Much of the current focus on emergency planning is on what planners perceive as “critical infrastructure.” Although many infrastructure sites are obvious – nuclear power plants and major weapons plants, for example – many others are elevated to that status only after the occurrence of events that reveal how much their loss might affect the local community, or sometimes the entire nation. Following are a few random examples of such events: a hurricane that cripples a power station in a major city; a water leak in the core of a nuclear reactor that causes a release of radioactive steam; an explosive device that shuts down the subway system in a large urban area; and a well-planned attack on hotels, train stations, or sports arenas.
After any of these or similar incidents occurs, the principal components of a community’s physical infrastructure almost automatically become the prime focus of an updated emergency plan. In addition, of course, after a particular site is elevated to the status of “critical infrastructure,” local agencies pay much more attention to it in their future planning sessions. This tighter focus gives that component of the infrastructure not only greater prominence from a planning perspective but also, in many cases, the additional funding needed to protect it from future terrorist attacks and/or major weather catastrophes.
Since the 25 November 2008 attacks in Mumbai, India, hotels have become a major focus for anti-terrorist plans in many other nations throughout the world – particularly in the United States. The hotels in most large cities are public areas that have not been “hardened” against an attack. Moreover, until very recently, most of them had never been surveyed to determine specific areas of vulnerability, and police and fire departments usually had ignored them during various emergency drills and exercises.
What Attracts Tourists Also Attracts Terrorists
There is an additional complicating factor to consider – namely, that hotels, by virtue of being essential building blocks in a vital service industry, are built and operated to provide a welcoming atmosphere for the general public. Moreover, they attract large crowds at scores of annual conferences and conventions – and for that very reason become exceptionally attractive targets for terrorists as well.
The same characteristics that make hotels such an attractive target also apply to hospitals. Not quite three years ago – on 14 December 2007 – the Bon Secours Hospital in upstate New York was notified that a man carrying a hand grenade was approaching the hospital. During a confrontation with the police he was shot dead – and the “grenade” was identified as a fake. More recently (on 16 September 2010), the distraught son of a patient at the Johns Hopkins Medical Center in Baltimore, Maryland, shot and injured a physician who was caring for the man’s mother. After police arrived and locked down the area, the man killed his mother, then took his own life. Less than two weeks after that incident – i.e., on 29 September 2010 – two police officers sustained minor gunshot wounds at the Creighton University Medical Center in Omaha, Nebraska, and a suspect who La Vista Police Officer Kevin Pokorny reported as being wanted for “domestic assault and terroristic threats” was mortally wounded.
As the preceding and scores of other incidents prove, hospitals and other healthcare facilities are obviously not immune to violence. In fact, with a simple computer search, numerous other instances of hospital shootings and other violence can be found that take place every year in cities and towns throughout the country. Ironically, in large part because of the very laws that help protect the public – the Emergency Medical Treatment and Active Labor Act of 1986, for example – hospitals are required to give priority access to those needing medical care and must quickly process these patients while remaining open 24 hours a day. The great deal of emotion that sick or injured patients – and/or members of their families – experience during hospital stays can make those places easy catalysts for sudden violence.
Indiscriminate Violence & Other Major Disruptions
There are two other complications that must be taken into account by emergency planners. The first is that the size and layouts of most if not all large medical centers make them similar in many ways to small cities. In New York City, for example, which is home to some of the nation’s largest hospitals, an estimated 40,000 or so people go through the doors of those hospitals in any given day. The second complication is that many of these same hospitals also serve as specialty centers that not only care for patients in a major metropolitan area of more than 10 million people but also are so well known internationally that they attract patients from other areas of the country and from overseas as well.
Given these characteristics, it is obvious that many or most, if not quite all, hospitals are an increasingly attractive target for indiscriminate violence in most communities throughout the nation. A hospital is an obvious place to find victims for potential random violence, shootings, or bombings. Hospitals and medical centers also are valuable physical assets that, if destroyed or significantly damaged in a terrorist attack (or by a random act of nature), would represent a substantial loss not only to their own community but to the entire nation. If the hospital had to close, for any reason, there would be many adverse long-term effects – the least of which would be causing people to travel longer distances to get to another hospital.
In short, all evidence suggests that hospitals and other major healthcare facilities should automatically qualify as “critical infrastructures” for emergency-planning purposes, and therefore be included in the same type of security planning that hotels are now receiving – very belatedly. Security reviews by local police and federal agencies, along with a steady funding stream for training drills and exercises, might well help to either prevent or mitigate not only terrorist incidents, but also the random “everyday violence” that routinely occurs in almost all hospitals.
Footnote: Not incidentally, the Mumbai terrorists entered the Cama Hospital in that ancient city to carry out one of their most coldly calculated attacks against innocent victims they had never seen before. Seven people were killed inside the hospital, and nine others outside. Many authorities believe the terrorists saw the hospital as both an easy and unprotected target.
Theodore (Ted) Tully, AEMT-P, is President of STAT Healthcare, an Emergency Management consulting group. He previously served as Administrative Director for Emergency Preparedness at the Mount Sinai Medical Center in New York City, as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Center for Emergency Services, which is responsible for coordinating the emergency plans of 32 hospitals in the lower part of New York State.