At about 1:30 p.m. July 24, 49-year old Richard Plotts walked into a Delaware County health center, griping about its gun ban.

Burdened with a criminal history involving drugs and guns, Plotts pulled a .32 revolver from his waistband and opened fire, killing his caseworker before his psychiatrist shot back with his own .32 semiautomatic, injuring Plotts.

Hospitals have traditionally been places where patients, staff and visitors come and go freely. But the numbers of violent incidents recently have forced them to rethink their security policies.

"Healthcare facilities are required to have security protocols in place, but there are not specific guidelines, and [the policies] vary by facility," state Department of Health spokeswoman Holli Senior said.

"It's up to each facility to have protocols and plans in place to ensure the security of patients, visitors and staff. When an incident like a shooting occurs, facilities are required to report them to the department within 24 hours," she said. "The department expects the facility to conduct a thorough review of the incident and determine if corrective action is necessary."

If a plan needs to be done, the department will monitor the facility to ensure it's implemented," Senior said.

The Joint Commission, which oversees hospitals in the state, also requires updated safety and security plans and drills.

Local hospitals plan for safety

Blue Mountain Health System, with hospitals in Lehighton and Palmerton, regularly reviews its policies and emergency preparedness response protocols, spokeswoman Lisa Johnson says.

While BMHS would not reveal specifics of its security polices, officials have learned from a 2010 shooting incident such as one at Johns Hopkins Hospital, Baltimore, Md., when a distraught man shot his elderly mother and her surgeon before turning the gun on himself, and the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Conn.

BMHS studied the tragedies to develop and refine its Code Black emergency response plan to alert hospital staff of any assailants with a weapon(s) that appear to be potentially or actively engaged in assaultive behavior on its campuses, Johnson said.

"We also do department-by-department education and inspections so staff know where to shelter in place, how to protect patients, lockdown procedures and potential escape routes from each department in the event of a Code Black. We have had Homeland Security evaluate our facilities from a safety standpoint and we will be holding a tabletop drill exercise with local authorities this fall," she said.

"From our emergency preparedness drills, we have limited access through certain entrance doors, are currently upgrading our security cameras and adding additional cameras added extra security guards in certain areas," Johnson added.

Like a city

Lehigh Valley Hospital Network, housed in complexes on Cedar Crest Boulevard and in center city Allentown, as well as Bethlehem and Hazleton, strikes a delicate balance between security and the calm, open atmosphere necessary for the comfort and confidence of patients, staff and visitors, said Mike Wargo, who is administrator of its public safety department.

"Lehigh Valley Hospital Network moved three years ago from security department model to a public safety department model," he said.

Security services, emergency communications (including an in-house 911 system), fire and life safety, emergency management, and medical evacuations divisions all work together.

The public safety department has a staff of about 300 people. Of those, about 80 report to security services.

"We look at our organization as very similar to a city," Wargo said. "Police, fire and emergency services all work under a single leadership."

"Any one of us can respond because our staff is cross-trained to be able to respond to any emergency on campus. Security services is really focused on community policing: access control and patrol, follow up investigations, and patrolling campuses for theft, vandalism and other problems," he said.

The cross-training enables those working for one division to help in another division. All staff are also trained in spotting odd or potentially dangerous behaviors, and in calming aggression.

"They're also trained in good communications skills," Wargo said. "Most people who require a security response can usually be calmed down. If they are physically acting out, we call local police."

They also take no chances.

"Our security officers have bulletproof vests and are trained in self-defense," Wargo said.

"We do drills with staff for exactly the scenario that took place [in Delaware County]. They were conducted by the emergency management division, which engages the emergency communications center, local police, and security services to immediately respond," Wargo said.

Prevention

Wargo said prevention is key.

"An incident like what happened in Delaware County are extremely hard to prevent unless you have a complete lockdown, such as airports do," he said. "But do you want a hospital where everybody goes through metal detectors and has their bags checked? It's just not the culture of health care. The culture of health care is a comfortable environment with the balance of security by other means, such as detection and observation."

Wargo said care is given after an incident to help staff cope with the emotional fallout.

"After an incident, everybody goes back to everyday operations. But there is still an impact. It's important to have programs help them mentally and physically recover. We have behavioral health specialists to talk with them and allow them to express their [concerns] and adjust to life after the incident," Wargo said. "It takes just as much if not more effort to get back to taking care of patients."

Wargo said everyone needs to be alert to changes or differences in their workplace to prevent violent incidents. Be aware of changes in co-workers' behavior or strangers in places restricted to staff.

"Report things that are out of place or that make you feel uncomfortable," he said.

St. Luke's University Hospital Network, based in Bethlehem, also would not share details of its security measures.

Spokeswoman Denise Rader said the network's security program is "accredited by the International Association For Healthcare Security & Safety. This network of safety professionals shares best practices and security information, as well as provides training for a variety of safety issues, including violence."

The network's safety program director, Alan Lynch, is a past president and co-founder of the IAHSS-Susquehanna Chapter and is a member of the IAHSS National Education Council.

"Some of the protocols followed by IAHSS members were developed by Lynch and are resources for IAHSS members," she said. "With the growing number of violent incidents throughout the country, the need for this training, heightened awareness and connectivity among emergency professionals is necessary and undertaken willingly."