On Saturday, Jan. 8, 2011 Congresswoman Gabrielle Giffords (D – Ariz.) was meeting with her constituents at a Safeway supermarket in Casas Adobes, Ariz., when 22-year-old Jared Lee Loughner shot her in the head, gravely wounding her. He then opened fire on the crowd, killing six people, including a federal judge and nine-year-old girl. Thirteen other individuals were also injured.
Although the attack was over quickly, it was clear that the healing and recovery process for Giffords and many of the other victims who survived the attack was going to be long and difficult.
What wasn’t clear at the time, however, was the nature of the threat to Giffords and the other survivors. Did the gunman act alone, or was he part of a larger conspiracy? Would someone attempt to finish what Loughner had started? For several weeks after the assassination attempt, no one knew for sure, and the University of Arizona Medical Center and Memorial Hermann Healthcare System in Texas — the healthcare institutions that treated Giffords — weren’t going to take any chances.
Arizona Medical Center Receives 20 Minutes Notice
The University of Arizona Medical Center, southern Arizona’s only level 1 trauma center, was the first institution to treat Giffords, as well as the majority of the victims of the attack. Officials at the hospital were notified about 20 minutes before the first victim of the shooting was admitted. At the time, all hospital officials knew about the scope of the tragedy was that there had been a shooting with several casualties.
“Normally, we do a lockdown of the facility, which means we limit access to only those who need to be here until we have a better handle on the situation and who was involved,” says University of Arizona Medical Center Director of Security Harry Kirlin. “That was done immediately as far as the emergency room was concerned. When we became aware of the extent of the number of patients and their identities, we extended that lockdown to the entire facility until we had an idea of what was going on.”
That meant everyone coming into the hospital had to go through the main entrance. Initially, there were three workstations to check in patients, but that number was soon increased to six so that waiting times would be reduced.
Individuals wanting to enter the facility were searched and required to show their IDs, and their appointments were verified before they could enter. K9s checked for explosives. Special badges were created for individuals (law enforcement, medical staff and visitors) requiring access to Giffords’ location.
Secret Service Survey Helps Prepare Hospital
While access control was being ramped up, the hospital also experienced an immediate influx of law enforcement personnel from the local sheriff’s department, police department, FBI and Capitol Police Department. Seven or eight Capitol Police officers guarded Gifford’s room 24/7. The Secret Service was also involved and was very visible when President Barrack Obama and his wife visited the congresswoman only a week after the tragedy. The Secret Service conducts an annual survey of the hospital, just in case one of its protected parties comes to the campus. This survey, which takes into account things like the number of hospital beds and helicopter pads, helped the medical center prepare for Giffords and the other patients, as well as the president’s visit.
Despite all of the law enforcement personnel involved, Kirlin says there weren’t any petty turf battles.
“I’m an ex-cop, and usually in situations like these, you have a certain amount of jurisdictional jealousies, but we didn’t have them here,” he says. “Everybody worked very well together. I think it was because everyone was so shocked by the incident that everyone’s focus was on making sure everything went well.”
Memorial Hermann Plans Help Smooth Transition
Cooperation was also critical when Giffords was transferred approximately two weeks later to the Memorial Hermann Texas Medical Center (TMC) in Houston. Although Memorial Hermann officials only received about 24 hours notice that their institution would be taking over the medical care of the congresswoman, they quickly worked out a transition plan for her. It included how she would be transported from Memorial Hermann’s Life Flight helicopter pad through the facility, security details, the clinical aspect of her arrival, as well as communications for the public and Memorial Hermann employees.
According to TMC CEO Craig Cordola, his institution’s plan and its adaptability were two important keys to Giffords’ successful transition. He recommends that other hospitals treating high-profile patients identify beforehand appropriate entrances and routes that are secure and not accessible to the media or other visitors. Outside vendors should also be vetted by security. That being said, a campus should also be prepared for a quick change in strategy.
“You could lay out a game plan and it could be good, but somebody’s going to call an audible along the way,” he says. “You need to be confident so you can adjust to that effectively without impacting the patient or their family, and be able
to go on to the next destination. The medical team decided they wanted to go to imaging, so we had to prepare pretty quickly to secure imaging and make sure we could get there appropriately on the least visible route possible. We were able to modify that well because we had people with the patient who knew the facility. We had security with us that could call ahead and secure everything in advance.”
Family Opts for Transparency With Media, Public
Drastic changes in plans might not only be due to medical necessity, but also according to the wishes of the patients and their families. With Giffords, the Capitol Police initially provided Memorial Hermann with a plan that called for maximum secrecy.
“We were going to have three helicopters that would land, but only one would be carrying her,” says Memorial Hermann Chief Facility Services Officer Marshall Heins. “Just before we were ready to implement all of those plans and she was scheduled to arrive, the family made a decision that they wanted the media to be more involved and they wanted to be more open with the general public about what was going on. That is really atypical in our experience for these types of situations, and so within a very short period of time, we had to completely change all of the plans.”
For example, Memorial Hermann and law enforcement officials allowed the public and media to know the route Giffords was taking. They allowed helicopters to fly over and follow the ambulances.
The openness and transparency to the media and public that Giffords’ family wanted was something very new for Memorial Hermann and posed a challenge for security.
“As a security professional, the less people know, the easier it is for us to manage the situation,” says Memorial Herman System Executive for Security Joe Bellino.
Additionally, with the bounty for a photo of Giffords running well into six figures, the temptation for the media, visitors and employees to violate her privacy was significant. To guard against this possibility, employees were prohibited from carrying cameras. Security also had to look closely at the hospital surroundings, such as rooftops and windows. To protect against unsanctioned photography, security used decoy rooms and obscured the windows where Giffords was being treated.
Access Control Safety Component Applied to Security
Visitor management and access control technologies were used at both Memorial TMC and TIRR Memorial Hermann, where Giffords was rehabilitated. The hospital was able to provide these security measures with little disruption to the other patients or their families.
“TIRR is more like a family environment, so we had to tweak things,” says Bellino. “We closed the perimeter down to two doors for the public. There is also a lot of access control because brain injury patients can wander. We don’t want them to get lost or go down a stairwell when they’re not ready for it. We were able to take the safety component of access control and apply it to security. It was a matter of reprogramming the system.”
Visitor passes were also needed. “We didn’t have to go out and spend a whole lot of money,” claims Bellino. “We kept it simple. We had a sign-in log, visitor pass book and all the passes were color coded with magic markers.”
Even something as simple as handling a package or piece of equipment had to be done carefully.
“We had some additional procedures for handling any mail or deliveries that were for her; any equipment or something that was made especially for her,” says TIRR Memorial Hermann CEO Carl Josehart. “It had to be handled in a special way to make sure that knowledge that it was going to get close to her didn’t create a security risk for her or the staff that was treating her.”
Hospital Security, Law Enforcement Partner Successfully
Like the University of Arizona Medical Center, TMC and TIRR Memorial Hermann campuses had a significant law enforcement presence during Giffords’ rehabilitation. In addition to the hospital’s sworn and nonsworn public safety staff, the Houston Police Department, the FBI, Capitol Police and even NASA security personnel were involved with the congresswoman’s security.
“They were very conscious that we had a medical operation here, and they didn’t want to impact it,” Bellino says. Indeed, an important point that Memorial Hermann officials conveyed to employees and law enforcement was that although Giffords was an important dignitary, the treatment of the institution’s other 699 patients should not be compromised.
To achieve the appropriate communications between Memorial Hermann public safety personnel and outside law enforcement, the campus set up a police command center that operated 24/7 while Giffords was on site.
“That was a big win for us,” adds Bellino. “Not only did the agencies communicate with us, they weren’t afraid to communicate with the officers on post. And we told our people that ‘it’s OK if a federal agent or Capitol Police officer asks you something; cooperate fully.’”
Employees, Medical Staff Encouraged To Be Vigilant
Although technology and strong relationships between security and police are extremely important, Memorial Hermann officials know that no security program can really be effective without the full cooperation and support of its staff and medical personnel. That’s why when they discovered that Giffords would be receiving medical care at TMC and TIRR, they made a concerted effort to keep all employees apprised of the institution’s mission, privacy requirements and customer service requirements.
“The constant vigilance of our staff in recognizing people who maybe look out of place on a day-to-day basis, whether or not it occurs with respect to Congresswoman Giffords or others, that ability to intervene and not walk by without making sure the environment is safe is probably the most critical success factor for security,” Josehart says.
This heightened awareness was achieved via what Cordola calls “town hall meetings,” which were held as often as every
three to four hours during the first 48 hours.
“We worked very, very hard to make sure that our employees and leadership knew what was going on,” he says. “They may not have known all of the specifics of the care, but they knew what the expectations were, the time of arrival and generally the route this patient was going to take. If we weren’t communicating and working effectively as a team, so many areas in between could have broken down, which would have potentially put her at risk.”
Some Lessons Learned
“Talk more with federal officials and make sure they’ve vetted the desires of the family and how they want [the hospital] to react.”
– Marshall Heins, chief facility services officer, Memorial Hermann
“With a protracted event like this (over five months), I’d be very careful not to burn your [campus public safety] team out. We pulled from where we could from our nine campuses and medical office complexes. In a situation like this, you need consistency of operations, but you’ve also got people working 10-, maybe 12-hour shifts over a long period of time. You’ve got to figure out how to rotate your people out. We were constantly in the background making sure we had the right people on post at the right time, all the time, so there weren’t failures, which we didn’t have, thankfully. We are going to a model now of supplemental [officers], which are on-call people. We make them work a specific amount of time so that they stay fresh. We’ve also hired some pretty good contract agencies, and we’re writing a training manual so that when, if we have to call in reserves, those reserves will be trained to our standards.”
–Joe Bellino, system executive for security, Memorial Hermann
“Security professionals need to be fully integrated with the clinical administrative team at the facility. Security at a hospital can’t be run independently of the folks who are in charge of clinical care. There may be things that are best practices if you provide security in a public place like a restaurant that could jeopardize the medical care of a patient in a hospital environment. If the security guard violates an infection control protocol for some reason and steps into a sterile field, that can cause harm to the patient.”
– Carl Josehart, CEO, TIRR Memorial Hermann
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