan Police Department to discuss the purpose of the box and to obtain their support for managing the items retrieved from the box. (Click here to see one of Virtua’s amnesty boxes.)
We used exterior signs to provide warnings to our guests that people/weapons screening would take place before they would enter our ED. (Examples of these signs are here and here.) Signs were posted along every possible route our guests use to enter the ED. We also posted signs in Spanish and English that provide the definition of an illegal weapon in the State of New Jersey and items that are prohibited from entering our facility. We also installed a sign on the amnesty box describing what items can be placed inside and that items cannot be retrieved once placed inside.
All illegal items from patients and visitors confiscated by our security officers are not returned to the owner. When a legal but prohibited item is confiscated from a patient, we secure it during our patient’s visit. We place a numbered tag on the property, provide the owner with a receipt with the same number and secure the item in our safe. When our guest has received their services and they are discharged, they provide our security officers with the numbered receipt. Our security officers then return the item to the guest outside the ED in the parking lot.
Our officers completed more than four hours of training on the use of the WTMD, the HHMD and the x-ray scanner. We decided to have several officers identified and trained as super users. Many of the super users came from law enforcement and/or corrections where they had experience with the use of this technology. Demonstrating ongoing competency on the use of the x-ray scanner was an important consideration, so we purchased an online training module to document our competencies.
Equipment and Supplies
Within the people/screening space, we utilize the following supplies and equipment:
- Sharps containers for needle and other potentially sharp objects
- Sanitizer wipes to keep the x-ray machine clean
- Puncture proof gloves for our officers
- Nitrile gloves to lace over the puncture proof gloves
- Property tags for managing confiscated property
- Gun lockers for law enforcement officers and appropriately permitted individuals
- Small lockers to manage confiscated items that will be returned to the owner
- A safe for items that are not immediately retrieved by the owner
We were able to obtain several policies from surrounding hospitals that use people/weapons screening through the use of metal detectors and x-ray machines. We wrote our own policy with input from security leadership and our office of general counsel. Once reviewed and approved, the policy was shared with senior leaders and employees at Virtua Camden. The policy was also shared with the Camden County Police Department.
The policy provides:
- The definition of weapons and illegal weapons in the State of New Jersey
- The definition of a metal detector and x-ray machine
- The process for managing the amnesty box
- The process for scanning people and property
- The process for when individuals refuse to be scanned
- The process for when an alarm is triggered
- Special screening procedures for patients on stretchers, child carriers, strollers, wheelchairs and the physically disabled
Between September 1, 2018 and November 1, 2018, there have been a total of 8,223 items scanned with the x-ray machine. We averaged scanning 104 items per day. A total of 37,592 walked through the metal detector. There were 24,330 alarms generated by the WTMD, which required a secondary search with the HHMD.
Within the first 30 days, approximately 10% of our guests had items that are considered illegal or prohibited. We expect the percentage of guests who have illegal or prohibited items confiscated to decrease as public awareness of this new process increases.
Within the first 90 days, we have confiscated several handheld Tasers, stiletto style knives, airsoft guns, pocket knives, credit card style knives, pen knives, screwdrivers, razors, scalpels and homemade pointed objects.
The amnesty box has proven to be a valuable addition to our people/weapon screening process. It has been used by many of our guests to safely discard illegal or prohibited weapons before entering our ED. Within the first 90 days of use, we had more than 40 items discarded in the amnesty box.
We have received overwhelming support from our employees and community members.
Due to the success of the amnesty box, we have ordered an amnesty box for our four other EDs. We will continue to evaluate redesigning other EDs to accommodate the addition of people/weapons screening equipment. The collection and analysis of data will continue and will be shared at our environment of care and violence prevention committees.
Paul Sarnese is the assistant vice president of safety, security and emergency management at Virtua Health.