**Abstract**

Disaster planning is integral component of hospital operations and management, and hospital resiliency is critical to society and health systems following a disaster. Additionally, hospitals, like all public institutions have significant risk of security incidents including terrorism, isolated and mass violence, social unrest, theft and vandalism, natural and human made disasters. Security and disaster planning are cumbersome, expensive and easy to deprioritize. When a hospital disaster is defined as anything that exceeds the limits of the facility to function at baseline, disasters and security incidents are intertwined: disasters create security problems and vice-versa. Hospital resiliency to disasters and security incidents stems from a systems-based approach, departmental and administrative participation, financial investment and flexibility. Significant best practices and lessons learned exist regarding disaster and security planning and ignorance or lack of adoption is tantamount to dereliction of duty on the part of responsible entities. This chapter consists of a review of the concepts of hospital disaster and security planning, response and recovery, as well as hospital specific disaster and security threats (risk) and their associated mitigations strategies. Risks will be presented follow a hazard vulnerability analysis (HVA), a common framework in emergency management, disaster planning and disaster medicine. As such, each element of risk is defined in terms of likelihood and impact of an event. Concepts of disaster medicine that are also addressed, as are administrative concerns, these elements are designed to be applicable to non-experts with an emphasis on cross disciplinary understanding. Additionally, elements are presented using incident and hospital incident command terminology and those not familiar should learn these concepts though free online training on the incident command system provided by several sources including The United States Federal Emergency Management Agency (FEMA), prior to reading.

**Keywords:** hospital security, disaster management, disaster medicine, disaster preparedness

### **1. Introduction**

*Disaster defined. A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts. -United Nations international strategy for disaster reduction (UNISDR).*

Security events involving healthcare are timeless. Examples of security threats include families seeking retribution for perceived substandard care and healthcare facilities seen as military targets during times of conflict, despite universal agreement on medical neutrality [1]. Terrorism and acts of violence against healthcare workers and healthcare institutions are common enough to have become a field of study. There is also some evidence that the trend is growing, and there are many efforts, globally and locally to address the problem [2]. With violence all to common, it is no coincidence that government, policy and security institutions focus much attention on healthcare.

Disasters, from natural and human created events, are defined by the disruption of normal functioning. When the disaster affects multiple social institutions, healthcare's role in society often expands. In such events, for example, hospitals function beyond the provision of healthcare: a refuge for those in need, a gateway to social services, a bellwether for societal wellbeing, a bastion of hope and communal security in the face of disruption. As such the effect of disasters and security incidents on hospitals has an additive physical and psychological effect on the population. From a practical standpoint, the populations access to health services are interrupted or they may choose to avoid care. Additionally, they may have an inherent sense of insecurity as a major and essential public entity has been attacked or disturbed. The resiliency of hospitals, in the face of major disaster and security events, is paramount to social functioning at many levels and as such is a major concern for public officials and citizens through society.

Hospital security has many elements consistent with security of other institutions and organizations as well as many unique areas of vulnerability. Common security elements include basic building security, employment security, asset and material security, crowd and social unrest security, basic disaster specific security and basic IT security. These elements are addressed largely commiserate with standard practices for public institutions and will not be addressed here. Unique security vulnerabilities of hospitals are too many to name and addressing them all is beyond the scope of this text. Additionally, very specific hospital vulnerabilities such as medical waste, unaccompanied minors, and radiation security among others will not be addressed. Major unique vulnerabilities of hospitals largely stem from their reliance on other public institutions, such as governance and businesses, and the central role they play in society.
