An Inside Look at Hospital Security

Security in hospitals is critical and they spend lots of money on security systems and services (e.g., third largest industry employing security guards). How hospital security works and what issues they face are key concerns.

In this interview with Margarita Castillo CPP [link no longer available], who retired after 24 years at University of New Mexico Hospitals as Manager Security Operations and Security team member, she explains why hospitals are different from traditional security settings, how officers coordinate with medical staff and what technologies worked and didn’t.

Why a Hospital Is Different From All Other Settings

“The most unique thing is the fact that, as security, we’re dealing with patients and people with all types of medical issues, sometimes life-threatening heath issues. That very fact delays our ability to move them (patients) immediately should an emergency situation occur that threatens the hospital at large," she said.

Among other critical concerns, one involved the security of newborns and the potential for a baby abduction. Because of these concerns, one of the primary security countermeasures at UNMH was the ability to lockdown and secure the hospital within seconds remotely from the dispatch office. “The baby alert system would sound in the dispatch office and in turn the dispatcher would release the doors, the mag-locks would fire and the doors would secure the area," she said. The security team would respond to the doors and maintain vigilance, noting people with large purses or bags, blankets and backpacks that could conceal a baby.

Why the Emergency Room is a Priority

The Emergency Room is one place in the hospital with the highest value of unknowns. People are constantly coming in or out of the Emergency Room area. The variety of medical issues range from a broken limb to a medical life-threatening situation from injuries sustained during a vehicle accident or other traumatic incident. Worried family members are among those in the ER along with sick or often, intoxicated people. “As a result, tension was high in there quite often due to the emotional stress of the person’s situation," she said. There was always at least one security officer assigned to patrol the ER and respond as the need arose.

Being the only Level 1 Trauma Center in New Mexico brought approximately 90,000 patients through their emergency room annually.  “It wasn’t just one patient an hour, it was over a hundred patients during the course of the day,” she said. 

Worst Security Technology and the One with the Most Potential

Castillo says that in her time at UNMH, the worst attempt at access control came during the late 1990’s, when the security department implemented the use of barcodes on employee ID badges. The barcoded ID badge was provided to all hospital employees and ranged from very basic permissions to access the main entry doors to the restricted permissions assigned to areas such as the “med” rooms. Because UNMH is a teaching hospital, many of the medical students or residents were assigned specific permissions that enabled them to access the area of the hospital pertaining to their rotation. Medical students or residents soon learned that copying the barcode from someone else allowed them permission to access areas assigned to that person. The barcodes were uniquely assigned and provided the security team the ability to discover who had shared their barcode stripe. “We started covering the barcode with a red tape to make it harder to copy the barcode,” she said.

By the mid 2000’s, the hospital had approximately 300 proxcard readers for a total of around 780. The security technology included 275 panic alarm buttons throughout the hospital and roughly 750 security cameras. Currently the hospitals security cameras number about 1000.

She says the technology that she has seen with the most potential is the ability for security officers to employ the use of an iPad or tablet while on patrol to view additional security cameras. “The ability to check an area out as you are walking over there or driving over there provides useful information to the security officer with regard to his or her safety. I think this is something to watch for in the use of technology. For example, if you are assigned to the mental health center and there are people in the waiting area, a properly positioned security camera and a security officer armed with a tool that allows him/her to patrol another area while keeping a watchful eye on the waiting room is tremendous. I think it is going to play a huge role for security staff.  It’s out there, but it’s not at the level it needs to be,” she said. Castillo says it should also have audio integration to help scrutinize those situations where you can’t be sure if a person is being aggressive or just talking with their hands.

Security Officer Training

Security officers were cross-trained to perform a variety of duties as required by the assigned location. Permanent location assignment often lead to complacency so security officers now rotate through locations and must learn the different tasks associated with that specific location, such as the Emergency Room or the Mental Health Center. This included patrols of the assigned facility, dispatch duties, access control, monitoring and operation of the video surveillance system. For patrols, they were trained not only to identify possible security threats, but to also challenge or question people who appeared to be lost or out of place, including people who might be off their medications. The training they received for this purpose was called “Crisis Intervention Training."

“When mental patients go off certain types of medication, they present with a certain nod or cock of their head to their left or right shoulder,” she said. The security officers were trained to recognize potential indicators of mental health issues in person or on video. This type of training is not common place for most security or police departments.

Castillo says the Memphis Police Department developed the “Crisis Intervention Training (CIT) [link no longer available]” in 1988 for police officers to teach them how to deal with mental health crisis such as suicidal people, or other  mental health issues, how to recognize people off their medication and what law pertaining to mental health patients.

The CIT training was adopted by the Albuquerque Police Department and through a joint venture modified and provided by the UNM Mental Health Center to the police officers. The UNMH Security department included the training trimmed down from 40 hours to 32 hours for their security team. The UNMH training eliminated eight hours reserved for law topics as any mental health decisions were made by the Emergency Room physicians.

While Castillo was at UNMH, a typical shift included seven to nine security officers. All of the security team were hospital employees, however on occasion, contract security were used for parking lot security on a limited basis. During her tenure, the number of security staff grew from 12 officers to 45. This did not include the position of Manager Technical Operations who was tasked with the video surveillance and access control systems, or the locksmith and office manager.

Challenging in a Hospital Setting

“While on patrol, security officers are constantly observing, they may pick a person out that draws their attention and watch that person for a while. The Officer will make a decision as to approach or not, this holds true for the security officer (aka dispatcher) watching the monitors. If the decision is made to check the person out, often it is communicated to the dispatcher. This allows the dispatcher to bring up a nearby camera and keep an eye on the security officer for safety purposes. When questioning the person, the security officer often obtains useful information as to the legitimacy of the person’s purpose in the hospital, she said. In some cases a person needs direction to another part of the hospital so security officers also provide customer service by directing a person or escorting them.

"All personnel should stop and question a person who appears to be lost, out of place or suspicious," she said. "At minimum, the suspicious person should be reported to security immediately. Having security cameras in place speeds this up and helps keep a watchful eye on the situation. Questioning these particular people minimizes the opportunity for theft or vandalism.”

Incident Logs

Security officers are required to maintain a log of any encounters or incidents that have occurred over the course of their shift. These logbooks are considered legal documents and are turned in to the shift supervisor at the end of their shifts. The logbook is assigned to each officer until he or she has completely filled the entire book, at which time the log-book is returned to the supervisor and archived. Shift briefing occurred at the start of each shift and all on-coming security officers were required to attend. Communication of the shifts events, BOLO’s, and other significant information were passed along as well as documented on a daily shift briefing sheet.

Communication between Medical Staff and Security

Castillo says one of the most important things about working in a special population is communicating with other staff. The security department not only put out regular newsletters to provide information to hospital employees, but also incorporated security training during new-hire orientations.

“That is probably the most successful thing we pulled off," she said. “We made sure to train hospital employees on what was occurring within the hospital with regards to security systems, and more importantly, the type of information that the security dispatcher needed when calling for the security team.”  

What kind of information was that?  “We didn’t need to necessarily know that someone is visiting patient X and patient X has diabetes”, she said. “Instead, we need to know that the visitor is room X and we need to be sure and wear personal protective equipment (PPE) for an aggressive person who is bleeding or that it is critical that a person gets their meds ... That way we know what to expect when we get to the patient (or visitor),” she said. Eventually, it became standard practice for security staff to wear gloves and eye protection when responding to an incident and became part of their daily gear.

Security Hotline

Another initiative was the implementation of a security emergency number within the hospital system. Medical staff were trained to dial 57 if they had a security emergency such as a potentially violent patient or visitor. “As soon as the emergency phone rang, the dispatcher would drop everything and respond to that call. We trained staff that this number was for security emergencies only,” she said. Staff could also call the security office non-emergency line to provide information about non-emergency situations requiring security.

Security Response

The security team tried to make sure they could respond anywhere in the three-building hospital campus in about two minutes (a five-story building, seven story building and a mental health facility that was a block away). While the closest responding officer moved in the direction of the needed assistance, the dispatcher would relay information about the scene obtained from both the caller and any security cameras in the area. If the call came through the emergency number, all available officers would respond.  

“We responded in force," she said. “If the first officer on the scene said he just needed one other officer then the other officers would drop off and return to their posts. If the officer didn’t say anything, then they would keep coming as backup."

The Value of Video Surveillance in a Hospital Setting

The main function of security cameras at UNM Hospitals was to provide real time situational awareness for the security team. The dispatcher and often, one other security officer monitored the security cameras while the others were on patrol and could be dispatched to check out anything observed from the control room. The priority cameras were at the entrances and the emergency room. If there was an incident, the dispatcher would pull up those camera views, or the camera views of the incident and do a quick review of the previous footage.

On cameras Castillo said, "The hospital uses a wide variety of cameras including PTZ's but no panoramic as of yet. The majority are all budget type, analog cameras with a push to newer technology and video analytics."

Surveillance was especially valuable in 1990’s during a period of newborn abductions [link no longer available]. Fortunately, UNM Hospitals had RFID bands for newborns and a lockdown procedure in place called “Code Pink."

“Anytime we received a code pink alert, all the doors would secure and the cameras from those areas would come up and officers stationed at each of those doors watching for anyone caring a large bag or anything they could conceal a baby in,” she said. One hundred percent of the code pink alarms were false from babies being moved without their status being updated in the computer, or the wristband being removed for one reason or the other, but their practice at watching the neonatal unit helped them provide evidence in another case.

In 1991, after a baby was stolen at a hospital in Las Cruces New Mexico, UNMH security reviewed its footage and found that the same woman had visited their hospital but was challenged by medical staff.  “So, this woman, instead of trying to do something at our facility, went to Las Cruces and abducted a baby there. That went to show the length that this woman went through to find the weakest target,” she said. Las Cruces is three and half hours away from Albuquerque.

UNMH reviewed their footage after the other hospitals security team put out an alert to look out for a woman who might be seeking medical treatment for the newborn.  The baby was eventually returned two weeks later and a woman arrested.