Although there are some glaring exceptions during every war, hospitals and medical personnel generally have been immune to direct attacks by an enemy. Insignias such as the Red Cross were once a near guarantee of safe passage.
That is no longer the case. With the massacres that occurred in Mumbai, we now know (even more so) that terrorists purposefully will target a hospital. This follows on the heels of taking out first responders and ambulances with secondary incendiary devices in Israel and the killing of medics with booby-trapped bodies in Iraq.
The question arises: Will one of our prestigious medical centers be the sole target or be among several simultaneous attacks, perhaps in Washington, D.C., or New York City or Anywhere, U.S.A.? No one knows, but clearly the chances have increased. This kind of multiple-target assault could happen to any U.S. shopping mall, sky rise, hotel, sporting event, transportation hub, religious house or school.
Consider how soft medical institutions really are and how frightening the impact could be. They are often centrally located, vital to the health of a community or city, never fortified, easily accessed, void of metal detectors or chemical sniffers and rarely protected by armed guards, yet they are staffed by indispensable professionals, stocked with critical medications, loaded with hazardous medical materials, and are home to scores of ill and injured patients who cannot fend for themselves.
No one checks parcels at the door, checks cars in underground parking lots or runs a wand over a visitor’s body. Any crazed person(s) can just walk in and wreak havoc. A car bomb driven into an emergency department or detonated beneath a crowded ward already has happened abroad.
Patients rarely know where the nearest exits might be, and that’s if they can walk. They rarely have shoes or warm clothing at hand. Few have access to a flashlight or know where the closest fire extinguisher might be. Weapons, understandably, are forbidden. Oftentimes, hospital staffers are inadequately trained for these critical incidents. And yet, they need to be.
Enormous strides have been made by many hospitals for natural disaster preparedness, especially for hurricanes in the Southeast, tornadoes in the Midwest and earthquakes along the West Coast. But based on data from 2005, very few of the 5,764 registered hospitals in the United States are truly prepared for worst-case, man-made scenarios. Once, a Tokyo hospital wasn’t prepared for the nerve gas attack in a subway; many staff members succumbed to their victims’ “gas offs” or fumes.
Our freedoms have made us a nation of soft targets, and for the most part, that’s an extremely good thing. But any mad person or armed group of zealots can easily find and take out soft targets among the tens of thousands of opportunities. The fact that there are so many targets statistically protects each of us, but it may eventually encourage them to up the ante and go for a nuclear or biological weapon.
The answer may not be arming hospital security personnel, locking all doors or hiding six-shooters under pillows, but the time has long since passed for smart minds to find ways to harden our softest and most precious targets. An ounce of prevention may be the best medicine. Our government needs to be proactive in every reasonable way to ensure our safety. To do otherwise would put us in a dangerous wait-and-see mode.
In the interim, what can a patient do? The choices are limited, but use common sense and don’t assume it couldn’t happen. Report unusual behavior to authorities. We all need to be the eyes of our community, like a village protecting a child.
Know your exits. Always have a plan. Make sure you are as safe in the hospital or at school or in a church as you are in your own home. Ask what safety measures are in place. Given the current political climate, it seems wise to be mindful of all potential dangers.
And, always, always be prepared.
Geoffrey Simmons, a Fellow of Discovery Institute’s Center for Science and Culture, is adviser to the Disaster Preparedness Committee at Sacred Heart Medical Center, a member of the board of governors of the American Academy of Disaster Medicine and volunteer community emergency response team coordinator for the city of Eugene.