Case Study 7: Automated Access Control

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1 Case Study 7: Automated Access Control

2 Contents Background Brief description of the area Trust statistics The Security Risks The problem The A&E layout The challenges Determining the response Defence in depth Identifying a need Key recommendations and lessons learned Conclusion Case study 7: Automated Access Control 2

3 1.0 Background This case study focuses on the use of an automated access control system that enables lockdown of an entire accident and emergency department (A&E), including the waiting and clinical areas. The case study also looks at the deployment of security staff during a lockdown situation. Fig 1: Aerial view of the site 1.1 Brief description of the area The A&E is located near the perimeter of the trust site on a major road into the city centre. The site contains a mixture of old and new buildings; with some parts as old as 100 years. The A&E is based in a part of the old hospital site. A&E is adjacent to a recently built medical assessment unit and a 35m PFI diagnosis and treatment centre. The A&E department is on the largest of the trust sites. 1.2 Trust statistics The trust is one of the largest teaching hospitals in the UK. It provides services from three sites approximately five miles apart (two acute hospitals and one community hospital). It has circa 1000 beds and serves a popultion of over 500,000. It has an employee base of around 7000 WTE staff. It treats around 220,000 adults and children in its A&E departments. Case study 7: Automated Access Control 3

4 2.0 The Security Risks The city centre is a hotspot for serious violent crime (according to a 2009/10 strategic assessment by a safer partnership group). The crimes include alcohol and gang related violence involving weapons such as firearms and knives. A proportion of the latter crime is linked to urban street gangs or organised crime. Corridor Emergency Vehicle Entrance Relatives Room Site Perimeter Main A&E Entrance Main Waiting Area Reception Resuscitation Area Corridor Post Resuscitation Area Fig 2: A&E Layout Members of the public Staff Members 2.1 The problem Due to the hospital s location, casualties from criminal activity within the city centre are primarily treated at its A&E department. Depending on the nature and scale of the incident, at times, there can be a need to segregate patients and visitors belonging to different gangs. The arrival of casualties is also often accompanied by the arrival of large sections of the community. At times there can be up to 150 people outside the A&E department, causing congestion and disruption to the normal operations of the department. As a result there are a number of challenges for the trust, including crowd management, controlling the movement of individuals and separating patients from visitors. Moreover a minor incident which takes place in the hospital grounds, occurring amongst visitors for example can quickly escalate into conflict that can spill into the department. 2.2 The A&E layout Figure 2 above shows the basic layout of the A&E s key areas and illustrates areas where members of the public and/or visitors to the hospital are likely to gather in the event of an incident. The blue striped dots represent clinical and nonclinical staff on site and red spot dots members of the public. The concentration of red and blue dots indicate the hot spot areas, where in the event of an incident, crowd management is required to control the movement of individuals and separate patients from visitors. 2.3 The challenges There are only a limited number of security staff on-site (up to five in total) to respond to incidents (trust wide) and manage crowd control issues in the A&E department. Whilst the trust may request police support for managing incidents, this is not always available due to police operations. Therefore, the trust is expected to be able to rely on its own resources to manage incidents occuring on its premises. Therefore, to prevent flare up of any situation, effective patient and visitor flow and crowd control is essential. Case study 7: Automated Access Control 4

5 3.0 Determining the response Fig. 3: Steps to determine the solution 7. Test your plan 6. Implement your plan 3.1 The trust s Local Security Management Specialist (LSMS) sought to address the problem of crowd management and managing patient and visitor flows by investing in the trust s security infrastructure, particularly the A&E department as a high priority area. In order to do this, the LSMS worked through the seven steps identified in Figure 3 above to examine the problem and identify a solution. 3.2 Following a thorough and systematic assessment of the problem, the LSMS undertook an Operational Requirement (OR) to determine the security requirments. An OR provides a statement of the overall security need and includes the site to be considered, asset description, perceived threat, consequence of compromise, perceived vulnerabilities, and success critera. (Source: Guide to producing operational requirements for security measures, October 2007) For further information on developing an OR see: hysical-security/ 5. Develop a strategy 1. Define the problem 3.3 This exercise assists in identifying the specification to suppliers/providers without making a commitment to a particular type of technology. 3.4 The process allows for 4. Undertake a risk assessment innovation amongst the suppliers/providers. In order to specify product requirement the LSMS defined what the system was expected to deliver i.e. the outcome as opposed to specifiying the product. For example, with access control you may define that you want the system to control movement rather than defining the type of access control technology. 3.5 Having worked through the what, why and how questions, the LSMS advised that it is important to test the concepts on a floor plan, consult with stakeholders and carefully think through the time to manage the introduction of new security measures. It is also important to appreciate that due to internal and external factors (such as legal, social or economic); plans can be subject to change during the project. 2. Identify what you are trying to achieve 3. Identify and consult with stakeholders 3.6 To achieve the solution, the LSMS submitted a business case that outlined the case for investing more than 300k in the capital funding programme for security measures and for future investment, as well as for other areas such as triage, clinical review rooms, majors and minors. The business case for security measures focused on funding for an automated access control system that enables lockdown of the trust s entire A&E department, including the waiting and clinical areas. 3.7 Lockdown can be defined as,.. the process of controlling the movement and access both entry and exit of people (NHS staff, patients and visitors) around a trust site or other specific trust building/area in response to an identified risk, threat or hazard that might impact upon the security of patients, staff and assets or, indeed, the capacity of that facility to continue to operate. A lockdown is achieved through a combination of physical security measures and the deployment of security personnel. (Source: NHS Security Management Service Lockdown guidance, March 2009) Case study 7: Automated Access Control 5

6 4.0 Defence in depth 4.1 The LSMS applied the principles of defence in depth to introduce an automated access control system. Defence in depth, also referred to as the onion peeling approach involves taking a layered approach to physical security, to allow the organisation to detect attacks and provide time to respond to such attacks. The progressive layers can for example, include the environment immediately beyond the perimeter of the building approach routes, neighbouring buildings the perimeter of the site, and the building. In order to achieve an automated access control system that enables lockdown of the trust s entire A&E department, the business case outlined the requirements for the following: Installation of management systems to integrate lockdown Link CCTV control room to major incident room1 Pan Tilt Zomm (x2) CCTV cameras monitoring main external doors Electronic security lockdown signs Integrate lockdown systems with 16 inner/outer A&E doors Resilience (uninterrupted power supply and cooling systems) Emergency exit panel alarm covers for emergency breakglass units. 4.2 At the trust site, the LSMS applied the defence in depth principles to segregate areas for implementing an automated access control as follows: Full A&E lockdown Applies to the area from the A&E main entrance to the reception desk A&E outer lockdown This encompasses the area just after the reception desk, only staff have access to this area during a lockdown A& E inner lockdown This applies to the corridor leading to and including the resuscitation area (where there is equipment allowing staff to view and manage the ambulance entrance) and relatives waiting room. 4.3 The application of the defence in depth principles are illustrated in Figure four below and lockdown zones are indicated in red. The red arrows also show how lockdown can be applied progressively. The illustration also shows where automated access control systems have been introduced to support lockdown. Full A&E Lockdown Emergency Vehicle Entrance A&E Inner Lockdown Site Perimeter Main A&E Entrance Main Waiting Area Reception A&E Outer Lockdown Corridor A&E Inner Lockdown Resuscitation Area Corridor Relatives Room Post Resuscitation Area Defence In Depth Fig 4: Defence In Depth Access Control 1 Note: full control of the cameras would still be retained by the security control room. Case study 7: Automated Access Control 6

7 4.4 The clinical adjacencies within the department as illustrated in Fig.4 were an important feature in enabling the implementation of an automatic access control system. The automated access control can be used to seal off the front of the building, then other parts of the building on a progressive basis demonstrated by the red arrows in Fig.4. Ambulance entrance leading to resuscitation area and relatives room. This entrance can be automatically locked. It is within this contained area that armed police are normally deployed when required to do so. Arrow depicts entrance to the resuscitation room. The resuscitation area is opposite the relatives room and the post resuscitation area. A camera screen and intercom has been fitted within the resuscitation room to allow staff to control emergency ambulance entry. Internal view of ambulance entrance. Arrow depicts entrance to the relatives room. Main A&E drop-off point and entrance. Case study 7: Automated Access Control 7

8 During an incident one member of security staff is stationed in the control room, another is deployed near the A&E outer lockdown area and decides if there is a need to control access, i.e. limit numbers of people being allowed in to two persons at a time. Depending on the situation, more than one security officer may be needed at this location. A&E outer lockdown point and reception area. Arrows indicate lockdown points (doors). A corridor separates the main waiting area and the resuscitation area. Automated access controls are in place at both ends of the corridor: this means that if needed the movement of people to and from the waiting area and the resuscitation area can be controlled. A third security staff member is positioned near the A&E emergency access doors. The inner lockdown allows armed police to accompany people in the resuscitation area if there is a need. The lockdown can be implemented either from the control room or within the A&E itself by security officers. Depending on the situation, more than one security officer may be needed at this location to prevent individuals exiting the department and compromising the integrity of the lockdown. Part of lockdown profiling should include an indication of possible number of staff may be required at each lock-downed door in order to maintain integrity of lockdown and to direct people away to a designated safe exit door for a particular building or department. This is an electronic communication system positioned just above the doors; in an emergency it displays a Lockdown message to alert staff. Lockdown indicators are positioned near each of the access doors. The illuminating red light on the indicators is used to alert all staff to the lockdown situation. Case study 7: Automated Access Control 8

9 4.5 Identifying a need One occasion which led to the A&E department being locked down, involved an incident where a car carrying four passengers overturned resulting in one death at the scene and other casualties being brought to the hospital in a serious condition. With news of the incident reaching relatives and friends of the casualties; the numbers attending the hospital increased throughout the day. This resulted in the area in front of the A&E and adjacent outpatients departments, as well areas inside the department being rapidly filled with family and friends. Over the course of the day, the police were called to assist with managing the growing numbers of the community as they gathered at the hospital. The A&E department was locked down in order to manage continuing operations and crowd management. The incident therefore highlighted to the trust the need for investing into the security infrastructure to manage patient/visitor flows to ensure clinical care could be effectively delivered. Case study 7: Automated Access Control 9

10 5.0 Key recommendations and lessons learned The LSMS makes the following recommendations in relation to implementing an automated lockdown capability which may be useful to others in undertaking similar projects. The standards referred to in this case study are the minimum requirements: however, local risk assessment may determine otherwise. LSMSs are advised to seek advice from their local police ALO or Crime Prevention Design Adviser in relation to their projects. 1. Undertake risk assessments and use these to support any bids made to secure funding. 2. Clearly identify what you intend to achieve from an electronic access control system for example, by using a structured methodology for determining the security requirements, i.e. involving stakeholders to develop an Operational Requirement. 3. Establish how much capital funding will be needed to achieve your outcomes. 4. Identify what maintenance for the system to be implemented will be needed and the financial implications (revenue costs). 5.1 Conclusion The LSMS emphasised that the aim of introducing an automated access control system was to allow the provision of healthcare to continue without disruption by using the minimum number of security officers. The system was introduced at the site in stages because it was not possible to secure the full level of funding at any given point in time. Funding bids, based on risk assessments, were made to capital estates over a number of years to secure small parts of the whole sum of money needed. The current financial climate means competing with other divisions across the trust to secure funding for security measures. As a result, it is important that risk assessments are carried out to support the business case for funding. A number of incidents handled at the trust were used by the LSMS to highlight the potential risks and develop the business case. Case study 7: Automated Access Control 10

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