Hospital & Corporate Security

How I Heard

Margeson: After 38 years of receiving middle-of-the-night phone calls, I’m used to them. Although they are pretty much commonplace for me, the June 12^th call was strikingly different. It was from our training and investigations manager who’s a retired law enforcement leader and very experienced as a high-risk incident commander. So when I heard the urgency in his voice, I knew this was big. “There’s been a mass-shooting incident at the Pulse nightclub. It’s just a few blocks south of ORMC. It’s bad, real bad, and there are mass casualties.” That was all I needed to hear. My reply was simply, “I’m on the way.”   

Lang: After I got the call from our night-shift security supervisor, I dressed quickly and jumped in my car. I immediately turned on the security radio, which was full of chatter and solidified the urgency of the security supervisor’s call. I live a few minutes from the hospital campus and as I got closer, I could see an ocean of emergency vehicles parked on Orange Avenue. It reminded me of when I was in law enforcement and an emergency distress call would go out for a backup (signal 43). Everyone would respond from every local agency, no questions asked. I later learned that call had in fact gone out. I entered the hospital via the north tower at approximately 0240 hours.

Synopsis

Margeson: The primary day-to-day responsibilities of an Orlando Health security officer revolve around three key components — prevention, protection and response. First and foremost, we train our officers to project themselves as professionals by both appearance and practice. This is largely achieved by staying alert and aware of their surroundings while being friendly and engaging with our patients, guests and team members. We train them to seek opportunities to protect and serve, to be proactive versus reactive. Prevention and protection are our goals, but when incidents occur how we respond matters. These clearly defined pillars of responsibilities coupled with our professional service delivery practices were critical to the success of our security operations for the Pulse incident. I could say it’s rare to have a situation like the Pulse shootings affect our security services in the way that it did, but that would be an understatement. The truth is this: We’ve never experienced an incident of such magnitude. It absolutely stretched our security department’s capabilities right up to the breaking point. But we did not break, we became stronger.  

Preparation

Lang: I am the security manager for the main adult campus, which averages more than 110,000 visitors a month. The security department is definitely a full-service one. In a typical 24-hour period, security officers perform numerous duties, including restraints, clearing the landing pad for helicopter takeoff and landing, vehicle patrols, foot patrols, key assists, property reports, investigations, weapons and visitor screening.

Security has a well-seasoned leadership staff and supervisors who have been involved in different types of high-risk incidents for decades. The usual training drills are mainly geared toward clinical and decon areas. We also perform lockdowns on a regular basis in the emergency department.

In the early morning hours before the Pulse shootings, we had 10 security officers on duty. Once the Pulse 0600 was called, we increased our numbers to 24. The extra officers all knew their core job duties, which never change, and adapted to the new circumstances and environment.

Margeson: The Orlando Health Security Plan is based on the premise that simplicity increases effectiveness. The plan requires the appropriate balance between three key components:

• Professional and well-equipped officers
• Integrated, electronic-security measures
• A robust security-awareness program with strong team-member engagement

Here’s a visual: It’s like a stool with three legs. When all the legs are in proper alignment, the stool is balanced and strong. However, if any one of the legs becomes weak, the stool becomes vulnerable. Historically, security programs have focused on the first two legs — professional, well-equipped officers and integrated, electronic-security measures such as cameras and access control. The third leg, which is a robust security-awareness program with strong team-member engagement, is often undervalued, but that is a huge mistake. Building a strong security-awareness program and engaging team members in it is an enormous force multiplier. The need for force multipliers has been recognized by police departments for decades and it’s what drove them to develop community-watch programs. Over time, the community-watch concept was adopted by the Department of Homeland Security and the “See Something – Say Something” campaign was born. Time and again this program has proven that simplicity and consistency improve effectiveness when it comes to safety and security.

Here’s another visual: If a hospital has strong access controls coupled with a visitor-management badging system, every person in the hospital will be wearing some form of identification badge at all times. This makes it easy to train team members to validate anyone wearing a badge and initiate a conversation with those without a badge. Those identified as suspicious or without a clear purpose can be reported to security. It’s this “all eyes are watching” posture that dramatically enhances our collective prevention, protection and response efforts. Team members in every corner of the hospital performing a basic but critical security function 24/7 — that is a simple and effective security force multiplier.

Hospital emergency departments are well-known for being fast-breaking and unpredictable, and the demands for security services encompass the entire spectrum of risk. The Pulse incident tested our security team at the extreme, high-risk end of the spectrum. By industry standards, emergency departments are always considered sensitive security areas simply by the very nature of the services they provide. As such, it can be challenging for security to maintain order during chaotic situations. It’s like a perfect storm of human emotions. Extraordinary, stressful situations can bring out violent behavior in ordinary people who would typically maintain an appropriate level of self-control. It’s like going from zero to 100 mph without time to pump the brakes before the crash of emotions happens.

Pulse was that perfect storm, but on steroids. Hundreds of the victims’ families and friends were caught up in the repeating cycle of going from zero to a 100-mph crash. That cycle went on for days, not minutes or hours, but days. Families and friends swung back and forth between a variety of emotions — denial, pain, guilt, anger and bargaining — while the answers they sought slowly trickled down a complicated path. The shock of the initial event was absolutely overwhelming from the start. But for security, it actually intensified in the days that followed because of the complexities surrounding visitor management and crowd control. The barrage of local and national media crews only added to the challenges for security. Training and preparing for an event of such magnitude is difficult, if not impossible. Don’t get me wrong, our training absolutely gave us a solid foundation, but it was the unbelievably strong commitment to duty and the true grit of our security officers and their leadership that got us to the finish line.   

Response

Margeson: When I first arrived at the hospital, I parked in the loading-dock area of the north tower and was immediately met by two Orlando police officers armed with M16 rifles. At that very moment, the gravity of the situation hit me — the hospital was on a “heavily armed police lockdown.” After checking in at the command post, I set out to speak with some of the front-line security officers who described in great detail the initial chaotic scene of victims and their supporters arriving at the emergency department. Most of the victims were being delivered in pickup trucks and passenger cars, not ambulances. Dozens of people arrived on foot and many were absolutely hysterical with fear and panic. A few of the security officers kept using the word “surreal” to describe the events they had witnessed. I’m so proud of the brave actions taken by our security officers to help the arriving victims, and I’m also very grateful for the support of Orlando’s police department. Without them, enforcing a lockdown under these conditions may have been impossible. One officer said it was like a bad dream and he couldn’t wake up. In the following hours, I personally witnessed many very sad and troubling events, but the most difficult was seeing the procession of vehicles from the medical examiner’s office leaving our ambulance bay with 9 deceased victims — and knowing that each one of them was young enough to be my own child.       

Lang: As I made my way to the emergency department, I could see we were on total lockdown. Hordes of heavily armed law enforcement, security, clinical and paramedic staffs were working franticly to attend to everyone. Once I made it to the ambulance bay, I found the night-shift security supervisor, who advised me on the location of the incident, but had little additional information. I walked up to a very tall, uniformed officer from the city of Orlando and asked who was in command here, and he responded that he did not know. I told him who I was, that I needed information, and that as far as I was concerned, he was in charge and would be our liaison. I asked for a run down, any information. I was told there may be multiple suspects and possibly IEDs. I also was told there were bodies everywhere in and near the Pulse nightclub just a few blocks away. There was no information as to the location of the suspects or whether they were mobile and out of the area. Attempting to make telephone contact for more support, I re-entered the emergency department and observed law enforcement with a patient they appeared to be guarding. I asked if that was a shooting suspect and was told possibly.

At this point, I observed law enforcement running toward the other side of the department and people yelling that shots had been fired. I yelled for everyone to get down and ran with the officers to the east-side employee exit by the department staff offices. I contacted approximately 15 law enforcement officers who advised that they needed to search the hospital. Soon a “code silver” active-shooter announcement was made on the overhead communications system.

I went with a group of law enforcement officers who had guns drawn and were clearing areas in response to the active-shooter call. Several other groups — escorted by team members — also were out searching. As I walked with my law enforcement group, kind of in the middle, we turned the corner toward the nurse administration office and I became fully aware that I was not a cop anymore and had no gun. That was one of the worst feelings I have ever had. With empty hands, I continued to assist with an area check. Several areas were checked but before we were done, a communication was prematurely issued that the active shooter call was being cleared. This process has been corrected.

I informed several team members who were walking the hall to find a place to hide because we were still in active-shooter mode. My group was clearing the cafeteria when I noticed six corrections officers at the elevators. I informed them of the situation and they assisted. I turned to go back down the hall when I heard yelling from the stairwell. I opened the door and saw Carlos Carrasco, our hospital COO, in the stairwell with several police officers also searching. I was briefed that a possible suspect was taken to one of the floors and was asked to escort the officers to the patient room so Carlos could assist back at the ED. One of the officers stated they had found and were following a blood trail. I escorted the group to the sixth floor and toward a specific room number. I was thinking, Is this the guarded patient from the ED who somehow got away? Are multiple shooters running around? And what did he mean about a blood trail? I knew one thing for sure: I missed my big, 45-caliber duty Glock I was given when I retired from the Sheriff’s Office. 

As we exited the elevator on the sixth floor, I observed several clinical staff hunkered down in an office. I told them to stay in the room and that we are still in active-shooter mode. We proceeded to the target room and law enforcement made entry. I heard yelling, and the person of interest was found hiding inside the bathroom. We located a wheel chair and I escorted the person of interest to the emergency department. While at the ED, I learned the command post had been activated and headed over because security has a position at the command table. When I got there, I was met by Mark Jones, ORMC’s president. We were the only two people in the room at first. Neither one of us wanted to be there; we wanted to be out in the field. Numerous times Carlos would run into the command post, give an update, say “I got to get back” and run out.

That early morning, everyone was doing their jobs to the best of their ability. This was a catastrophic incident that had the right people in the right place at the right time from minute 1 to months later. Security has maintained its new heightened level still to this day. We never went back to pre-Pulse.

Lessons Learned

Margeson: I’ve been directly involved in a great many emergency-management situations throughout my career, and “communications” is always one of the top, critical issues identified during all the debriefings. Even though first responders work tirelessly to develop tactics and strategies to overcome communication shortcomings during emergencies, they still persist. I’ve come to believe that many of the communications problems typically encountered can be minimized through training and equipment investments, but they can never be eliminated. For example, you can plan for a hurricane, but you must react to a tornado. In the event of the latter, humans simply react to horrific, fast-breaking and ever-changing situations, and I’ve never witnessed training with that level of reality.

Security’s biggest issue after the Pulse shootings was dealing with the enormous command and control issues brought about by the media, well-meaning community partners, visiting political leaders from all levels of government, family and friends of the victims, and the general outpouring of sympathy from a large cross-section of the community. For 10 days after the event, we were literally overwhelmed with the challenges associated with a wide range of crowd-control situations better known as visitor management. Hospitals are not designed to keep people out, so shifting gears and changing our security model on the fly was quite the challenge.

What We Changed

Lang: After Pulse, the downtown campus became semi lockdown with security monitoring and weapons screening at all public entrance points. We also reduced the number of access points into the hospital and increased security staffing by about 15%. The new normal is to screen all guests and patients. Plans have been developed for a visitor-management and badging system. Currently, team members freely enter and exit with proper badging. Several locations are not monitored by security, but have team-member badge access.

Cameras have been upgraded in some areas and an extra vehicle patrol was added. Areas of concern were identified and documented with infrastructure enhancements in process. We have become a Security Department of Distinction with IAHSS and have enhanced training. We have upgraded to walk-through metal detectors and have deployed three X-ray screening machines. Law enforcement go bags for emergency situations have been added to the three public entrances. These bags contain badges for hospital access, a master key and a laminated architectural drawing of the hospital’s first floor. Better communication processes among all departments have been developed to keep all informed on large crowd, media events and any issues with general access control. In Human Resources, managers and supervisors have been making notifications as to workplace violence issues and terminations that could pose a risk. To me, it seems that a majority of team members now take safety and security more seriously.

Conclusion

Margeson: In conclusion, the Pulse incident presented significant challenges for security. Orlando Regional Medical Center (ORMC) has the largest security command in the Orlando Health system, and it’s led by an outstanding security manager, Mark Lang. As a retired law enforcement leader, he is highly experienced in emergency-management situations. His leadership coupled with the unbelievably strong commitment to duty and the true grit of his officers are what got us to the finish line.

Key Takeaways

Margeson:

• Simplicity increases effectiveness of security programs.
• The best “force multiplier” is a robust, security-awareness program with strong team member engagement.
• Visitor management and badging systems drive the organization’s “awareness program.”