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Lock it down

Answers in Practice

By Victoria Houghton, Managing Editor, September 1, 2020

Dermatology World talks to Jon Ward, MD, founder and president of Dermatology Specialists of Florida, about developing office lockdown procedures.

Dermatology World: You have procedures for several emergency events — not only natural disasters, but also for human threats like bomb scares and active shooters. When and why did you institute these policies?

Dr. Ward: In 2019, the Occupational Safety and Health Administration (OSHA) made a big push to get information out about other types of threats. We’ve always had a weather policy — being in Florida it’s something you have to be mindful of. When OSHA rolled out the bomb scare and active shooter situation procedures, we decided now is the time to implement these policies. Our office administrators embraced the suggestion and took the lead. They made bulletin boards with procedures for these situations that we keep in our back hallway where staff can see them, but where patients can’t.

DW: What are your procedures if someone were to phone in a bomb threat?

Dr. Ward: The first step is to call 9-1-1 if the threat is over the phone. Also, try to get as much information from the caller as possible. Then evacuate everyone from the building.

DW: What are your procedures if someone were to enter your office and threaten staff and/or patients?

Dr. Ward: This depends on the type of threat. We, unfortunately, from time to time do have patients who are unruly. Usually in that situation, we just have our nurses try to calm the patient down. However, if it’s ever a threat of bodily harm we immediately ask the patient to leave and call the authorities. If it’s a death threat, the same policy would apply.

If it was a death threat that was carried out, we activate our active shooter policy. In that case, we immediately call 9-1-1. In that situation, the goal is to try to leave the building and the situation. We also have a room in the facility that has a locked door. That’s the room that everyone knows they would try to go to if that was happening and they couldn’t get out.

Also, we do have a no-gun policy at our office. Florida doesn’t have many gun restrictions. However, our office policy is that patients, with the exception of law enforcement, aren’t supposed to bring in guns.

DW: How do you assess if someone is a threat and is going to be violent, or simply just an angry patient or visitor?

Dr. Ward: With that you just have to go by feel. If you can calm someone down, that’s ideal. We try to reason with people. We ask, 'What’s going on? What do you hope to get out of this? Obviously, you’re upset, but what do you hope to get out of this situation that would make you not upset?' If you are able to reason with someone, we consider that not an escalated situation.

DW: What have you done to ensure that your office is relatively secure?

Headshot of Dr. Jon Ward

“There is a lot to consider here: Are your doors open or are they locked? Do people have access to patient-care areas? For us, the exterior of our building is all on lock and key for off hours. The clinical area is on a keypad.”

─ Jon Ward, MD

Dr. Ward: There is a lot to consider here: Are your doors open or are they locked? Do people have access to patient-care areas? For us, the exterior of our building is all on lock and key for off hours. The clinical area is on a keypad. During the early morning or late afternoon — when patients aren’t coming in and out of clinic — if you don’t have a fob or a code to the key pad, you can’t get access to the clinical area. The genesis for this was that one of our employee’s significant others threatened harm on that employee. That made us really think about what do we do and are we secure enough?

DW: What guidance do you recommend for staff in terms of how they should behave in these situations?

Dr. Ward: Remain calm. If there’s a gun, obviously try to get away from the situation as quickly as you can. I tell staff to try to remember their training. In addition to the bulletin boards that we have up that list what to do, we go through a scenario of various situations together once every year, usually on Friday. We go through all the scenarios and role play and practice the procedures.

DW: How are staff instructed to communicate with others if there is an emergency?

Dr. Ward: Our staff verbally communicate the situation to each other. OSHA has each situation color coded. An active shooter situation, for example, is code silver. A bomb threat is code purple.

DW: What are staff instructed to do with patients (in the waiting room and exam rooms) if there is an emergency?

Dr. Ward: If you can, try to assist patients out in that situation, but I think everyone’s individual safety is going to be the main concern. Communication is the key. We tell everyone to remain as calm as they possibly can. More than anything, be prepared to act.

DW: In the instance where the office is on lockdown for an extended period of time, do you have food and water available?

Dr. Ward: We keep snacks on hand for patients as well as juice and water. We also have non-perishable items on hand.

DW: Why would you recommend that other physician offices institute procedures for these types of events?

Dr. Ward: The old adage, ‘failure to prepare is preparing to fail,’ is true. I think that OSHA has made it easy to come up with a policy and you don’t have to do it from scratch. Someone else has already done the work. All you need to do is take their system and recommendations and educate your staff on what to do in these situations. Most offices could pick a point person who could spend eight hours educating themselves on the policies. I just don’t see any disadvantages to having a policy and the staff trained.

Jon Ward, MD, is the founder and president of Dermatology Specialists of Florida and serves as managing director for the Dermatology Solutions Group.

Learn more about the Occupational Safety and Health Administration’s resources on how to develop evacuation and shelter-in-place policies.

Learn more about how to prepare for a disaster in Dermatology World.