part 3 about “thrashing” of healthcare workers in Nepal – building design

Part three of a series

Be sure to read parts 1 and part 2. The threat of violence against health care workers in Nepal is real.  CCNEPal has always addressed this issue in our training. In fact, people say that the part where we cover this has been just as useful as going over the actual protocols. I’ve been sharing all the info about ways to keep safe.

This section of the series may be boring to some, but it is a way to minimize the problem.

Part of the answer is – build the building in such a way as to discourage the things you don’t want. Many hospitals are already doing this. If you know what to look for, you can see for yourself. This should be part of every employee’s orientation.

I did a websearch on security. The most comprehensive review is a pdf from which gives excellent instructions on how a building can be secured.

at the end of that booklet, there is a checklist of items to assess. Here it is:

48 Secured By Design Checklist – Hospitals

Please tick appropriate boxes

Campus Layout

 A secure boundary equivalent to 2m high paladin, weldmesh or similar. Note – Unless particularly dense and well-developed soft landscaping (i.e. hedging) is not acceptable. (Defensive planting in addition to secure fencing is encouraged)

 Entrances to be strictly limited.

 Entrances controlled by gates of similar construction or security rating to boundary treatment. There shall be no unobserved access or escape routes to or from the hospital.

 All access points clearly signed including clear directional information to key areas (i.e. reception)

 Reception area and main entrance shall be in close proximity with the route between clearly signed and controlled.

 Direct access to children by visitors to be monitored. Babies and children should be tagged.

 The site arranged to maximise natural surveillance of all external spaces including entrances, car parks, cycle storage and main circulation routes.

 Buildings arranged on the site to avoid creation of unobserved areas.

 Recesses and complicated plan shapes that can conceal criminal activity from surveillance shall be avoided.

 External lighting and landscaping proposals considered together to maximise natural surveillance and avoiding hidden, shaded areas.

 Landscaping materials and external furniture i.e. litter bins and seating, to be robust so as not contribute to the crime risk.

 Avoid climbing features that provide unauthorised access to roofs or vulnerable windows

 Secure bin store area away from buildings.


 Lighting provided to all entrances, recesses, movement routes and car parks.

 External lighting levels to be to BS 5489 Part 9.

 Light fittings shall be vandal resistant and easily maintained

 Lighting mounted at a height that allows best spread of light, without shadows and reduces vulnerability to vandalism.

 Lighting to be compatible with landscaping

CCTV System

 Designed fit for purpose – facial identification, general surveillance or management, quality of pictures checked to ensure suitability.

 Monitored on site or by remote station.

 Cameras, wiring and recording or monitoring equipment secured.

 Robust with easy to maintain components.

 Designed in coordination with external lighting and landscaping.

Building Design Generally

 Low or flat roofs to be avoided, use simple roof shapes that do not provide hiding places as seen from the ground and are not accessible to unauthorised persons.

 Roof materials and construction to provide a robust and secure construction with roof glazing, service openings and plant rooms protected.

Secured by Design Hospitals 2005 Page 18

 No climbing aids. (Check rainwater down pipe design, low canopies over entrances and roof eaves details).

 Simple plan shape is without recesses.

 Entrances kept to minimum number (preferably one).

 Fire escapes secured and controlled – see fire doors below.

 Avoid surfaces vulnerable to graffiti that are difficult to maintain and keep clean.

Entrance Doors

 All door sets to BSI. PAS 24. Specialist entrances using composite sets to achieve equivalent standard.

 Glazed panels in and adjacent to doors to be minimum 6.4mm laminated glass.

 Solid doors giving access to the public shall have a door viewer fitted at 1500mm above floor level.

 Fire doors without external door furniture. Each fire exit must be protected by an intruder alarm.

Letter Boxes

 Letterboxes shall be installed ‘through the wall’ to discharge into a secure and fireproof chamber. Installation shall comply with Post Office recommendations.


 Windows shall comply with BS 7950. 6.4mm laminated glass shall be used in all ground floor windows and vulnerable, easily accessible windows at other levels.

 Locking devices and opening restrictors shall be fitted to all ground floor and other vulnerable windows.

Roof Lights

 Roof lights shall be robust and use polycarbonate materials and where necessary with internally fitted steel mesh or grill.

Intruder Alarms

 An intruder alarm system shall be installed in compliance with ACPO Security policy.

Management practice

 A security file shall be created and maintained. Policy Statement in respect of hospital security should be put in place and displayed in a prominent position.

 Visitor Control procedures to be established.

 Contractors working procedures established and activities logged.

 Surveillance including CCTV and patrolling procedures established and recorded.

 Property marking record maintained.

 Crime Log and Police Contact Records maintained.

 Cleaning and repairs recorded.

NB Developers/architects should liaise at the earliest opportunity with the ALO / CPDA, who can provide useful advice from the outset in respect of Secured By Design – Hospitals, the potential crime risks and recommendations to constitute an approved design.

Every nurse and doctor needs to take an interest in the above.  Don’t assume that the hospital administrator has magically taken care of it.

One further step – Important

Having a secure building helps, but it doesn’t cover everything.

Here is a video from USA that describes how security guards work in that country.

and another one that tells what it is like to be a guard in USA.

In the above, “visitor control procedures established”  is on the list. We’ll go over that in the next blog.


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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4 Responses to part 3 about “thrashing” of healthcare workers in Nepal – building design

  1. Pingback: part 4) De-Escalation skills for Critical Care nurses and doctors in #Nepal March 31st 2015 | CCNEPal 2015

  2. Pingback: part two of debriefing video is now on YouTube July 25th 2015 | CCNEPal 2015

  3. Pingback: Hospitals in Nepal Terai and elsewhere need to keep their workers safe Sept 2 2015 | CCNEPal 2015

  4. Pingback: Two doctors thrashed at Patan Hospital Sept 10, 2015 and what to do about it | CCNEPal 2015

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