In the Ferguson, Missouri case of an unarmed black teenager killed by a white police officer, we have seen how quickly tensions can boil over; escalating from a small group of protesters to a full blown riot in the space of a few hours, and even minutes. Politics aside, the first lesson here is that this kind of thing unfortunately can happen anywhere, urban or suburban. The second is that mass casualties can result very quickly, ranging from respiratory irritation to contusions, to burns, to gunshot wounds. As usual from a healthcare security perspective, the most dangerous place in the hospital is the Emergency Department; it is surging and starting to overflow with visitors. In this scenario, we imagine casualties coming into the hospital from both the community and law enforcement, along with family members and other visitors. Immediate questions that come to mind include:

• What is the Access Control Protocol? Parking Lot and Perimeter visitor surge?
• Will visitors be segregated?
• How can we prevent weapons from coming into the hospital during the surge?
• Roles and Responsibilities for physical security in the ED – employees and contractors?
• What triage protocol will be followed? Who will explain it to those whose family members are in line for care?

While these challenges are not new, they are very timely for two important reasons: The first is that we have probably yet to see the peak of unrest in St. Louis County Mo., and the second is that new CMS regulations that will mandate Emergency Preparedness Standards for all service providers who seek reimbursement from Medicare and Medicaid.

What Happens Next in Ferguson?

We mentioned above how quickly things can escalate on the ground. As the next steps in the legal process unfold in St. Louis, there is a high probability for violent demonstrations and quick law enforcement response regardless of the outcomes. Two obvious flashpoints, not limited to St. Louis, are the grand jury decisions to indict or not to indict, and if indicted, the ruling of the jury.

There is a window of opportunity for the healthcare community to begin preparing for this known threat. Both Defense and Prosecution will delay the Grand Jury to gather additional information to meet their objectives. For example, a toxicology report may or may not be used, although information selectively leaked to the press suggests that Michael Brown had marijuana in his system.

In terms of community tension and managing the crisis from a communications perspective, the authorities have fanned the flames by not being transparent in all details of the case. For example, if the officer was attacked and seriously beaten by the 6’3, 300 lb. teenager as some rumors suggest, why hasn’t that come to light? We know a crime scene investigation is required but why was Michael Brown’s body not transported by an ambulance and why not sooner after the shooting? And what is the actual chronology of the alleged strong-arm robbery and the radio call to the field; was the officer responding to a legitimate description from the robbery? As we can see, all of these natural questions work in favor of the victim because without information, the narrative begins to take on a life of its’ own and the community agitates for more information, resulting in escalating violence and ultimately forcing the top law enforcement official in the nation to make a personal appearance to calm things down and reassure the public that justice and accountability will prevail. There is a lesson here about crisis communications and lack of transparency; the longer you take responding to an escalating event, the more likely that (even good) arguments will be dismissed and be insufficient to calm public opinion.

Are Hospitals Prepared for the Worst?

Back to the point, there are at least two more flashpoints here: The Grand Jury findings and the jury verdict for the police officer, if there is a trial. The grand jury in this racially-charged situation is comprised of 9 Caucasians and 3 African Americans, appointed by the local District Attorney, who has been portrayed by many Ferguson residents as being biased for personal reasons, according to the New York Times.

Our question is whether the local hospital systems have the Emergency Plans and situational awareness to respond appropriately to the civil unrest that will almost certainly break out regardless of these outcomes. Another simmering issue here is that Missouri law allows for law enforcement to respond with deadly force during the commission of a felony crime, according to the Washington Post.

The clock is ticking on both of these pending legal decisions – it is reasonable to ask how the large hospitals in the Ferguson area have updated the Emergency Management and Operations Plans to account for these known threats. Given the lack of information made public, it is very difficult to predict what will happen, but we can be reasonably sure that it is going to be a long summer in Ferguson.