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View Full Version : Hospitals -- procedures/security/structure



monkey see monkey do
10-06-2010, 11:41 PM
Hello all,

I was wondering if someone could please provide some general info on a typical large/busy hospital. I understand all hospitals are different, but any insight is much appreciated.

In an ER, what's the typical procedure? Particularly after the patient is treated.

What is the security like? Is it reasonable for someone to just walk in and roam the hospital from top to bottom without being stopped by anyone? What is the security presence like [if any] from floor-to-floor? One security officer per floor? Are they security or are they real police officers? How realistic is it for some stranger to walk in a hospital, go up to someone's room who's in a coma, and unplug their lifeline without ever being stopped by anyone?

How is a hospital organized structurally? One floor -- one specialty? Are there floors entirely devoted to patient quarters? Are there such things as doctor-only or nurses-only lounges?

A patient is in critical condition/coma -- how often will he be checked on? Or at all? Who usually does the checking? Can visitors be in the same room?

Sorry, it's a bit lengthy. Thank you for your help.

waylander
10-07-2010, 12:41 AM
Where is this set?

monkey see monkey do
10-07-2010, 12:56 AM
A big US city like LA/NYC/Chicago.

heyjude
10-07-2010, 01:06 AM
I worked in a hospital for a couple of months and was friendly with the security guys. Pretty much anyone could wander around (you had to be buzzed in the ER door, but all anyone did was yell "Buzz me in!" and they would without checking). ICU was locked down fairly tight. No one would get in to see a patient there without the nurses knowing about it.

Not a complete listing of what you were looking for, but a little peek. Others will be able to answer better.

And I dig your user name. Welcome to AW!

Giant Baby
10-07-2010, 03:08 AM
As with so many things, hospital security has changed quite a bit since 9/11. I work at a large hospital in a large city. All entrances are now manned by a security guard at a podium. Most secondary entrances require badge access. Patients and visitors can only enter through the main entrance where there are several security guards posted.

Security guards are both stationary (as at the entrances) and patrol in rounds. If I use my badge to open a secured door, it keeps a record of who I am that can be retrieved if necessary. I am required to wear my ID at all times.

A friend of mine was in a coma for several weeks (in another major hospital, same city). Whenever I visited, I not only had to be buzzed in and greeted by nursing staff, the family had to approve letting me in. Nursing checks are frequent, and doors are typically open. Oh, and you can't just turn off a machine without sounding various monitors' alarms.

My experience as both a patient and an employee is different from HeyJude's in regard to the ER (which could be due to time frame or facility size). It would be a feat to get buzzed into an ER in any of the hospitals I'm familiar with without the name of the patient you were there to see, and even then, the staff are going to go back or call to check what's happening with the patient at that time (ie, they're not going to usher visitors/family members back only to find out the patient is coding). Also, like the ORs, ERs are the spots where anything and everything could happen any moment (not to mention a prime target for drug seekers), so staff are pretty vigilent.

As far as how things are structured geographically, that depends on the hospital, but yes- there will be different specialties on different floors. In a hospital like the one you're describing, there won't just be different floors, but likely different buildings, as well, with multiple, seperate elevators. Some buildings might connect with each other on all floors, some might only connect on certain floors, and some none at all above the ground/lobby floor.

There have been other changes over the past several years as well, due to medical errors/ litigation/ what have you. You may have noticed that you now have to recite your name and date of birth when you have anything done, even something as minor as a blood draw. You have to sign forms stating you've been aprised of the facility's procedures for keeping your personal health information private. Surgeons now actually sign their names at the place on the body where the surgery is to occur prior to the operation (and while everyone is conscious or someone conscious is advocating for the patient) to avoid errors. While none of these details relate specifically to your question, they all speak to a general atmosphere of vigilance.

I think someone slipping into a room where a patient is in a coma, unplugging the soon-to-be-screaming machines, and then slipping out again undetected is going to strain credibility in the type of setting you're describing. If you don't mind your character getting caught or having to fight his way back out through all the people rushing toward the patient's room, you could probably get him in there with some creativity (I have some ideas I won't post here, but you can PM me). Out's going to be a lot harder, though.

monkey see monkey do
10-07-2010, 05:06 AM
Thanks a bunch heyjude and Giant Baby. Lots of info to mull over. The character doesn't need to escape or succeed, he just needs to get in -- make an attempt on the coma patient -- then get caught.

Kenra Daniels
10-07-2010, 05:25 AM
Even at the very small town hospital where my hubby was recently a patient, a person would find it difficult to get to a critical patient. He was in ICU for 24 hours, and each time I went in to see him, I had to show an ID to prove I was the person listed on his record as approved to visit him, then I had to be buzzed in.

One thing I found interesting was that his bed had a built in scale. An alarm sounded when he sat up on the edge of the bed, because there was significant change in weight.

The ER at the same hospital also has secured doors, you have to wait to be buzzed in to get into the treatment area, and no one is buzzed in unless they're accompanied by hospital personnel.

As for security officers, at this little hospital, there is one posted in the ER, one at the main entrance, and one on patrol, whose main job seems to be chasing smokers away from the entrances.

Cyia
10-07-2010, 05:40 AM
My experience:

Small town hospital, all they do is check to see if you have the right colored "dot" stuck to your clothes, then buzz you in. The dots are interchangeable with whoever wants to visit. If they recognize your face, they don't even bother with that.

Larger city, like Dallas, it's high security. ID's, metal detectors,etc.

hammers
10-07-2010, 11:08 AM
In the hospital that I worked in all wards except out patients had security doors. Maternity, special care baby unit and ICU were the only wards though which would be the hardest to gain entry to.

Canotila
10-07-2010, 11:33 AM
My husband used to work in the ER at UMC in Tucson. They had pretty high security. To get into pretty much any unit you had to scan your ID card. I guess someone could steal an employee's card and do it, but then there are cameras everywhere too.

They also had a whole slew of security guards, three of them were K9 handlers even. I asked them once what the dogs were trained for, and the handler said detecting explosives, and apprehending suspects. Once an angry patient tried to hit a nurse in front of my husband, and before he or the security guard could even react the dog had the guy on the floor.

The local police also had an office inside the ER where an officer was generally stationed. Because it was the closest trauma center to the mex/am border, it was typically crawling with border patrol officers too, who had brought in injured detainees.

monkey see monkey do
10-07-2010, 08:33 PM
Thanks for all the replies. Good to that hear hospitals are so safe -- but not very good news for my would-be-killer.

What if the coma patient wasn't in the ICU, but a regular patient recovery area? Can you be in a coma and not be in the ICU? The patient really doesn't need to in a coma, just unconscious. Can you be unconscious and be in stable condition?

Horseshoes
10-08-2010, 06:48 AM
A persistent unconcsious state is a coma, whether natural or medically induced. You can be quite stable in a coma and not in ICU.

One key factor to know is whether or not your coma pt is breathing on his own. This "lifeline" you want unpluggged...well, there's no lifeline machine that's keeping him alive, unless your pt is not breathing on his own, so is intubated and on a ventilator and you want your bad guy to unplug the ventilator. Well, ventialtors etc often have batteries to protect against an accidental or short term power loss.

Are you willing to let your bad guy attempt murder directly rather than depriving the pt of medical care provided by an electrical socket? Maybe inject a lethal OD into his IV?

Re security, so big hospitals in big US cities have a number of full time police, some have internal PDs.

One of the most interesting security developments has been bracelets on newborns that lock elevators when a baby is carried nearby. And yet, even with those, a baby's been snatched from a hospital. Near Atlanta, if I recall right. That news story will lead you to a lot more info on big hosp security.

monkey see monkey do
10-08-2010, 08:05 PM
Much thanks for clearing things up. I'm starting to get a better feel of things. The patient is there because of gunshot wounds -- he needs to be unconscious.

The lifeline unplugging is not vital. I much prefer that the killer uses a gun. But it looks like that's going to be difficult. A lethal injection seems way too sophisticated for the killer -- this is an off-the-streets-type hoodlum.

That's pretty incredible about the baby bracelets. I'll try to dig up that story, thanks Horseshoes.

Horseshoes
10-08-2010, 09:41 PM
Oh, the hood can prepare a big syringe with an entire 8-ball of crack. Lots of the hoods know that we have a drug to reverse narcotic ODs (heroin and all other opiate derivatives) but we do not have a drug to reverse cocaine. (And of course if you want your pt to lie, make the OD a heroin derivative, not coke, so the medical personnel can shoot the pt w/ Narcan and save him.

Giant Baby
10-09-2010, 10:51 PM
One key factor to know is whether or not your coma pt is breathing on his own. This "lifeline" you want unpluggged...well, there's no lifeline machine that's keeping him alive, unless your pt is not breathing on his own, so is intubated and on a ventilator and you want your bad guy to unplug the ventilator. Well, ventialtors etc often have batteries to protect against an accidental or short term power loss.

No need to unplug a ventilator. Just cut or detach to tubes, or (for a slightly more dramatic finish) have the character extubate him with a good swift yank. Makes my throat hurt just thinking about it.

I'd probably extubate him and then snap the tubes. Everybody's going to be rushing into the room when that airway is lost, and they're going to get him hooked back up ASAP. Needing to get a doc in there who can re-intubate him and replacing the ventilator will buy you a *little* time. Maybe yank out the IV on his way out the door, too, just to destabilize the situation a little more w/out sacrificing time.

I'm glad you said it's okay if the character gets caught, though. He will definitely be caught.



The lifeline unplugging is not vital. I much prefer that the killer uses a gun.

Careful with that if the patient is hooked up to oxygen.

Tsu Dho Nimh
10-11-2010, 03:02 AM
What does your plot NEED the situation to be.

Tell us that and we can tell you how to make it happen.

monkey see monkey do
10-11-2010, 05:24 AM
What does your plot NEED the situation to be.

Tell us that and we can tell you how to make it happen.

Okay.

The patient is unconscious in an ICU, because of gunshot wounds -- admitted just days ago. A low-level gangster needs to get to where he is [as smoothly as possible] with a hidden gun and attempt to shoot this patient. He will be caught by someone just before pulling the trigger. The patient unharmed in the whole ordeal.

Tsu Dho Nimh
10-14-2010, 06:56 AM
hmmmm ... If I wanted to go places in a hospital, I would wear a labcoat over whatever seems to be the general attire, slip into the LAB, pick up one of the phlebotomist baskets for blood collecting and head for the elevators. they can go almost anywhere without being challenged.

You might have to mug a lab tech to get an access badge.

The person catching him ... I know of a lab tech who had a high-level belt in karate. She took out a guy who was holding a gun on a nurse, demanding drugs.

She/he sees an unfamiliar person from the lab (walks wrong, doesn't quite know where he's going, no one from that shift yet carrying a basket) and decides to alert security and follow him.

monkey see monkey do
10-14-2010, 09:59 PM
Thank you for the ideas, Tsu Dho Nimh et al. I'm still toying around with different ideas and such, but I think I'm heading towards the right track.

Shwebb
10-15-2010, 10:41 PM
The hospital where my husband works (I'd call it a medium-sized hospital) they have ID badges that don't grant access to everywhere, so it would be very easy for someone to make a fake badge that would pass casual muster. (Heck, some employees "accidentally" wear theirs backwards, it seems. Some even have stickers here and there on them that cover up part of the identification info!)

My husband was able to go into ICU as a medic--he wore his uniform and when he was asked told the nurse that he was one of the medics who brought in the patient and wanted to check on how he was doing. Even now that HIPA laws have become enforced more seriously, docs and medical staff have respect for the people who have treated the patient and it's not uncommon for my husband to get updated info days after he's taken care of someone when he calls in to get status on a patient.

As long as he has his hospital uniform on and he tells them he brought in the patient, he's always buzzed in on the ICU unit. I imagine that would work in a number of hospitals. It also would give an opportunity to glean detailed info on the patient's prognosis. Amazing how often people like to be helpful in situations like that.