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Dr. John Ruiz recently suffered a bit of culture shock. In his professional life Dr. Ruiz was a New York City physician on the cutting edge of detection and treatment of malignant melanoma, the most serious form of skin cancer. He had recently flown to Florida to visit family hospitalized there and had entered the hospital unchallenged without even identifying himself when he entered the intensive care unit in Orlandos most prominent hospital. In Florida he had seen children running up and down the hospital halls and family visiting anytime they chose. Far from strictly enforced, in Florida families challenged the authority of nurses and doctors to restrict visitation even to allow for patient recovery. Further, Dr. Ruiz had seen nurses publicly reprimanded by supervisors for enforcing visitation policies in Florida. He was seeing that the All Hazards preparedness and Situationally Sensitive Security to which he was accustomed to was far from universal.

A year earlier, at age 39, Dr. Ruiz suffered a heart attack while working in New York City. Like so many heart attacks in the north, his began while shoveling snow and ended on the operating table. Owing to his young age and the fact that he exercised daily, he did well and went home. His story would have ended there except Dr. Ruiz realized there was a stark difference between his reality and the state of healthcare safety in the rest of the nation.

Dr. Ruiz had always been one of those doctors who never saw the need for increased disaster preparedness for healthcare. Practicing in New York City after 9/11 it seemed to him that every hospital and healthcare facility had instituted Situationally Sensitive Security and All Hazards Disaster Plans. Despite the fact that he had family and friends involved in national preparedness he had always assumed that every facility was as ready as the ones where he worked.

Prior to his heart attack, Dr. Ruiz had never walked in the front door of the hospital. When he arrived as a patient, he entered the front door and was immediately asked for photo id. He showed his drivers license and his wife was immediately stopped and asked for her id. For the first time he saw that no one entered the hospital without scrutiny and business at the hospital. This was such a contrast to what he now saw in Florida. Could it be that the rest of the nation was this unsafe?

Once admitted to the hospital, Dr. Ruiz learned that visiting hours were not only defined and restricted, but strictly enforced. Moreover, small children such as his own could not visit on the patient floor; he would have to be well enough to visit with them in the family spaces. What a difference from the world he now saw! How do the doctors and nurses work in such a place?

When Dr. Ruiz returned home he decided to see if his perceptions were in fact correct. He again entered through the front door. Had it not been for his hospital id, he would not have gotten in. He learned that on this day there had been an incident at another hospital and the hospital had increased the level of security. For the first time he took note of the attitude and decorum of his own patients visitors. In sharp contrast to what he had seen in Florida, these New York visitors listened to instructions, obeyed visitor policies and followed the instructions of the nurses.

The Safe Work Environment

What Dr. Ruiz came to realize is what preparedness experts have been saying for years; healthcare has few well prepared institutions while the majority of healthcare has chosen to ignore the threats and the most obvious solutions.

The most important change is to incorporate security and preparedness into the daily regimen of every hospital function and every hospital employee. The Situationally Sensitive Security Dr. Ruiz encountered in his hospital ensures that the hospital staff as well as all visitors are accustomed to some level of scrutiny when entering the hospital. At the lowest levels, no more that an id check occurs, but as security concerns increase, the level of scrutiny and restriction increase. This type of daily routine ensures that when increased security is required, the baseline behaviors are in place and familiar. The same philosophy is the basis of Continuous Integrated Triage and several other All Hazards protocols.

Workplace safety has become as much a component of All Hazards preparedness and patient safety initiatives. Facilities that have instituted this expanded approach to preparedness have found that patient safety initiative, employee safety programs and All Hazards preparedness are a natural combination. Funding once used for just one program can be applied to all three areas simultaneously thus allowing a hospital or healthcare institution to benefit in all three realms for each dollar spent.

More importantly, Dr. Ruiz inadvertently identified the reason that many preparedness experts have failed to successfully persuade hospital and healthcare decision makers to spend money on preparedness. Like Dr. Ruiz, many of these experts practice in places where most of the preparedness lessons have been not only observed, but learned and acted on. These experts are assuming that those practicing across the rest of the nation have already made the changes found in communities like New York City. The sad reality is that the vast majority of the nation has not made these changes. The only question is what will it take for the majority of hospitals and healthcare institutions to make these changes.

Workplace safety has become as much a component of All Hazards preparedness and patient safety initiatives. Facilities that have instituted this expanded approach to preparedness have found that patient safety initiative, employee safety programs and All Hazards preparedness are a natural combination. Funding once used for just one program can be applied to all three areas simultaneously thus allowing a hospital or healthcare institution to benefit in all three realms for each dollar spent.