Emergency department security challenges during civil unrest: A narrative review

INTRODUCTION: Periods of civil unrest pose significant operational and security challenges to those seeking to provide emergency care to patients. For emergency departments (EDs) and their staff, effectively operating in this potentially hostile environment requires careful planning. Understanding the challenges posed during periods of civil unrest is paramount for emergency medicine staff and emergency planners to ensure continuity of care. OBJECTIVE: To provide ED and hospital staff with an understanding of the challenges faced during periods of civil unrest and to offer recommendations to maintain safety and operational viability. DISCUSSION: Preplanning before any anticipated civil unrest is essential to a well-coordinated response. During the period of civil unrest, maintaining effective communication between command elements and clinicians in the ED is vital to ensure bidirectional sharing of information. Deviations from normal operating procedures should be expected and relayed to clinicians as quickly as possible. Similarly, staff may need to shelter in place or relocate to a more secure area within the hospital. Civil unrest is highly dynamic, and hospital leadership must follow developments closely to protect staff and facilities. CONCLUSION: This review provides ED and hospital staff with an understanding of the significant challenges during periods of civil unrest.