There have been many changes in the healthcare environment over the past decade. The Affordable Care Act has been established, severe weather events are on the rise, violence along with active shootings continue to increase, behavioural health patients present treatment challenges and hospitals continue to consolidate to increase purchasing and service capabilities. Over the next decade, healthcare will continue to transform. Emphasis will be on financial reform, violence response, emergency preparedness, the proper care and handling of behavioural health patients and service efficiencies.

Current issues affecting healthcare security

Violence in healthcare continues to pose the greatest risk to hospital staff. Several key healthcare organisations have published information to assist security directors in the reduction of violent incidents.

The International Association for Healthcare Security and Safety (IAHSS) publishes security and design guidelines specific for healthcare facilities. These resources provide valuable and internationally recognised practices and standards for addressing healthcare violence. The IAHSS Foundation (IAHSSF) publishes an annual crime and incident survey analysing violence in healthcare.

The American Hospital Association (AHA) recently published a webpage specifically to assist in the mitigation of violence. ASIS International has published several whitepapers addressing healthcare security; specifically violence related to behavioural health patients and disruptive and violent behaviors in healthcare. The Occupational Safety and Health Administration (OSHA) website offers numerous tools and resources pertaining to workplace violence and safety with a section devoted specifically to the healthcare industry.

Possibility of healthcare workplace violence prevention

At the time of writing, the Republican Party had not figured out how to change the Affordable Care Act (ACA) while still making healthcare more affordable. Most likely changes in health care will occur within the expanded purchasing options, Health Savings Accounts (HAS’s), Medicare reimbursement and the use of government exchanges. The indoctrination of the ACA included increased investigation to Medicare fraud and audits to hospitals for billing errors. In 2016, the Federal government collected over three billion dollars in fraud and reconciled billings to Medicare.

Violence will continue to challenge the healthcare sector in the future
Domestic violence, child abuse, behavioural health, drug and alcohol abuse will all continue to challenge hospital staff

The Joint Commission issued Sentinel Alert 57. This alert focuses on the role of leadership in developing a safe culture. The Occupational Health and Safety Administration (OHSA) contemplated issuing a healthcare workplace violence prevention standard. This standard required healthcare institutions to have a clearly defined prevention programme in place.

This year, a total of 25 states have legalised marijuana. This legislation will dramatically change how we care for patients and deal with patients, employees and visitors who are using the substance and may be impaired at work and within the hospital, and who may request continued use while being an in-patient within a facility that is smoke free.

The future for healthcare security

In the future, healthcare security professionals will have to deal with a variety of events from severe weather, violent and active shooter incidents, terrorist attacks, and continued changes to healthcare reimbursement. Severe weather has the potential to impact all healthcare systems across the globe. Specific attention must be directed at knowing the weather threats common to specific geographical locations. A Comprehensive Emergency Management Plan (CEMP) must be current and thorough for disaster response. Performing exercises is a valuable tool in staff education and opportunity to reinforced skills for those assigned to incident command positions.

The Hazard Vulnerability Assessments helps in defining risk severity and identifying historical
patterns of violence

Violence will continue to challenge the healthcare sector in the future. Domestic violence, child abuse, behavioural health, drug and alcohol abuse will all continue to challenge hospital staff in the Emergency Department, Women’s Health, and behavioural health areas. The Hazard Vulnerability Assessments (HVA) along with facility wide risk assessments helps in defining risk severity and identifying historical patterns of violence.

Active shooting incidents

According to the FBI, an analysis of 2014 and 2015 active shooter incidents identified 20 incidents in each of these years. This annual tally is an increase from 17 in the year 2013. In a John Hopkins study entitled, “Hospital-based Shootings in the United States: 2000 to 2011,” Hopkins identified 154 hospital related shooting events (26.6 events per 1,000 hospitals) in 148 hospitals, affecting 235 victims (0.79 per 1,000,000 population). The risk of experiencing an active shooter incident is increasing. Hospitals must be prepared to not only deal with their own active shooter incident, but any that could occur in their service community.

Changes in terrorist tactics now present a new challenge for the healthcare security. According to Homeland Security, hospitals play a major role in the response for terrorist-related incidents and terrorist activities within the United States. Today, incidents are comprised of local combatants whose goal is to kill civilians in crowded areas like restaurants, concerts, and other mass gatherings. Attacks in the past have focused on first responders and their ability to treat victims. Healthcare institutions need to be ready to again accept victims of terrorist events and prepare for the potential for becoming victims of an event as well.

Trump Care

At the writing of this article, “Trump Care” is still being debated. However, certain things seem clear. In the future, Medicare reimbursement will probably be reduced leaving hospitals with less money within their payor mix. Trump Care may also see increased State control over the reimbursement process, allowing each State to decide its own fate when it comes to Medicare and Medicaid payment rates. This could provide hospitals with less revenue, leaving hospital security departments with budgets struggles for both staffing and technology.

Severe weather, violent and active shooter incidents and terrorist attacks all affect healthcare security
Today, incidents are comprised of local combatants whose goal is to kill civilians in crowded areas like restaurants, concerts, and other mass gatherings

Staff recruitment will remain amongst the most challenging endeavour. The need for qualified and skilled security staff will challenge the best of talent recruiters. Competitive wages and benefits will require continual focus for attracting skilled labour. Recruiting practices and personal skill screening tools will be of benefit. Some systems find outsourcing their security department the best option. Hybrid models are options as well as contracting with local law enforcement for additional presence.

Training for healthcare security staff

A key factor of success for security in healthcare is training. Providing staff with the necessary tools and skills will afford significant return on investment with quality and satisfaction outcomes. Healthcare security staff should receive training focusing on patient safety, patient experience, customer experience and quality of service. Awareness and understanding of behavioural health, aggression management and de-escalation talents, crime prevention and customer service abilities and aptitudes are a must. The International Association for Healthcare Security and Safety (IAHSS) offers several educational certification levels designed specifically for healthcare security officers.

Importance of robust security department

Utilising concepts and dynamics of lean tools, technology options, clinical throughput, and Standard Work all influence security services. The concept of Standard Work is popular in the business world. Utilising this concept is beneficial to security. Standard Work can identify staffing needs, work flow process, consistency in service levels, and maximum utilisation of technology resources and equipment. Striving for the right person doing the right work with the right skill set is the desired outcome. Often the same concept will hold true for identifying the right department providing the right service for the right reason.

Data will be of extreme importance in the distribution of those resources. Security departments need to collect relevant data on all aspects of security services from reported crime data, security calls for service, annual risk assessments and benchmarking data. Hospital security departments must create a data-driven environment that can help to demonstrate service needs and improve processes over time. The real success of using data is the analysis of data to determine patterns and trends that can demonstrate the need for and successes in security services.

Methods for managing healthcare security are driving factors. A robust security department will implement and utilise security technology to support and influence safety, security and quality outcome measures. Return on investment (ROI) and the ability to show quality metrics and positive influence in life-safety, security and patient satisfaction scores will be core in driving positive capital decisions. Challenges of healthcare security in the future will require continued education and knowledge of current trends, guidelines, and standards within the healthcare security industry.

By Ben Scaglione and David LaRose

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2018 FIFA World Cup Russia integrates safety, security and service
2018 FIFA World Cup Russia integrates safety, security and service

The 2018 FIFA World Cup tournament is bringing 32 national teams and more than 400,000 foreign football fans from all over the world to 12 venues in 11 cities in Russia. Fans are crowding into cities including Moscow, St. Petersburg and Kazan. Given continuing global concerns about terrorism, security is top-of-mind. Protection of the World Cup games in Russia is focusing on an “integrated safety, security and service approach,” according to officials. Combining the term “security” with the terms “safety” and “service” is not an accident. An aggressive security stance is necessary, but at the end of the day, fan safety is paramount, and a service-oriented approach ensures a positive fan experience. Medical responders will be working side-by-side with police and antiterrorism personnel. Risk management best practices We asked Sean T. Horner and Ben Joelson, directors of the Chertoff Group, a global advisory firm focused on best practices in security and risk management, to comment on security at FIFA World Cup 2018. Although not involved in securing the 2018 World Cup, the Chertoff Group is experienced at securing large events and enterprises using risk management, business practices and security. Integration is another important aspect of protecting the games, says Horner. The use of multiple resources, including Russian military, intelligence and law enforcement, will be closely integrated to provide the best security for the large-scale event in each of the host cities, he says. The approach will be centralised and flexible, with resource deployment guided by effective situational awareness. Primary security and emergency operations centres will be dispersed throughout each host city “There is a unified command structure at the Russian Federation level, and they will keep resources in reserve and shift them as needed to various events and venues based on any specific intelligence, in effect deploying resources where threats are greatest,” says Joelson. “There will also be some regional commands, and resources will incorporate a spectrum of police and military personnel ranging from the ‘cop on the beat’ to the Spetsnaz, the Russian ‘special forces'.” Primary security and emergency operations centres will be dispersed throughout each host city, and additional forces can be shifted as necessary, he notes. Role of law enforcement In Russia, the lines of separation between law enforcement and the military are not as stark as in the United States, for example, where military forces are restricted from deployment for domestic law enforcement by the Posse Comitatus Act. In Russia, there is no such restriction.  A broad range of technology will play a role at the World Cup, Horner and Joelson agree. Technology will be used primarily as a force multiplier and a decision-support tool for security personnel. There are robust CCTV systems in many Russian cities, and mobile CCTV systems, such as camera towers or mobile security centres on wheels, will also be deployed. Technologies will include infrared cameras, flood lights, and ferromagnetic screening systems to scan hundreds of individuals as they walk by. In some locations, facial recognition systems will be used, tied into various intelligence, military and law enforcement databases of known bad actors. Behaviour analytics will be used as a decision-support tool. In addition to security in public areas, private CCTV systems in hotels, at transportation hubs, and inside the venues themselves will be leveraged. Video analytics and detection will help personnel review live view of people who may be acting suspiciously or who leave a bag unattended. In some locations, facial recognition systems will be used, tied into various intelligence, military and law enforcement databases of known bad actors Rigorous anti-terrorism measures A Fan ID card is required to enter the 2018 World Cup Tournament, even for Russian residents. The Russians have an aggressive stance against domestic terrorism, which will also help ensure the safety of the World Cup games, say Horner and Joelson. Terrorist group ISIS has promised “unprecedented violence” at the games, but they make similar threats at every major global event. Russia has been an active force disrupting ISIS in Syria, and experts suggest that losing ground geographically could lead to addition “asymmetric” terrorist attacks. However, Russia is leveraging all their intelligence resources to identify any plots and deploying their security apparatus to disrupt any planned attacks, experts say. Russia’s rigorous anti-terrorism measures include a total ban on planes and other flying devices (such as drones) around the stadiums hosting the World Cup. Private security In addition to military, intelligence and law enforcement personnel, private security will play a have a high profile during the 2018 World Cup in Russia. Private security personnel will be on the front lines in hotels and in “fan zones.” They will operate magnetometers at entrances, perform bag checks, enforce restrictions on hand-carried items, etc. Private security will be especially important to the “guest experience” aspects of protecting the games. Private security will be especially important to the “guest experience” aspects of protecting the games Another private security function at the World Cup is executive protection of dignitaries and high-net-worth individuals who will be attending. Executive protection professionals will arrive early, conduct advanced security assessments before VIPs arrive, and secure trusted and vetted transportation (including armoured cars in some cases.) VIPs will include both Russian citizens and foreign (including U.S.) dignitaries attending the games. Private security details will be out in force. Aggressive security approach Overeager and outspoken fans are a part of the football culture, but Russia will deploy a near-zero tolerance policy against hooliganism and riots. An overwhelming force presence will take an aggressive approach to curbing any civil disturbances, and offenders will be removed quickly by Russian security forces. Strict restrictions on the sale and consumption of alcohol will be enforced in the venue cities before and after the matches. Officials will also be cognisant of the possibility of a riot or other event being used as a distraction to draw attention from another area where a terrorist event is planned. It will be a delicate balance between deploying an aggressive security approach and preserving the fan experience. Joelson notes that freedom of speech is not as valued in Russia as in other parts of the world, so the scales will be even more tipped toward security. “The last thing they want is for things to get out of control,” says Horner. “The event is putting Russia on the world stage, and they want visitors to walk away safely after having a great time and wanting to go back in the future.” Attendees should also have good situational awareness, and keep their heads up, scanning crowds and identifying unsafe situations" Precautions for World Cup attendees Attendees to the World Cup in Russia should take some basic precautions, Horner and Joelson agree. For example, Russia requires a translated, notarised letter explaining any prescription drugs. The country has a more aggressive foreign intelligence environment, so visitors cannot depend on their data being private. Joelson recommends the usual “social media hygiene” and privacy settings. Visitors should not post information about their travel plans or locations, and it’s best to travel with a disposable mobile phone that does not contain personal information. Location tracking should be deactivated. Travellers should also beware of talking and sharing information with others, or of saying anything derogatory. “They should also have good situational awareness, and keep their heads up, scanning crowds and identifying unsafe situations,” says Joelson. “If you bring a personal electronic device, you should expect that it has been compromised,” says Horner. Text messages and email will not be private, and he suggests creating an email address used only for travel. Don’t leave drinks unattended. Travellers from the U.S. should register at the Smart Traveler Enrollment Program (STEP) operated by the U.S. State Department. “Plan before you travel and before you get to the airport,” says Horner.

The benefits and challenges of in-camera audio analytics for surveillance solutions
The benefits and challenges of in-camera audio analytics for surveillance solutions

Audio is often overlooked in the security and video surveillance industry. There are some intercom installations where audio plays a key role, but it’s not typically thought about when it comes to security and event management. Audio takes a back seat in many security systems because audio captured from a surveillance camera can have a different impact on the privacy of those being monitored. Audio surveillance is therefore subject to strict laws that vary from state to state. Many states require a clearly posted sign indicating audio recording is taking place in an area before a person enters. Analytic information derived from audio can be a useful tool and when implemented correctly, removes any concerns over privacy or legal compliance. Audio analytics on the edge overcomes legal challenges as it never passes audio outside of the camera Focused responses to events Audio analytics processed in the camera, has been a niche and specialised area for many installers and end users. This could be due to state laws governing audio recording, however, audio analytics on the edge overcomes legal challenges as it never passes audio outside of the camera Processing audio analytics in-camera provides excellent privacy since audio data is analysed internally with a set of algorithms that only compare and assess the audio content. Processing audio analytics on the edge also reduces latency compared with any system that needs to send the raw audio to an on-premises or cloud server for analysis. Audio analytics can quickly pinpoint zones that security staff should focus on, which can dramatically shorten response times to incidents. Audio-derived data also provides a secondary layer of verification that an event is taking place which can help prioritise responses from police and emergency personnel. Having a SoC allows a manufacturer to reserve space for specialised features, and for audio analytics, a database of reference sounds is needed for comparison Microphones and algorithms Many IP-based cameras have small microphones embedded in the housing while some have a jack for connecting external microphones to the camera. Microphones on indoor cameras work well since the housing allows for a small hole to permit sound waves to reach the microphone. Outdoor cameras that are IP66 certified against water and dust ingress will typically have less sensitivity since the microphone is not exposed. In cases like these, an outdoor microphone, strategically placed, can significantly improve outdoor analytic accuracy. There are several companies that make excellent directional microphones for outdoor use, some of which can also combat wind noise. Any high-quality external microphone should easily outperform a camera’s internal microphone in terms of analytic accuracy, so it is worth considering in areas where audio information gathering is deemed most important. In-built audio-video analytics Surveillance cameras with a dedicated SoC (System on Chip) have become available in recent years with in-built video and audio analytics that can detect and classify audio events and send alerts to staff and emergency for sounds such as gunshots, screams, glass breaks and explosions. Having a SoC allows a manufacturer to reserve space for specialised features. For audio analytics, a database of reference sounds is needed for comparison. The camera extracts the characteristics of the audio source collected using the camera's internal or externally connected microphone and calculates its likelihood based on the pre-defined database. 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A standard VMS that only supports generic alarms, may not be able to resolve all of the information. More advanced VMS solutions can identify different messages from the camera. Well configured audio analytics can deliver critical information about a security event, accelerating response times and providing timely details beyond video-only surveillance. Analytics take privacy concerns out of the equation and allow installers and end users to use camera audio responsibly. Hanwha Techwin's audio source classification technology, available in its X Series cameras, features three customisable settings for category, noise cancellation and detection level for optimum performance in a variety of installation environments.

How important is packaging in the commercial security market?
How important is packaging in the commercial security market?

High-quality products are the building blocks of successful physical security systems. How they are packaged may sometimes be seen as an unimportant detail or an afterthought. But should it be? Effective packaging can serve many functions, from creating a favorable customer impression to ensuring the product isn’t damaged in transit. Packaging can also contribute to ease of installation. On the negative side, excess packaging can be an environmental concern, especially for customers who are sensitive to green factors or to minimising waste. We asked this week’s Expert Panel Roundtable: Is packaging of products important in the commercial security market? Why or why not?