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October 27, 2010
Terrorists On the Move With New Flexibility in Target Size and Selection
Planning attacks which require large numbers of participants using sophisticated weapons are by their own nature risky. Past plots which were too ambitious, adding one more plane to a series of aircraft attacks, led to the undoing of the entire operation.
The changing face of terrorism is accompanied by changes in strategy and increases in the number and location of those who would do us harm. Open source information has revealed these evolving changes for years.
As much as I would like to think that the delivery of my book (mid-July, 2010) to key members of the Senate and House Homeland Security Committees was the catalyst for the renewed interest in Cesium137 in America's hospitals as a real terrorist threat, it is probably not the case.
Ironically, years of sharing our concerns with the Hill over the issue was trumped by the unfortunate closing of St. Vincent's hospital in NYC and the reality that one must secretly relocate the hospital's dangerous blood irradiation device. As tragic as the loss of healthcare to patients in the area, it did prove to energize the system to address this long standing threat.
Soon after the 9/11 attacks, federal authorities alerted the nation’s largest clustered healthcare systems that they had been identified as targets for terrorist attacks. The Veterans healthcare system was warned that their hospitals were viewed as soft military targets for future attacks.
Serial attempts to secure sensitive information from hospitals across the nation is well documented. Warnings were sent to the industry to alert them that imposters posing as hospital surveyors were seeking information about their operations. Special interest was focused on nuclear medicine and pharmaceutical stockpiles. There were no common elements in these intrusions relative size, geography, specialties, only that they were hospitals.
Early purchases and thefts of ambulances and emergency vehicles have been replaced by the less risky practice of “cloning” them for use as delivery platforms for any manner of bomb delivery, suicide or non-suicide attacks.
The threat of a small group of terrorists storming soft targets, with or without insider help (but with a real probability of such help), has been a concern for years.
The very nature of hospital operations make them soft and desirable targets for small group terrorist attacks apart from the attraction to create a dirty bomb with radioactive materials. The new hospital building boom has seen few attempts to use the “mother of all mitigation in reducing vulnerabilities” design and construction to make them more robust and less exposed to all-hazards, both natural and man-made).
Hospital security forces are under-staffed, under-trained and under-equipped. The recent Johns Hopkins and Creighton hospital active shooter events speak for themselves. Statements made by the experts on the scene did not speak well for a comprehensive understanding of the fundamental issues facing such facilities.
The notion that 400 unarmed security officers is any match in a “Mumbai like attack” with a choice of 80 entrance points is folly. The availability of 150 armed off-duty police officers may be useful if the attackers are intercepted on their way from the harbor but when the terrorists are on the inside and armed forces are on the outside, a grim picture presents itself. Russia suffered one of its most humiliating political defeats with Chechen terrorists in the negotiated solution to the Budyonnovsk hospital hostage incident and cost two ministerial officials their jobs.
Some may cling to the myth that the hospital is a “safe haven.” In reality hospitals are very dangerous places. Try convincing the hundreds of patients and caregivers in New Orleans who were abandoned by the healthcare system during Hurricane Katrina. Hospital officials had three days of advanced warning and Exercise PAM to guide them to the decision to “protect in place or evacuate.” Many of the victims looking for a surge “safe haven” found only rejection from within the organization. Nurses were ordered to provide for only those patients who were registered at the time the hurricane made landfall. There was little comfort in the “safe haven” inside and no place to go, with domestic terrorists in the streets and gangs hijacking relief supplies.
Many hospitals across the nation find metal detectors an indispensible tool in their war against violence and mayhem adding an extra measure of protection for their stakeholders .
Metal detector use in the healthcare environment is a hard sell to the C-suite. One of many examples in which the C-suite was persuaded to use the tool was in a mid-west hospital with increasing violence in the ER. One month’s catch numbered over 500 weapons capable of inflicting irreparable damage to stakeholders, firearms, knives, razor blades, etc. Continued use across the campus became accepted practice.
International terrorists may have to queue up behind a long list of folks already in the country. Years of failure to protect the nation's borders has allowed for the uncontrolled flow of potential terrorists to set up cells across the United States. In their book Lightning Out of Lebanon, Tom Diaz and Barbara Newman reveal a tale of almost twenty years of infiltration of Hezbollah groups into the U. S. These groups are well organized and have a well developed network of cells engaged in profitable illegal tobacco smuggling activities.
Events in the Middle East have prompted the FBI to place them on its domestic terror squad 24/7 list. An additional concern focuses on Hezbollah involvement and influence in the drug wars in Mexico. Prior to 9/11 Hezbollah had killed more Americans than any other known Islamic terrorist group.
In the next article I will look at the numbers and distribution of “Anti-Groups” and what attracts them to hospitals.
FamilySecurityMatters.org Contributor Dr. James Blair, DPA, MHA, FACHE, FABCHS, is president and CEO of the Center for HealthCare Emergency Readiness. This article was adapted from excerpts from Blair's book, Unready: To Err is Human: The Other Neglected Side of Hospital Safety and Security, which was published in June. He is also a career-retired army colonel with 28 years of active service. Among his private sector experiences, he served as VP of Hospital Corporation of America, Middle East Limited and as an independent consultant to Joint Commission International.
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