March 13, 2015 | | Comments 1
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An interesting security development: To arm or not to arm?

In a February 18 Joint Commission leadership blog post, Mark Crafton, TJC’s executive director of communications and external relations, focuses on the benefits of investigating different approaches for mitigating violence in hospitals. At least that’s where the conversation starts, but it ends up in kind of an interesting (and to my eyes, unexpected) direction: the question of whether hospital security officers are a more effective deterrent/mitigation strategy when they are armed. (N.B.: In Crafton’s post, he refers to security “guards”; call me whatever you like, but I think the term “guard” just doesn’t ring well with me. I’m okay with the terms “security staff” or “security officers,” but “guards” just gives me the vapors—metaphorically speaking, of course.)

In the course of the posting, Crafton points to an article in the Chattanooga Time Free Press that will likely generate some debate among healthcare security professionals, and I tend to agree with that thought. Apparently the article was the result of a healthcare system’s decision to disarm their security staff and adopt the “soft” uniform look (e.g., blazers, etc.) to more effectively emphasize the security officer’s role as a more customer-oriented (my description) countenance. Now we’ve touched on the subject of arming security officers in the past (it’s been a really long time) and it’s probably way past the time for looking at this topic, particularly as the good folks at CMS have some rather strong thoughts on the subject:

CMS does not consider the use of weapons in the application of restraint or seclusion as a safe, appropriate health care intervention. For the purposes of this regulation, the term  “weapon” includes, but is not limited to, pepper spray, mace, nightsticks, tazers, cattle prods, stun guns, and pistols. Security staff may carry weapons as allowed by hospital policy, and State and Federal law. However, the use of weapons by security staff is considered a law enforcement action, not a health care intervention. CMS does not support the use of weapons by any hospital staff as a means of subduing a patient in order to place that patient in restraint or seclusion. If a weapon is used by security or law enforcement personnel on a person in a hospital (patient, staff, or visitor) to protect people or hospital property from harm, we would expect the situation to be handled as a criminal activity and the perpetrator be placed in the custody of local law enforcement.

The use of handcuffs, manacles, shackles, other chain-type restraint devices, or other restrictive devices applied by non-hospital employed or contracted law enforcement officials for custody, detention, and public safety reasons are not governed by this rule. The use of such devices are considered law enforcement restraint devices and would not be considered safe, appropriate health care restraint interventions for use by hospital staff to restrain patients. The law enforcement officers who maintain custody and direct supervision of their prisoner (the hospital’s patient) are responsible for the use, application, and monitoring of these restrictive devices in accordance with Federal and State law. However, the hospital is still responsible for an appropriate patient assessment and the provision of safe, appropriate care to its patient (the law enforcement officer’s prisoner).

As you can well imagine, equipping security staff with weapons of almost any stripe can result in the classic slippery slope. My personal practice was to have a clear delineation between security staff and law enforcement responders. Security staff were provided ongoing crisis management education and worked closely with clinical staff to proactively manage at-risk situations. Law enforcement response was summoned when appropriate and the use of weapons was solely at the discretion of those responders. I know those lines can get pretty blurry in the heat of the moment, but specific roles are, I think, the best starting point for an effective security program.

At any rate, Crafton goes on to discuss the following: the cases for armed/not armed security staff; armed staff as authority figures vs. armed staff as a potential for raised anxiety of patients who are already distressed/stressed; and how do you make patients and staff safe, etc. There are, of course, good arguments on both sides, but ultimately (and this is one of the common threads when it comes to TJC standards and expectations), it is the responsibility of each organization to determine how best to manage, in this case, security risks. It doesn’t seem likely that peace, love, and understanding are going to be breaking out any time soon; the role of the security officer has never been more important.

Entry Information

Filed Under: CMSHospital securityThe Joint Commission


Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at

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  1. Steve, below is a copy of my LinkedIn page on this same subject. There are lot’s of things healthcare facilities should consider before arming security staff.

    Today, TJC posted Different Approaches to Mitigate Violence in the Leadership Blog. The post focuses almost exclusively on the question of arming hospital security officers. I find many clients are also focused, almost solely, on this question when considering what to do to reduce the potential for workplace violence. Arming security officers or having police officers on staff are certainly options. However, there are many, many other options to also consider. Healthcare facilities should carefully assess all the options as they look to implement reasonable measures for reducing the potential for violence on their campuses.

    In July of last year, I wrote a LinkedIn piece on this subject after a patient shot and killed his case worker and wounded a physician at Mercy Wellness Center in Darby, PA. The wounded physician then pulled a gun and shot the gun wielding patient who was then subdued by other staff members in the clinic. Click on the following link to view the post in it’s entirety. Should Hospitals Allow Doctors and Other Staff Members to Carry Firearms?

    As you might expect, a broad range of comments at the bottom of the original post cover the spectrum of opinions when it comes to arming security staff. A summary of options from the original piece is provided below:

    So what can and should hospitals do? Each HCF should at a minimum take the following actions to assess risk and implement measures to reduce the likelihood of an adverse incident and provide an effective response if one does occur.

    Conduct a comprehensive evaluation of your security program -Reducing the likelihood of a serious incident involves a layered approach involving many aspects of security including policies, procedures and training as well as physical security, design and other factors. A competent hospital security professional should lead this effort using a multidisciplinary team. Competent means someone with hospital experience and credentials (CHPA and/or CPP). The local PD may have some resources, but you want someone that understands healthcare.
    Workplace Violence Policy Assessment – Evaluate your policy and make sure it has senior leadership support. There are several excellent resources to assist in this process including OSHA’s “Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers”, and the ASIS Workplace Violence Prevention and Intervention Standard.
    Threat Management Team – A threat assessment team will be part of any decent workplace violence program. Establish this team (usually composed of representatives from Legal, Security, Human Resources, Psychiatry, local law enforcement and others depending on the resources readily available in your HCF). Train the team and use them for threats. This group gets better with experiences as with most teams.
    Implement Flag Systems in the Electronic Medical Record – Develop policies and procedures for identifying threatening patients and family members, and patients with violent criminal records. Patients and family members that have previously threatened and or assaulted staff in the past should be identified and flagged so staff members that encounter them in the future have the benefit of the previous experiences. This then allows them to take appropriate measures to protect themselves and others. The best predictor of future behavior is past behavior.
    Design Security into New Construction and Renovation Projects – In the next decade there will be billions of dollars spent on new construction and renovation projects. This is a major opportunity to build security into each project. The IAHSS has developed Security Design Guidelines for Healthcare Facilities. HCFs and healthcare systems should consider these guidelines and develop systems security requirements that each design project implements as a required part of any new project.
    Training – Train staff in security sensitive areas on crisis intervention and security policies and procedures. Evaluate your current crisis training and consider if it meets your needs given this new era of violence toward healthcare and human service workers.
    This is a call to action. It is easy to become complacent and think these things don’t happen here. Every healthcare organization should consider the risks and take action to make sure you have reasonable, appropriate, risk based security programs in place.

    The original posts can be found on my LinkedIn page:

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