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Lessons Learned: Rival Gang Members in the Same Hospital


Field Director, Surveyor Management and Development Accreditation and Certification Operations 

I’ve seen a lot in my career as a field director—even more as a vice president of safety and security for a four-hospital system on Florida’s Space Coast—and won’t soon forget the night when members of rival gangs presented in our ED trauma center. 

These days, this could be a reality at many urban, and even suburban, medical and trauma centers anywhere in the United States. 

On the particular night I recall, a gang shooting brought two rival members to our trauma center due to the injuries caused by this event.   

The staff was not aware of the event. They had been busy with patient care and other duties. Both patients were moved from the trauma rooms to pre-op. One individual was ambulatory and the other was not, due to the extent of his injuries. A single nurse was providing care to both patients but often had to leave the area to prepare for the surgeries to follow, which is standard. Essentially, we had both victims of a rival gang altercation in the same area – side-by-side in pre-op.   

We were lucky. Nothing occurred during this event. As more information came to light regarding this situation, updated protocols were established to ensure staff safety should it happen again. This could have been catastrophic for the staff and the non-ambulatory patient. 

Law Enforcement Collaboration Complications 
Following this incident, I met with local law enforcement officials to address notice to hospitals regarding gang shootings. I was a member of the Brevard County Chiefs of Police and asked for their buy-in to address notice to the hospital or assurance that members of rival gangs would be transported to different hospitals. They immediately and wholeheartedly agreed, especially the police department that served the trauma center.  

Further meetings had to be scheduled with local EMS as well as the Space Coast Fire Chiefs Association, responsible for ultimately transporting victims to area hospitals.  One complication we identified is that law enforcement typically does not arrive to the hospital with the patient. Officers arrive sometime later due to work at the scene. This means that there’s no police protection on site at the hospital in the first moments, when tensions are typically highest. 

Summoning local law enforcement for assistance is also more problematic if the event occurred in a different area of the county. Information may be slow in coming if the crime happened in a further part of the county or especially if helicopter transport was involved. In these cases, it’s up to hospitals to assign security to the pre-op area.   

Furthermore, the law enforcement personnel who show up to collect forensic evidence do not necessarily have arrest powers. Even though police may be on site working with the forensics team, it’s ultimately the hospital in charge of providing appropriate security when gang members visit. 

Protocols for Staff Safety 
In our case, even though local law enforcement agreed to notify hospital security before transporting victims of gang shootings, it was apparent that staff safety is the responsibility of the individual hospital. My former hospital established policies so EMS also notified the trauma and OR staff.  

Comprehensive safety and security programs must be built based to address what may occur on throughout the hospital campus. Risk assessments that may be helpful include OSHA 3148 and those from Emergency Nurses Association

This is every security director’s worst nightmare. While I’m pleased that we had a good outcome, I fear what could’ve happened. Have your hospitals ever treated rival gang members? Please share your successes in preparing for and managing the situation. 

James Kendig, MS, CHSP, CHCM, CHEM, LHRM, field director, Surveyor Management and Development Accreditation and Certification Operations, oversees half (approximately 40) of the surveyor cadre who specialize in surveying The Joint Commission’s life safety, environment of care, and emergency management standards. Prior to joining The Joint Commission, he was a vice president and safety officer for a four-hospital system in Florida. 

Kendig also serves on the faculty of the University of Central Florida’s Licensed Risk Management Program. 

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