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Hospitals that were built 10 to 15 years ago were not designed to confront the security threats of today's society. In fact, the design of those hospitals was antithetical to the needs of present-day facilities. Back then, openness and ease of access was paramount. Hospital design intended to encourage unfettered access. Criminals also had a different view of hospitals several years ago. Their peculiar code of conduct seemed to declare that hospitals were exempt from their criminal activity.
Things have changed radically within the past 5 to 10 years. Now when we watch the evening news, we hear about three emergency room physicians being shot in Los Angeles. We read about nurses being murdered on the job. We hear reports of newborns being snatched from nurseries. A stranger molests a child in a pediatric hospital. We find patients and visitors bringing weapons into emergency departments.
What is the result of these incursions? The answer is: an epidemic of security lawsuits against hospitals claiming inadequate security. SMSI has seen lawsuits against hospitals for inadequate security, where a portion of the complaint alleges inadequate design.
The Ritchie Organization (TRO), an award winning architectural/engineering firm headquartered in Newton, Massachusetts, has been aware of this changing environment for the past several years. TRO has maintained a health care design specialty for more than 50 years. The professionals at TRO acknowledge that contemporary security threats have affected the way they design health care facilities. The TRO architects indicate that some departments have been affected more than others. They point out that they have had to apply their expertise for security design especially for emergency department as well as L&D and postpartum. From a design perspective, the challenge is to try to exercise some control over ingress and egress while at the same time not detract from the primary mission of the hospital. One of their architects, Shawn Kirouac, indicated that the location of the nursery and postpartum within the hospital has a major impact on design considerations. For example, birthing centers located on ground level floors raise a set of concerns that differs from units located on upper floors. TRO's designs must factor in time. Time required by a perpetrator to carry out an abduction must be considered. Time required to effect security intervention must also be taken into consideration when designing these units.
Many times, design requirements are for upgrade requirements of existing facilities. Alberto Salvatore, AIA, of TRO, indicates the need to create a sense of security integration. The architectural firm must become familiar with the crime environment as well as the security incident history of the hospital being remodeled. The overall design must take into consideration the security technology presently being used as well as technology upgrades anticipated in the future. Alberto Salvatore believes that both clinical and security staffing levels can have an impact on the ultimate final design. For example, Salvatore states the fields of view, for both nursing staff and security personnel, will influence the design.
Shawn Kirouac states the security needs are considered in the design of hospital parking structures. These considerations not only include the parking facility proper, but also include the anticipated walkways between the parking facility and the hospital.
Clearly the challenge is to design hospitals that are as safe and secure as reasonably possible. The trick is, "How can this be done in a manner that does not detract from the image the hospital wishes to portray to the community it serves?" Making a hospital secure would not be such a challenge if no one cared if the end result looked more like a penal facility. Hospital design must not only consider vulnerabilities for crimes against persons, but it must also consider the rising threat of property crime. Some hospitals may be suffering internal losses mounting up to $3500.00 per/bed per/year. Again, ease of ingress and egress is a significant contributing factor. Any hospital that is planning new construction in the foreseeable future, must consider the need for sound security as part of their design requirements. All too often, these vulnerabilities come to the forefront only after a major incident.
Many hospitals mistakenly believe that they are not vulnerable unless they are a Level 1 Trauma Center and serve the inner city. Nothing could be further from the truth. SMSI has provided security expertise in 13 lawsuits involving hospitals over the last 12 months. None of those hospitals were inner city hospitals.
There is a real need for architectural design firms that serve the health care community to become partners with qualified security experts in order to insure the best for their clients.
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