In last months addition, we began a discussion on the difficult challenges that security professionals face in protecting the pediatric patient. In that article, we looked at operational elements of the security management program specific to pediatric protection. This month, we continue exploring this difficult and sensitive issue, with a look at environment of care concerns that, when properly addressed, can lesson the vulnerability of these young patients. 
Alarm Systems
In simplest terms, an alarm or duress system is used to summon help quickly when the provider feels that he or she and/or the patient may be at risk. In todays wireless society, portable duress alarms are becoming common place. A portable, carry-along duress alarm system should be installed on the unit and provided to every staff member on duty. We recommend the type that will also locate the person(s) in duress. In addition to the portable duress alarm system, a fixed duress alarm should be installed at the nurses station. When any duress alarm is activated, it should send a signal to both the nurses station and to a central monitoring location, such as a switchboard, call center, or a dispatch center. Dispatchers must be trained that when this alarm is activated, it is an urgent emergency that requires a prescribed emergency security response. All alarm systems should be tested monthly to ensure proper operation. This should be incorporated into a written preventive maintenance program.
Access/Egress Control Measures
Access/Egress control is likely the single most important factor in protecting young patients. A well developed access control system allows staff to screen every visitor who enters the unit, and, at the same time, allows necessary staff to be able to enter and exit at will. It is recommended that the staff entrance be in a separate location than the visitor entrance to avoid tailgating. We also recommend that the visitor entrance be designed with a video intercom system, so staff will be able to see and hear the person(s) needing access. Securing the pediatric unit does not need to be as challenging as is sometimes thought. A card access control system should be installed on all doors and elevators to the unit, as well as on clean and dirty utility rooms. Utility rooms are often overlooked in the process of securing the unit, but they present very special and unique risks to the security of the patients. Additionally, all exits should be equipped with an electronic surveillance system reader. This reader should be capable of activating a doorway detection unit from a self powered tag or bracelet system whenever the tag passes through the portal. This is a valuable tool in preventing the unauthorized removal of pediatric patients from the unit, and address not only unauthorized removal by an outsider, but also elopement issues as well.
Closed Circuit Television Systems
CCTV cameras should be positioned in such a way that they view every entrance and exit to the unit. Monitoring of CCTV cameras is essential. When not properly monitored, a CCTV camera will only be used as a reactionary tool. The CCTV monitoring station should be staffed by trained and qualified personnel, and should be monitored at all times. To be truly effective, CCTV cameras must be used proactively and not reactively.
While we strongly advocate proactive use of a CCTV system, it is not our intent to negate the value of a CCTV if used after an incident occurs. Recent improvements in CCTV technology allow us to capture much clearer and better defined images, making reactionary use much more effective. Digital recording on motion and/or alarm is imperative to the success of a CCTV system. In addition, all cameras should be enclosed in a protective housing where they are not subject to damage, vandalism, or tampering.
Technology is a critical component in protecting the pediatric patient. In next months addition, we will explore issues of staff training, post incident response, and miscellaneous considerations affecting our ability to protect the pediatric patient. In the meantime dont hesitate to call us if you have any questions.
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