By Greg Freeman
Executive Summary
Violence continues to be a serious threat to healthcare workers. Recent incidents show that the problem is not getting better.
- Adequate security staffing is only part of the solution.
- All staff must be trained in violence prevention strategies.
- Technology and infrastructure can improve safety.
Hospitals and other healthcare facilities have been hit with multiple incidents of significant violence in recent months, illustrating the continuing need for effective prevention and response strategies.
A gunman held intensive care unit staff hostage at University of Pittsburgh Medical Center Memorial Hospital in York, PA, before killing a police officer and injuring five other people. According to police reports, he believed the staff could have done more to save his wife, who was on life support at the time.
In Scottsdale, AZ, a patient shot a security guard in the upper body before other security team members and employees were able to disarm and restrain him, Scottsdale Police reported.
At Brooks Rehabilitation Hospital in Jacksonville, FL, a Baker Act patient assaulted a 67-year-old female nurse, causing severe injuries, before running out to the highway and claiming nurses were trying to kill him.
Three female staff members were punched in the head by a patient at Jefferson Hospital in Jefferson Hills, PA. The man punched a responding officer as well.
Violence against healthcare workers is a growing concern, says Bethany Friedlander, CEO of New Bridge Cleveland, a nonprofit in Ohio that works to improve workforce issues in healthcare. Workforce development is measured by retention after employment, and it is hard to ask healthcare workers to stay in jobs when they feel unsafe, she says.
“Our critical approach is emotional regulation training for healthcare workers. Hospitals and training centers should prioritize trauma-informed care, which helps staff recognize and respond to signs of distress before they escalate,” Friedlander says. “Teaching emotional de-escalation techniques, active listening, and conflict resolution can empower workers to defuse volatile situations without resorting to force.”
Friedlander says these are some of the most effective strategies:
- Regulation training: Regular training in regulation and co-regulation, in addition to verbal and non-verbal de-escalation techniques, helps staff manage high-tension interactions and reduce conflict.
- Wearable security devices: Panic buttons and wearable alarms allow staff to discreetly call for help in case of a threat. These devices have proven effective in alerting security and de-escalating incidents faster.
- Staffing and workload balance: Overworked employees are more likely to experience burnout, which can make it harder to effectively manage aggressive behavior. Maintaining appropriate staffing levels helps prevent confrontations.
On the other hand, some commonly used strategies have proven to be less effective than hoped. Friedlander advises avoiding these common mistakes:
- Overreliance on armed security: While security personnel play a role, an excessive focus on armed guards can create a hostile environment and escalate tensions rather than resolve them.
- One-time regulation training: A single session will not be enough. Ongoing, scenario-based training is more effective. Co-regulation with patients and family members needs to be practiced over time. This approach requires the healthcare worker to be able to internally scan their emotional landscape and to be able to move through negative emotions and quickly get back to balance. This takes practice, she says.
Staff should be trained in best response strategies to employ when someone becomes violent, Friedlander says. She offers this list:
- Stay calm and engage non-threateningly: Using a low, steady voice and open body language can de-escalate the situation.
- Create space and identify an exit: If possible, avoid being trapped in a corner or small space with an aggressive individual.
- Call for help early: Use panic buttons or alert security before the situation escalates too far.
- Use trained co-regulation techniques: These may include validating concerns, offering choices, and redirecting attention.
- Know when to disengage: If a situation becomes physically dangerous, staff should be trained to remove themselves and seek safety rather than attempt to control the individual.
“Unfortunately, these suggestions and responses may feel inadequate in the face of violence. However, New Bridge had a phlebotomist attacked in an inpatient setting and she was able to return to her sense of purpose, contextualize the behavior in the face of fear and pain, and was able to return to work,” Friedlander says. “This is really all we can ask of healthcare workers.”
When it comes to hospital security, just like any other facility, “muscle memory” is critical, Lee Mandel, CEO of XSponse, a company in Miami that offers facility security technology. Training and understanding exactly what to do in an emergency situation is extremely important, he says.
“The challenge that a hospital faces vs. school and other facilities is that people [who] are within the hospital may not be people who are there all the time. There are many patients, visitors, and even medical professionals who are not regularly on the property,” he says. “The challenge is, how do you support and protect the people who are not familiar with the facility while continuing to train the people who are familiar with the facility?”
Simplifying the process of notification and communication and performing drills are important, he says. Technology, such as wearable units that allow staff to send alerts during an emergency, can help notify security or law enforcement promptly.
“Another challenge we find with hospitals is that multiple languages are usually being used within the facility, from the staff to the patients. There needs to be a system that is able to communicate quickly in multiple languages for specific instruction,” he says. “New technology exists today that allows this communication challenge to be overcome.”
History has shown that human error is a major problem during emergency situations, Mandel says. When people are faced with an event such as an active shooter, they do not follow procedures, they have trouble contacting first responders, and some freeze in place, he says.
“Under high stress and when in situations that are out of the ordinary, we can expect this. For this reason, simplifying emergency response by using one-button alerts and lockdown systems, wearable badges that with the pressing of a button or easily accessible wall mounted screens, individuals can quickly initiate a response,” he says.
This response triggers multiple actions, such as alarms, strobe lights, email and text alerts, building or floor lockdown, and, with advanced systems, first responders are given access to security cameras that have the ability to see where incidents are occurring, he says. Technology also allows for cameras to track intruders as they move through a building.
“Events like we have seen recently at hospitals, unfortunately, will continue. They are soft targets,” Mandel says. “Technology that takes human error out of the alert process is critical, and this will allow first responders to get to a location faster and act. Seconds save lives when it comes to response time.”
Culture Is Key
In terms of practical solutions, the most effective ones must transcend conventional physical protections, says Gregory Gasic, MD, a neuroscientist and cofounder of VMeDx, a company in Nashville, TN, that provides virtual assistant technology.
Surveillance and controlled access are two components of prevention, but Gasic says the most effective solutions involve cultivating a culture of respect and communication within any community or workplace.
“When people in a community feel like the decision-makers that influence their lives are making an effort to engage them in the process, work toward building trust, and open a dialogue, it can disarm tensions before they evolve into violence,” he says. “Graduates of conflict resolution training, who also possess skills to detect the early indicators of aggression or distress, help to establish a climate in which potential threats are recognized and diffused at an early stage.”
When it comes to response strategies to actively violent or threatening behavior, the trick is balancing preparedness and real-time adaptability, Gasic says. Members of a community or workplace need access to clear, actionable protocols indicating that the situation is serious, he says. Moreover, they need to know practical skills, such as how to protect themselves, how to safely alert authorities without provoking the individual further and putting themselves or others in harm’s way.
“Further education for leaders or managers in handling situations of this unique nature with grace and compassion would minimize injury and calm situations faster. Equally important is a post-incident review to understand the gaps and improve how we respond in the future so we get better over time,” Gasic says. “And mental health resources must be accessible for all riders, including the victims themselves and the men who perpetrated the crisis.”
Understanding what can drive patients to violence is part of the solution, says Taher Saifullah, MD, founder of Spine & Pain Institute in Los Angeles. “As a pain management doctor, I’ve unfortunately seen firsthand the distress and desperation that can sometimes manifest in violent ways. While my primary focus is on alleviating physical suffering, I’m also acutely aware of the emotional and psychological burdens that contribute to volatile situations in healthcare settings,” he says. “The recent incidents are deeply concerning, and they underscore the urgent need for robust security and risk management strategies.”
Violence in healthcare is, sadly, more common than many realize, Saifullah says. It includes not just physical assault but also verbal abuse, threats, and intimidation. Factors like long wait times, patient frustration, underlying mental health conditions, and the effects of certain medications can escalate situations, he says.
Emergency departments and mental health units are particularly high-risk areas, Saifullah notes. “The stress of illness, coupled with a sometimes-chaotic environment, creates a perfect storm for aggression,” he says. “Studies consistently show that healthcare workers face a significantly higher risk of workplace violence compared to other professions.
These incidents highlight the importance of proactive, rather than reactive, security measures, he says.
“It’s not enough to simply have security personnel on site. Hospitals must invest in comprehensive risk assessments that identify potential vulnerabilities. This includes analyzing patient demographics, common triggers for aggression, and the physical layout of the facility,” he says. “Learning from these cases involves understanding the specific circumstances that led to the violence and implementing targeted prevention strategies.”
A multi-faceted approach is crucial. Saifullah recommends covering these points:
- Enhanced security presence: Visible security personnel can deter potential aggressors.
- Access control: Limiting access to certain areas and implementing stricter visitor policies.
- De-escalation training: Equipping staff with the skills to recognize and manage escalating situations.
- Environmental design: Creating a calmer, less stressful environment with adequate waiting areas and clear communication.
- Mental health support: Integrating mental health professionals into the care team to address underlying issues.
- Improved communication: Clear, compassionate communication can prevent misunderstandings and frustration.
“It’s not just about ramping up security; it’s about strategic security. A balanced approach is needed. Investing in de-escalation training, improved communication, and addressing mental health concerns are equally important,” Saifullah says.
A well-designed physical environment also can play a role in reducing stress and preventing aggression, he says. Technology like security cameras and access control systems can enhance security, but they must be part of a broader strategy, he notes. “Ultimately, preventing violence in healthcare requires a culture of safety and respect. It’s a continuous process of assessment, training, and adaptation,” he says. “We must prioritize the well-being of both patients and staff, recognizing that a safe environment is essential for providing quality care.”
Artificial Intelligence Helps Detect Guns
Some hospitals have responded by implementing artificial intelligence (AI)-based gun detection. This software works discreetly with existing security cameras to detect firearms and instantly send images to trained veterans for verification. If the threat is confirmed, alerts are sent to hospital staff and first responders within five seconds, explains Sam Alaimo, cofounder of ZeroEyes, a company in Conshohocken, PA, that provides AI-based gun detection technology.
“It’s modeled after what we had in the military called a tactical operation center. It’s a low-lit room with computer screens, and everybody in that room is former law enforcement or a military veteran,” he says. “They’re very calm under pressure and they’re very good at identifying guns. If a gun is seen, the algorithm says, ‘Hey, I think it’s a gun’ and a still frame image pops up in our operating center. The human in the loop verifies, and if it is a gun, they are in immediate contact with the hospital and 911.”
AI also can be used to provide pinpoint accuracy of locations when a staff member reports an emergency, says George Valentine, general manager at Cognosos, an AI technology provider in Atlanta.
“If they detect a problem, they can hit a button discreetly on their person and get immediate help. They can do that inside the facility, as they’re walking to another facility that’s part of a campus, or when they’re going to the parking lot,” he explains. “The AI helps us pinpoint the location in a highly detailed way at a lower cost.”
Sources
- Sam Alaimo, Cofounder, ZeroEyes, Conshohocken, PA. Email: [email protected].
- Bethany Friedlander, CEO, New Bridge Cleveland. Telephone: (216) 867-9775.
- Gregory Gasic, MD, Cofounder, VMeDx, Nashville, TN. Telephone: (615) 866-1649.
- Lee Mandel, CEO, XSponse, Miami. Telephone: (305) 204-0050.
- Taher Saifullah, MD, Founder, Spine & Pain Institute, Los Angeles. Telephone: (626) 469-2939.
- George Valentine, General Manager, Cognosos, Atlanta. Telephone: (833) 736-7348.
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Hospitals and other healthcare facilities have been hit with multiple incidents of significant violence in recent months, illustrating the continuing need for effective prevention and response strategies.
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