A woman carrying a Louis Vuitton purse and Macy’s shopping bag hurries through the front doors of a hospital in Washington, DC, and immediately eyes a recently installed weapons detection system (WDS) portal. Perhaps experienced with such fixtures at airports, she steps aside to allow others passage, then begins the ritual unburdening of bags, phones, keys, rings, pocket change, and other items that could possibly trigger an alert. A hospital security officer quickly intervenes and directs her to walk through. “But I have all these keys in my hand and other things,” the visitor objects. The officer assures her that she can pass with all those items, and she breezes through without a beep, partially amazed and partially relieved.

The hospital’s system uses advanced technologies and precise sensitivity settings to detect only weapons and not ubiquitous harmless items such as phones, keys, notebook computers, and umbrellas. While the officer’s principal role is to provide security, close behind are facilitating swift pedestrian traffic flow and offering excellent customer service. As this healthcare facility performs a trial of the system, the vast majority of visitor encounters are similar to this one: appreciation that hospital management prioritizes security, helpful and positive interaction with staff, and minimal delay.

The D.C. hospital soon realized that it could further improve throughput and the visitor experience by posting clear and hard-to-miss signage to set expectations for people arriving at the hospital. Hospital management planned to do so shortly after my visit.

That’s a tiny snapshot in the world of weapons-detection screening at healthcare facilities, where management must balance safety, convenience, and throughput. The author spent hours at entryways of healthcare facilities this winter observing examples of this intricate dance between security screeners, hospital entrants, and technology.

Perhaps no day was as busy as Valentine’s Day at a large hospital center in New York City, where hundreds of visitors, eager to see their loved ones, poured through the system carrying every possible type of bag and gift: Briefcases and balloons, valises and vases, truffles and totes. Similar to the Washington, DC, facility, visitors passed through the twin pillars with whatever they were holding or carrying. Secondary screening — bag checks or wand sweeps — occurred for the occasional person carrying a bag or other large item.

The exceptions were patients and visitors in wheelchairs, on walkers, or pushing strollers, where they are wanded in a separate area.

This article is the result of observing many such scenes and speaking to both security screeners and management. It assembles issues, challenges, and effective practices in deploying WDSs in healthcare environments.


Types of technology/system capabilities

WDSs range from basic metal detectors to elaborate affairs that combine metal detection, LiDAR, artificial intelligence to distinguish harmless items from dangerous ones, visual cameras with onboard analytics, radar, millimeter wave technology, and so on.

Layering various technologies is an effective way to maximize weapon detection, but that doesn’t mean healthcare institutions are best served by loading every available technology onto their solution. Selecting a WDS requires a balance of needs — determining exactly what types of items are you trying to detect, and to not detect — budget, staffing, location, logistics, throughput, false-alarm tolerance, and other factors.

Generally speaking, however, the more effective systems go beyond mere metal detection. Though a small number of hospitals I reviewed rely on that technology only, the more modern and sophisticated systems incorporate features such as LiDAR, AI, and visual detection — even catching people who try to circumvent the system. These latter systems also allow people to carry keys, phones, and other harmless metal objects through the system without triggering an alarm.

The more advanced systems that I witnessed were cloud based and integrated with multiple security and facilities interfaces, including access control, visitor management, mass notification and video surveillance. These facilities leverage the combination of security components to establish an enhanced security stance. For instance, security can quickly pinpoint the location of an individual, capture and collate various sources of threat data, and reduce response time. Moreover, the cloud-based platforms facilitate incident reporting, compliance documentation, guard check-in, data analysis, and mobile monitoring.

In fact, failing to integrate a WDS with other security technology is a missed opportunity, says Josh Phillips, a security practitioner and founder of the online community Physical Security Today. “Any output from the WDS is just as powerful a data point as a read at a door,” he emphasizes. “It just makes sense to integrate these systems with access control and video.”


Sites and locations

WDSs are obviously not practical or cost-effective for every type or size of medical facility. They are most frequently deployed in hospitals or healthcare centers with adequate funding that are located in higher-risk areas. Healthcare systems with multiple locations face the issue of allocating limited resources to multiple facilities, notes Phillips.

“There are so many outpatient facilities now,” Phillips says. “Hospital systems are very distributed. How do you decide where to install them?” The answer can be a combination of risk assessment, resources, community input, potential liability, and other factors.

Once you decide which facilities will receive them, the next questions are how many systems and where.

Some hospitals place WDSs at the entrance to the ER. Some situate them inside the main doors. Others cover both areas.

Chris Ciabarra, Chief Technology Officer and Co-Founder at Athena Security, who has overseen installation and maintenance of dozens of systems in healthcare environments, says that ERs are logical places for WDSs, considering that they have 24-hour operations, often deal with victims of firearms, and are the site of 40% of violent incidents in hospitals. But he adds that if other entrances don’t have WDSs, visitors can elude screening. (In fact, I was able to do just that at some sites.)

Ernie van der Leest, who has overseen healthcare security operations in Texas and Colorado, has witnessed that exact phenomenon. “Many hospitals use weapons detection systems at their ERs, but not at any other entrance,” he observes. “Anyone can get right around it.” His strong recommendation: use a WDS at every entrance.

Sometimes people can evade a WDS by entering the hospital through an adjoining medical office or facility. In those cases, if the hospital doesn’t want to add another WDS, connection points should either have electronic access control for staff use, an officer assigned to the entry, or a way to direct entrants back to a screening station.

What about limiting entrances, as schools do, to funnel patients, staff, and visitors to one or two entryways — which would improve security, reduce staffing costs, and minimize the number of WDSs to purchase?

Be careful with that approach, warns van der Leest. “If you shut down entrances that don’t have WDSs, you hurt the patient experience. People in wheelchairs, on crutches, the sick, the elderly might have to walk a long way to the only entrance.”

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All staff should be trained on the specific system in use, as well as procedures that involve issues such as secondary screening, dealing with irate people, discovering a weapon, and requesting assistance.”


Staffing

All staff should be trained on the specific system in use, as well as procedures that involve issues such as secondary screening, dealing with irate people, discovering a weapon, and requesting assistance.

Then the institution should determine how many staff members are appropriate to operate a WDS.

According to a draft guideline issued for public comment on November 13, 2023, by The International Association of Healthcare Safety and Security, “The number of personnel assigned to the weapons detection process should be based upon the volume of people being screened, the type of monitoring equipment, search processes, secondary inspections, storage of belongings, etc.”

Athena’s Ciabarra says Department of Homeland Security (DHS) best practices specify two officers for normal conditions for high-volume entrances. DHS has even published a patron flow-rate formula for WDSs (see sidebar). Ciabara adds that the officer overseeing the screening should be able to both see the visual alert and hear the audio alert if an entrant triggers the system. The secondary screener conducts follow-up wanding and bag searches. One of those two officers also screens anyone who can’t pass through the portals or would definitely set off the WDS, such as the wheelchair bound.

A third screener can be considered at high-volume times, when risk is greater, when low wait time is critical, or as otherwise deemed viable by hospital management, Ciabarra adds.

Rarely did I witness three officers on duty at any facility, even urban hospitals at busy times. Often I only saw a single person do everything. Van der Leest confirms that my experience isn’t rare. In one hospital, I asked how long it would take to get backup if she found a weapon and someone threatening to use it. She didn’t know because it hadn’t happened yet.


DHS best practice: Patron flow-rate formula

Conduct an analysis to determine the quantity of patrons searched in a block of time.

Formulas:

Total time period ÷ average search time per visitor = number of visitors searched per total time period.

Number of visitors searched per time period x time period = number of visitors searched.

  • Eample 1: It takes 16 seconds to use a hand-held metal detector on one visitor. 60 seconds ÷16 seconds = 3.75 visitors searched per minute. 3.75 visitors x 60 minutes = 225 visitors searched per hour
  • ample 2: It takes 9 seconds to use a walkthrough metal detector on one person. 60 seconds ÷9 seconds = 6.67 visitors searched per minute. 6.67 patrons x 60 minutes = 400 visitors searched per hour


Throughput

Traffic volume and flow — throughput — helps determine system requirements. Some companies trumpet their ability to screen streams of people moving quickly into the facility. But not all facilities require that level of technological sophistication. “Most hospitals don’t have volume like stadiums do,” van der Leest says. “Consider whether you need a high-throughput solution.”

Quick and hassle-free entry adds to the all-important visitor and patient experience. “What sets healthcare apart is that people aren’t there on their best day,” says van der Leest. They are sick or a loved one is sick. People are upset. We need to make it easy for them to get in.” As a competitive business, hospitals can lose clients if they gain a reputation of having an onerous process of entering and checking in.

Compliance
Healthcare institutions must adhere to a variety of local, state, and federal requirements. Several have implications for weapons screening. For example, Eric Sean Clay, Vice President of Security at a major healthcare system in Houston, notes that the Emergency Medical Treatment and Labor Act may require staff to bypass screening for emergency patients.

Hospitals should have appropriate policies and procedures for such situations, especially since a high percentage of violence in hospitals occurs in ERs, especially by victims who themselves are armed when they are wheeled into the hospital. In fact, a 2019 article in the Western Journal of Emergency Medicine cites the statistic that one quarter of trauma patients brought into ERs have been found to carry weapons.

Also at the federal level, OSHA imposes duty of care considerations for staff, as well as ensuring a means of egress during an emergency that could affect the placement of WDSs (Local building and fire codes may have similar requirements). To comply, hospitals might want to make sure their WDSs are easily movable, perhaps on wheels. Larger institutions with open lobbies and multiple doors may not have that same issue, Ciabarra says.

State laws may also come into play. Most states do not prohibit carrying firearms in hospitals, but van der Leest says most hospitals have policies that prohibit guns on the property. In states with no gun ban, hospitals should have well-articulated and disseminated policies if they wish to keep weapons off the premises.

Other requirements and recommendations may be relevant. The Joint Commission, which accredits hospitals, imposes broad requirements for security that may influence use of WDSs. Guidance by the Joint Commission also calls for the potential use of WDS in areas with “a high crime rate or gang activity.” Their security requirements are descriptive rather than prescriptive, but they should be consulted to ensure compliance.


Signage

Clear, abundant, and well-placed signage is essential to informing the public that screening will take place, and thus streamlining the flow into the building. Most, but not all of the hospitals I visited had at least one sign. At one extreme, one healthcare center festooned its parking garage, outside walkways, atrium, and some doors with easy-to-read signage. At the other extreme, some facilities had no notice at all, or a single easily overlooked placard or sign with small type.

Signs also spell out local law as well as management’s policies on bringing weapons into healthcare institutions. Before preparing and displaying signage, it is essential to refer to local and state law. Some states require certain formalities, which may differ depending on whether the facility is publicly or privately owned or whether a firearm is carried openly or concealed.

For instance, Texas law states the following about prohibiting unlicensed firearms on the property of a private business:

A person may provide notice that firearms are prohibited on the property by posting a placard at each entrance to the property that:

  1. includes language that is identical to or substantially similar to the following: ‘Pursuant to Section 30.05, Penal Code (criminal trespass), a person may not enter this property with a firearm’;
  2. includes the language described by Subdivision (1) in both English and Spanish;
  3. appears in contrasting colors with block letters at least one inch in height; and
  4. is displayed in a conspicuous manner clearly visible to the public.

Signage serves health purposes as well. The IAHSS draft guideline for signs states that “Consideration should be given to signage that provides information for those that may have medical devices or conditions that may be impacted by weapons detection screening, such as alternative screening processes, handheld wands, or visual inspection.”

Deploying WDSs in hospitals carries multiple logistical, legal, personnel, operational and public relations considerations. With those in mind, healthcare environments can use WDSs to improve security, maintain smooth pedestrian flow, minimize false positives, increase staff retention, and heighten an atmosphere of care, healing, and peace of mind.