Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey

Abstract

ABSTRACTBackgroundWorkplace violence, including violent extremism, is a growing concern in the healthcare environment. Furthermore, there has been a disproportionate rise in the rate of terrorist attacks on hospitals during the past two decades. Hospitals are vulnerable targets due to their easy accessibility and their high density of patients, staff and visitors. Nonetheless, little is known about the hospitals’ awareness of these risks, and to which extent these facilities protect themselves from violent extremism and terrorist attacks.MethodsThis was a cross-sectional survey study among emergency managers of acute care hospitals in the Netherlands. The questionnaire included 42 items across six themes: demographic (hospital) data; general and emergency department (ED) access control; ED security and preparedness; online security and offline transparency; violence, terrorism and warfare; and impact of the COVID-19 pandemic. Responses were collected and stored in a secured online database, and subsequently exported to an Excel spreadsheet for descriptive analysis. Continuous data were reported as means or as medians with interquartile ranges (IQR), using SPSS. Categorical data were reported as absolute numbers and as valid percentages.ResultsThe questionnaire was completed on behalf of 33 out of 71 hospital organizations (46%), representing 38 out of 82 EDs (46%). Hospitals had broadly different policies with regards to patient and visitor registration, and the presence of security guards. Most hospitals had controlled vehicle access for the parking lot and ambulance bay, but this was not 24/7 in all hospitals. A paragraph on terrorist attacks was included in 34% of hospital disaster plans. Eighteen percent of hospitals had previous experience with acts of violent extremism and 55% of hospitals had sustained (attempted) cyberattacks. Whilst the likelihood of a physical terrorist attack was deemed low at 3.6 (median 4, IQR 2.6) on a 10-point Likert scale, the likelihood of a cyberattack was considered high at 7.3 (median 8, IQR 2.3). A significant proportion of emergency managers reported to experience an increased risk of violence since the onset of the COVID-19 pandemic.ConclusionPractice variation with regards to counter-terrorism defence measures in Dutch hospitals is high. The preparedness of hospitals for terrorist attacks or acts of violent extremism could be improved and may benefit from uniform, evidence based hospital security policies.