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July 27, 2018

In moments of crisis, many hospitals go on 'lockdown.' Is it time to reconsider?

Daily Briefing

    Hospitals treating victims of mass-casualty events often deploy extra security precautions, such as hospital lockdowns—but those lockdowns can separate visitors from loved ones being seen for unrelated conditions, prompting some hospitals to re-examine their response protocols, Jessica Bakeman reports for WLRN.

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    Why hospitals shutdown access

    Hospital officials from across the country say extra security measures are necessary to keep employees and patients safe when treating victims of a mass casualty event, such as a shooting.

    Bryan Margeson—corporate security manager for Orlando Health, a private hospital chain that treated victims of the Pulse nightclub mass shooting—said facilities may restrict hospital access after they have received several victims of a mass shooting or other crisis to prevent "worst-case scenarios," such as large crowds rushing into the ED, a person retaliating against a suspected perpetrator, or a suspect entering the hospital to cause victims further harm.

    According to Margeson, security guards patrol entrances when there is a crisis at any of Orlando Health's hospitals. During crisis situations, security guards will ask people seeking to enter the hospital why they need to come inside, Margeson explained. If they aren't seeking medical care, they're not considered high priority, WLRN reports. "[O]ur first and foremost responsibility is treating the patients, and that overrides everything," he said.

    Louis Yogel, who was the chief of medical staff at Broward Health Medical Center (BHMC) when a mass shooting occurred at Marjory Stoneman Douglas High School in Parkland, Florida, told reporters the night of the shooting, "In a time of crisis like this, it's better to have control over the situation. You have better control when you control who is coming in and who is coming out."

    The problem with hospital lockdowns

    But often those additional security measures prevent visitors from entering the building to see loved ones who are hospitalized for conditions unrelated to the mass casualty event, WRLN reports.

    Alan Butler, president-elect of the International Association for Healthcare Security and Safety, said, "When you shut down access to a hospital, the people that you're keeping out are in this heightened emotional state. It's not uncommon for people to yell and be frustrated. We've seen scuffles in the parking lot."

    After the Parkland shooting, BHMC went into lockdown and family members of several patients who were hospitalized for conditions unrelated to the shooting were barred from entering the hospital.  According to WLRN, "[a] few hours into it, tensions were running high," with people "crowding the entrance of the emergency room trying to persuade staff to let them inside the hospital" to see loved ones.

    Fawn Patterson arrived after the lockdown and was not allowed in to see her daughter, who at the time, was seven months pregnant and in the hospital for bleeding. "If there's somebody up there that's worse off, and a family member would like to see them before something happens, nobody can get in," Patterson said.

    BHMC's lockdown lasted for about five hours, but Patterson had already gone home by the time visitors were allowed in the hospital. Patterson's daughter ultimately spent one night in the hospital before being discharged, and two months later she gave birth to a healthy baby girl.

    Other patients were allowed in earlier. For example, Porcha McIntosh, a mother whose newborn son was being treated at BHMC because he did not have fully developed nasal passages, were able to enter the hospital, "didn't budget from the door," WLRN reports. McIntosh was eventually escorted in by a staff member and spent the evening with her son.

    How hospitals are seeking to address the problems with lockdowns

    While experts say the lockdowns play a critical role in ensuring patient and staff safety during an emergency, hospitals are continuously reviewing their response plans to make improvements, WLRN reports.

    Butler said hospitals across the country share notes and reassess disaster plans after every mass shooting. As part of those reviews, some hospitals are weighing whether to revise they're lockdown responses. "Sometimes, we stay in these elevated lockdown stages longer than we need to," Butler said.

    For example, some hospitals have additional staff who they can call in when there are large crowds (Bakeman, WLRN/NPR, 7/13).

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