Healthcare professionals accept that they have inherently stressful jobs. At the very least, they should be safe and secure in their workplaces. But for an ever-growing portion of the healthcare industry, that is not the case.
In a January 2024 survey, the American College of Emergency Physicians found 91% of ER doctors reported that either they or a colleague had experienced workplace violence.
Of the physicians surveyed, 71% said that workplace violence was getting steadily worse.
According to the American Hospital Association, the total cost of violence to U.S. hospitals was roughly $18.27 billion in 2023 alone.
Even worse, it appears that violence in the healthcare industry is probably massively underreported: One often-cited study found that 88% of workplace violence incidents in healthcare went undocumented, with many healthcare workers resigned to attacks as “just part of the job.”
These conditions are terrible for everyone’s health.
There is no easy fix for healthcare security, and traditional approaches are more reactive than proactive, which leaves a lot of room for improvement.
In most situations—a school, a government office—your best proactive security measure is to fortify the main entrance with something like a secure vestibule. Once you’ve checked someone in and are sure they aren’t a threat, they are free to go about their business anywhere inside.
But that doesn’t work in a hospital.
Not only are there often several “main” entrances, but in most cases, traffic needs to be let in quickly. In a major hospital, entrances can feel like Grand Central Station, around the clock.
That doesn’t lend itself to vetting each individual before buzzing them in, especially when so many visitors are not capable of coherently answering questions.
Hospitals have traditionally addressed this problem with additional security guards or a law enforcement presence ready to deploy throughout the building.
But that’s essentially a reactive approach. Yes, having a stern security presence can deter some misbehavior, but this is reliance on strong arms ready to address violence after it already happened.
This isn’t to say that proactive hospital security systems can’t exist. If you think about a hospital, it’s already broken into smaller units. The bulk of these are individual departments: cardiology, gastroenterology, radiology, testing labs, each with its own reception desk, waiting area, and consultation areas usually behind closed doors.
This layout creates an excellent opportunity for layered, proactive security that both protects patients and staff and creates containment in an emergency.
That approach minimizes the effect if someone gets violent, protecting others from becoming targets of the attack and increasing the chances of apprehending the attacker.
At Total Security Solutions, we encourage a systems approach to ballistic security, one that thoughtfully layers security components to balance worst-case scenario safety with day-to-day functionality.
When it comes to security, everybody wants to add layers: access control, cameras, man-traps and buzz-thru doors, bulletproof glass at reception desks, security stations and checkpoints.
But you can’t just haphazardly add security components.
When security measures aren’t thoughtfully deployed, they get in the way of operations.
Then the people you are trying to protect—doctors, nurses, and other healthcare providers—become the people most likely to compromise security: Doors that should remain closed are propped open, people are waved through rather than checked in, staff come out from behind barriers to give visitors their badges or place wristbands on patients, and so on.
This is why TSS places a premium on understanding day-to-day operations prior to designing a security system for that facility.
Passers are an excellent example.
Every reception area needs to handle documents, packages, paperwork, and more. In many cases, if they just need to scan IDs or pass papers, a traditional deal tray is fine.
But in a hospital, they often need to pass a clipboard, tablet, or a medical sample—items with awkward dimensions or require special handling.
There is a range of conventional secure passers and drawers available, but these were mostly developed for retail or banking and might not function precisely how a hospital needs.
We’ve designed many different custom solutions to address this need—for example, creating a specialized passer for accepting larger blood and organ deliveries at Texas Children’s Hospital—that both function smoothly and look good, year after year.
Embracing a systems approach to hospital security means using the structure of healthcare operations to your advantage and building defense in depth.
We accomplish this by bringing together individual security components into coherent layers, both within departments and building-wide, to prevent incidents whenever possible and minimize harm in an emergency.
This might look different in each department, but the underlying philosophy remains the same.
Here are a few examples:
Most individual hospital departments ( radiology, gastroenterology, labor and delivery, etc.) have three core elements:
While the waiting area might be located either before or behind the reception desk, the consultation/examination rooms are always behind closed doors.
However the layout, you can substantially improve security by taking several proactive steps, including:
While some departments (such as billing offices) can function well with just a deal tray, most will want a bullet-resistant passer, so they can easily handle clipboards, tablets, medical samples, and deliveries.
We’ve even made custom hinged doors in bullet resistant acrylic or polycarbonate, directly integrating them into the reception windows, so patients could reach through to have a wristband secured without compromising staff security.
Currently, most healthcare facilities are opting for Level 3 or 4 ballistic materials for such barrier systems. These materials will stop multiple shots from any sort of handgun. In the case of Level 4 walls, windows, and doors, staff are also protected from high-powered rifles, some explosions, and attempts at forced entry.
Behavioral health units pose a slightly different challenge, because security enhancements in these offices must protect staff both from patients and external threats without creating an atmosphere that undermines patient trust.
In behavioral health departments, hospitals often want the reception desk barriers and doors to be both ballistically and forced-entry rated. That means it has been tested against both UL-752 ballistic standards and a recognized forced-entry standard like UL 972, ASTM F3038, or ASTM F1233.
In the office areas and consultation rooms past reception, it’s often safe to opt for sturdy non-rated doors and more cost-efficient non-ballistic forced-entry rated windows, like SchoolDefender® Glass.
Adding ballistic barriers to pharmacies is quickly becoming the standard best practice in many parts of the United States, but this is still the most often neglected department in a hospital.
That’s most likely because the pharmacy is often buried so deeply in the hospital building that it just doesn’t seem a likely target.
But if you are already securing departments in your hospital, adding the pharmacy to that project is probably a good investment.
Most hospital pharmacies are smaller, and easily secured with fiberglass paneling and UL Level 1 or 2 ballistic glass (although, given how costs have decreased, most hospitals now opt for Level 3 ballistic glazing here, as the increase in cost is negligible relative to the increase in security).
In many hospitals, the pharmacy is compact and utilitarian, and could be served by a good transaction window and fiberglass panels to reinforce the walls.
The emergency department (ED) is both the highest risk area in the hospital and the most challenging to secure. Most shooting incidents in hospital settings occur in or near the emergency department.
According to some research, nearly one-quarter of emergency department shootings involve weapons taken from a security officer.
Meanwhile, these are the busiest departments, where seconds count the most.
Any security that gets in the way is bound to be undermined.
All of this is further complicated by the fact that each emergency department is unique in its layout and operations; there are no cookie-cutter solutions.
Most hospital security systems use Level 3 or 4 ballistic materials in the emergency department, since exposure to the street brings a greater risk of higher-caliber weapons.
Some emergency departments have reception areas that can be secured as in any other department. Others have security stations or police substations near the entryway. In those situations, you might prefer something similar to the screening checkpoints seen in municipal buildings.
This is where our experience taking an in-depth systems approach to custom ballistic security pays off.
Over decades, we’ve had more experience creating custom solutions than anyone else, and as a result have a wide array of healthcare security solutions to reference when we see something new and challenging.
Hospitals, while clearly a major focus for security, are far from the only part of the healthcare system that needs to enhance safety.
The U.S. Bureau of Labor Statistics notes that healthcare workers and those who work in “social assistance” (think mental health advocates and substance abuse counselors) are five times more likely to suffer violence in the workplace.
According to the Occupational Safety and Health Administration (OSHA), roughly 73% of all serious workplace assaults happen in either healthcare or social service settings.
That includes outpatient clinics, small medical practices, mental health counseling offices, and so on.
In contrast to hospitals, especially emergency departments, which have long had security or police presence, these smaller clinics and medical practices have not historically been seen as targets, and thus had little reason to address security.
Unfortunately, that’s changing. We’re doing more work to secure these outpatient clinics and specialty offices outside of the hospital itself.
Smaller medical offices usually go with Level 3 ballistic security.
They will either use a reception area approach that we apply in a clinical hospital department, or install a secure vestibule through which they can buzz in patients and visitors individually.
Physical barriers are the foundation of hospital security, but a complete healthcare security system requires multiple layers, all of which seamlessly integrate security technology:
Access control systems with role-based access ensure that only authorized personnel can enter restricted areas like pharmacy storage, server rooms, infant care units, and executive areas.
Video surveillance systems and security cameras in high-risk and sensitive areas provide real-time alerts and documentation for after-incident review.
Visitor management systems, combined with identity verification at reception, ensure that only those with legitimate access to a department are admitted. Nurse call systems and alarm systems allow clinical teams to trigger a rapid response without leaving their post or compromising patient care.
Most importantly, staff need proper training and preparation.
Regular de-escalation training and crisis intervention workshops ensure that everyone is up to speed on protocols, so they have time to act and react.
But all these systems and structures are only as effective as the physical infrastructure that supports them. Barriers need to be in place at the points most vulnerable to potentially dangerous incidents, and they must be designed to accommodate actuators, sensors, electric strikes, wire-runs, and cameras. Those barrier systems must also be thoughtfully designed so that no one is tempted to undermine them for convenience.
At TSS, we and our customers share a common goal: We want employees to feel safe and secure by reducing the threat level.
A thoughtful, systems approach to security minimizes the effect of perpetrators, whether they have a premeditated plan or are spontaneously losing control.
If there’s a good barrier and thoughtful access control in place, some of those situations will be defused or eliminated altogether.
TSS has completed more than 30,000 custom barrier installations nationwide, including more than 5,000 in the healthcare sector alone.
Our team makes site visits, evaluates layouts, takes measurements, and designs systems that account for operational realities: shift changes, patient flow, cleaning protocols, and uninterrupted patient care.
We regularly work closely with architects and security consultants to ensure ballistic materials integrate with the overall aesthetic while meeting your safety needs and complying with relevant standards and respective laws.
To learn more about how to approach hospital and healthcare security or to start planning your project, download our free guide, How To Bulletproof Your Healthcare Facility, or schedule a consultation today.