The National Association for Healthcare Security (NAHS) is committed to promoting the safety, security and wellbeing of all staff, patient and visitors accessing healthcare facilities and services. This article discusses some of the key challenges and aspects of the Healthcare Security Officer’s job that often put them in harms way and has been written from an operational perspective. This article concentrates on the numerous challenges and operational solutions as opposed to discussing the specific and detailed Health and Safety legislation.
Hospitals routinely treat people whose emotions are heightened, they are often worried, distressed, scared, and in pain; if you then add drugs, alcohol or mental health to the mix and you have a situation that takes a particular type of person to manage. It is our opinion that there are specific skills and training that Healthcare Security Officers need, in addition to those of the commercial SIA licensed officer in order to deal effectively with whatever comes their way. It is imperative that in order to keep our Healthcare Security Officers safe, we must ensure that all our officers are provided with the appropriate and role specific training, they are provided with all necessary and appropriate safety equipment and the ability to work and integrate as part of the wider Healthcare team.
In preparation for writing this article, I spoke to NHS colleagues and fellow NAHS members and can state with a clear conscience that frontline Healthcare Security Officers are working harder than they ever have been. We are seeing demands both physically, mentally and emotionally that would test the strongest and most experienced officers. The Healthcare environment is constantly changing and evolving, the risk picture is never stable and what can be a quiet Emergency Department or Ward can suddenly erupt into an exceptionally violent, aggressive and volatile situation in the blink of an eye. It is therefore essential that the Healthcare Security Officer is able to think on their feet, constantly risk assess the situation and ‘Improvise, Adapt and Overcome’ (to use one of my moist favourite and personally adopted military movie quotes from ‘Heartbreak Ridge’). My reason for saying this is because one minute they could be dealing with a rough sleeper who refuses to leave the hospital and the next, they could be dealing with a patient suffering from a drug induced psychosis who is smashing everything in arms reach, who feels no pain, has the strength of 10 men and is throwing fire extinguishers at staff and patients and using them as battering rams to smash doors and equipment. This may not sound dissimilar to a busy town centre in many ways but whereas the Police will often attend and arrest disruptive, violent individuals out on the street, this is not always possible within a Hospital environment.
As an Accredited NHS Security Management Specialist, having worked in Acute Hospitals, Mental Health units and Forensic Mental Health NHS Trusts as well as Community Healthcare services, I have personally seen an marked increase in the professionalism of Healthcare Security Officers and a willingness to undertake additional training which in the end, helps improve officer safety but also enhances their own personal understanding of the patient and the problems they may be experiencing. A good example of this is the nationally recognised and delivered Dementia Awareness training which highlights the challenges of dealing with Dementia patients and the common mistakes untrained people make. A simple change in the approach and the way an officer talks to the patient will make a monumental difference in how the patient responds and in the vast majority of cases, will help keep everyone safe and will defuse and de-escalate a potentially violent and traumatic incident. One piece of advice our experts have offered to staff when working with dementia patients is to show the patient the same respect and dignity one would expect to be shown to your own Grandmother or Grandfather. Taking this approach has helped officers establish a rapport and personal contact with the patient. Incidents where a patient is behaving completely out of character can be very traumatic and emotionally challenging as well as very difficult for staff to process, especially if restraint has to be applied in order to keep them and others safe.
Many NHS Trusts and Healthcare providers provide training for their Security Officers in Mental Health awareness, however, such training does not make them mental health specialists or experts; it just improves and enhances their awareness and understanding of an incredibly complex area of our work. Mental Health now features heavily in an officer’s daily routine, especially as recent changes in the law have defined the ED as a safe place and as such, it is the right place for person with a mental health illness as opposed to them being locked up in a cell for the night. I am sure readers can fully understand the impossible challenges our Police colleagues face around the country and the extreme demands placed on their time and as such, having a whole team of officers looking after one mental health patient in a Hospital does not appear to be the best use of Police resources. This is where it can become controversial as in many respects I wholeheartedly agree, however, Healthcare Security Officers do not have the same level of PI training, the vast majority do not have handcuffs or leg straps and they often work in much smaller teams and finally, they do not have the level of backup Police colleagues can call upon. Where Police bring a highly aroused patient into the ED in restraint, handcuffs and leg straps, it is only right that when the Police wish to handover the patient, the Security Officer receives a detailed risk assessment and handover from the Police Officers and an assurance that the person has been searched and they no longer pose the level of risk needed for mechanical restraint and the presence of, in one recent case, six Police Officers to maintain their safety for example. If this is achieved, the Nursing staff, in consultation with the Security Officer would be happy accept the patient and for those in the Metropolitan Police area, the Police Officers should complete a Voluntary Attendance Handover form. The use of the phrase ‘Voluntary attendance’ and how they came to the Hospital is a subject for another day but the crux of this is for Healthcare Security Officers to undertake a risk assessment and in conjunction with the Nursing staff ensure the patient, staff and visitors are safe and the patient can receive the care they need.
Promoting a safe working environment will also often include the provision of Control and Restraint (C&R) training. This is an essential skill needed for officers to remain safe but also to deliver a legally compliant and safe service to the organisation and its patients. This is not just Physical Intervention (PI) as delivered as part of the SIA licence; Healthcare restraint is more specialised and differs in its levels and approach. The training is often bespoke and is specifically tailored and targeted dependent on the sector you are working in. The terms and names of the training packages may differ but on the whole, C&R with the additional healthcare element covers such areas as restraint on a bed, restraint for the administration of chemical sedation and specialised methods for care of the elderly. Mental Health providers may utilise PSTS (Promoting Safer Therapeutic Services) or PMVA (Prevention Management of Violence and Aggression) for example, which are training packages designed specifically for that environment. Whilst on the subject of restraint, it should be noted that the use of prone / face down restraint is an area that all providers have moved away from as the default position, with many implementing the ‘least restrictive method’ approach in an attempt to avoid using restraint at all. It should be recognised, however, that prone restraint often occurs unintentionally when the individual takes themselves and the restraint team to the floor. It is therefore the job of the supervisor / restraint lead, to ensure that the patient / subject is moved without delay to a more appropriate position, whist ensuring the safety of the patient / subject and staff. Although not always possible, a nurse or healthcare professional should be involved in a restraint to monitor the person’s physical health and maintain their airway, as the danger of positional asphyxia is one all those involved in a restraint must be aware of. Protecting the officers involved from allegations of over-zealous restraint, assault and criminal or civil prosecutions is achieved through a well designed, documented and robust training regime with regular updates and ‘in use’ assessments. Other methods such as the use of Body Worn Video is quickly becoming the norm with many Hospitals Security Officers using up to date technology to record all such events and incidents.
It is the responsibility of the Security provider and the NHS Head of Security to protect the health and safety and the wellbeing of their officers through the delivery of appropriate training and certification. This forms the basis and legal protection of the provider supported by robust healthcare governance, up to date Assignment Instructions, a legally sound Restraint Policy and an up to date Management of Violence and Aggression policy. In addition, the documentation of risk (perceived and actual) and the regular review of such measures is paramount.
Officer PPE (Personal Protective Equipment)
For years, the Hospital security officer wore no real PPE as a general view by many was that stab vests made them look too much like Police or paramilitary. This meant that they were relatively unprotected but were still expected to go into situations that would make most people balk and run away. We now see some Healthcare Security Officers wearing stab vests, knife resistant gloves and in some NHS Trusts, officers have access to handcuffs or soft cuffs. The provision of PPE stems from the legal requirement for employers to mitigate risk where possible and to provide all necessary and appropriate protection for them to do their job, however, there are still some organisations that take the view that stab vests attract violence and cause a situation to escalate out of hand.
Every organisation must undertake a robust risk assessment that documents the rationale for the use of the various PPE items. If the decision is that certain PPE is not required, this too must be documented as this one of the first areas the Health and Safety Executive will look should an officer be injured. I am also aware that in other areas (not specifically healthcare) where PPE is available and has not been provided, the Coroner has taken an employer to task for failing to provide adequate protection and equipment to their staff.
Responsible security providers undertake detailed risk assessments and have trained and protected their staff but even with all this PPE, there will always be one individual that manages to cause injury. The image below is of an injury sustained by a Security Officer who was bitten by an extremely violent patient during a restraint. In response to this incident, the officers have now been provided with a hardened and protective baseball cap; however, the officer will bear the scar forever.
Mental Health and Wellbeing
As many will know, Security can be a demanding and highly stressful job following exposure to traumatic incidents. It is therefore our job to support our staff physically and emotionally; recognising the need for a person to ‘decompress’ and process things in a safe environment after an incident. It is recognised that by providing them with the opportunity and the ability to de-brief and to talk about their experiences and emotions is extremely important. This is now becoming a recognised approach with post incident de-briefs with counselling provided or offered as standard. It should also be noted that many organisation have staff trained in mental health first aid allowing them to recognise the warning signs and symptoms of a crisis before it develops fully. The importance of such training and the need for all sectors to embrace mental health first aid and make it a standard service is vital, bringing additional value to any contract or service, whilst investing and protecting the health, safety and wellbeing of our officers.
Vaccinations and Inoculations
The resurgence of Measles in areas of London emphasises the importance of defining certain inoculations as a pre-requisite for all Healthcare Security Officers. It is recommended that Healthcare Security Officers comply with the same vaccination regime that NHS staff have as part of their contract of employment. In addition, an awareness of hand hygiene and infection control protocols is absolutely essential for the Healthcare Security Officer as MRSA, Hepatitis, Clostridium-Difficile (C-Diff) and Norovirus can be present in a Healthcare environment. Many of which can be picked up and transferred through poor hand hygiene, contact with body fluids and blood for example. Ensuring our workforce are given the protection and inoculations including the annual Influenza injection along with providing all appropriate training prevents cross contamination, transmission of infection and protects the officers themselves, preventing them from succumbing to infection and disease.
In conclusion, the health, safety and wellbeing of our staff is paramount which is why it is absolutely essential that we embrace this subject and invest in the protection of our frontline security officers.
NAHS is currently lobbying the SIA and has proposed that a specialist category be created for licensing and equipping Healthcare Security Officers with the tools and skills needed to work within this very demanding sector. The NAHS Executive team welcome any enquiries from readers involved in Healthcare Security and look forward to supporting colleagues in the provision of a safe and secure environment and in keeping our staff, patients, visitors and assets safe.
John is Head of Security and NHS Accredited Local Security Management Specialist (LSMS) for Lewisham and Greenwich NHS Trust. He was recently voted in as NAHS Executive Director. John is a former Royal Air Force Police Special Investigator who began working with the NHS in 2005 as a Drugs Worker with the Coventry Drugs Intervention Programme. He moved back to the Policing and Security field in 2006, gaining his NHS Security Management LSMS accreditation in 2007.
John has worked across all sectors of the NHS and has a particular interest in Mental Health Acute and Forensic services. He now works closely with two Mental Health Trusts, hosted on his two acute hospital sites. In addition to the ‘normal’ day job, John delivers Lone Worker, Personal Safety skills, PREVENT and Project GRIFFIN Counter Terrorism awareness training.