Hospital security is paramount, particularly so during any Major Disaster.

Failure to swiftly activate adequate security measure can lead to - potential serious harm and possible death of patients, especially the vulnerable, immobile & children who may be left unattended as staff leave in fear of their own safety, - chaos as patients, relatives and media moving about in an uncontrolled manner, - unidentified victims not receiving proper care due to chaos, - fear among patients, relatives and staff, - terrorist attacks, - impostors posing has hospital staff thereby potentially leaving patients & staff vulnerable, losses due to theft, It is possible that matters of hospital security have held a low priority in the past as hospitals, like schools, temples and places of worship, have largely been considered sacred and therefore a low security threat. However, increasingly, hospitals have come under attack by terrorist ( 26/11/2009 Mumbai Terror Attack; Govt run G.T Hospital attacked ) and have also been the subject of major natural disasters allowing for severe security hazards. Currently hospital security requirements are so minimal that they do not even meet the basic standards of security. As such apathy about hospital security is very high as neither the management nor the staff seem to be particularly interested in hospital security measures. There is minimal communication between management, staff and security personnel regarding security issues and most often the security personnel are viewed as a separate entity from the hospital staff. The hospital security personnel are sometimes contracted by an external agency that may rotate their security on short notice, amongst different sites. This movement of security personnel allows for breaks in continued security as the new staff often get no induction training and therefore lack basic ground knowledge of the specific hospital site and its local procedures. The lack of commitment from the hospital managers is evident from both, the lack of adequate budget allocation to security measures and lack of adequate training given to the security staff regarding Major Disaster Planning. With robust security planning and procedures, both patients and staff, have a higher level of confidence in the overall capabilities of the hospital and in return, the hospital enjoys a better reputation amongst its clients. Besides, by strengthening the hospitals' emergency security measures, hospitals can help prevent opportunistic breaches of security, thus ensure that there is minimal long term disruption in the days after a major disaster or attack, whist also ensuring a quick recovery of standard levels of operation and preserving the continuity of the business of the hospital. Not only during a disaster, but at all times hospitals must provide a basic level of security. This is very important has hospitals house a large population of vulnerable people -sick, disable and frail children and adults. There are some basic principles of ensuring a level of security in any large organization such as a hospital. Some of these security measures, along with those of particular importance during a major disaster or terror attack have been highlighted below. ID Badges must be carried by all members of staff . NO member of staff should be allowed to access the secure hospital zone without appropriate hospital photo ID Staff awareness regarding security issues must be raised. The staff within hospitals must be encouraged to act in a responsible manner and must adhere to stringent security requirements particularly during a Major Disaster. The set hospital rules must NEVER be broken for ANY member of staff whatever the situation. The security personnel should be appropriately trained with special emphasis on response plans in a major Disaster or Terror attack. They must be extremely familiar with the hospital lay-out and evacuation plans. Security Departments must have a plan and procedures for the following (1) ability to call on extra staff to increase staff capacity (2) procedures in place to activate this up scaling (3) ability to interlink with other security networks to sustain this up scaling 4) establish command and control link

measures with State security In the event of a major disaster or terror attack, international recommendations for securing the hospital follow the universal principals of scene securing, i.e. the hospital is secured in 3 main zones (1) OUTER ZONE is the Hospital Complex or site (2) MIDDLE ZONE is the Hospital Building itself (3) INNER ZONE is the zone surrounding the critical patients and staff. There should be a dedicated area within the hospital, which is a designated Security Control Area from where a security command and control unit is set up, initially by the first security personnel on scene, sequentially handing over command to the more senior security personnel arriving. They should work closely with the hospital emergency officer and the State police. The other important gap that needs to be addressed when assessing the security of a hospital, is the emergency communication plan. Communication failure is a common problem that leads to the amplification of chaos and confusion during a major disaster leading to a major security hazard. At all time 3 main communication links must be up and running - (i) Hospital to all - this link is usually established by using alert sound systems like fire alarms and intercoms to alert people quickly and give them clear instructions. (ii) Command and Control to Incident Officers - this link is the arterial link that need to be quickly established when a disaster strikes, ensuring that the pre designed operative procedures are carried out to safeguard the patients in the hospital and appropriately respond to the new casualties that may arrive. And finally, (iii) Command and Control to all - this communication link is set up to ensure correct information is regularly transmitted to all the worried staff, friends, relatives as well as the media. This should be in the form of regular, timely, pre-arranged regular updates either on a written board outside the OUTER ZONE of security or through press updates in a media room separate from the hospital site. This further ensures security of the hospital scene as members of the public or media that are seeking information will be naturally diverted to the site where these regular updates and briefings are being given. At the same time rumours are dispelled as correct information is clearly being channelled through this established communication link. In the above article we have highlighted some key features relating to security issues during a major disaster or terror attack on a hospital. Further it is important to realise that the heightened level of security during a major disaster often has to continue for many days after the disaster or attack as ended. This is mainly due to the added media and public focus on the hospital and the security implication of potential VIP visits to the hospital. Thus the security demands may continue to be stretched for more extended periods that may be initially anticipated. One must also remember that these added security measures must be on the background of robust basic security measures, which must be in places during the day to day running of the hospital. Along with this, hospitals must ensure regular security training that involves and integrates managers, hospital staff and the security department of the hospital. Finally, and very importantly, hospitals must be should show leadership and responsibility when it comes to security related through commitment and training, and in turn should be held accountable when they fail to do so