The Vulnerability of Public Spaces: Challenges for UK hospitals under the ‘new’ terrorist threat

Abstract

This article considers the challenges for hospitals in the United Kingdom that arise from the threats of mass-casualty terrorism. Whilst much has been written about the role of health care as a rescuer in terrorist attacks and other mass-casualty crises, little has been written about health care as a victim within a mass-emergency setting. Yet, health care is a key component of any nation's contingency planning and an erosion of its capabilities would have a significant impact on the generation of a wider crisis following a mass-casualty event. This article seeks to highlight the nature of the challenges facing elements of UK health care, with a focus on hospitals both as essential contingency responders under the United Kingdom's civil contingencies legislation and as potential victims of terrorism. It seeks to explore the potential gaps that exist between the task demands facing hospitals and the vulnerabilities that exist within them.

Unhealthy complacency: The vulnerability of US hospitals to direct terrorist attacks

“…Soft targets are those wherein large numbers of people congregate regularly, with numerous entryways, making them vulnerable to attacks resulting in a high number of casualties . Hospitals are open and public places with large numbers of people in confined spaces, many too sick or incapacitated to easily evacuate, thereby making them vulnerable to mass casualties . Thus, hospitals would make desirable targets for terrorists for reasons including, but not limited to, the likelihood of significant numbers of casualties, poor security, visibility and media impact, easy public access, and the difficulty in evacuating victims .…”

“…Two of the physicians arrested had made inquiries about working in the United States . Thus, insider threats are issues deserving serious consideration, as employees of a hospital could themselves be threats . In 2010, a plot to attack the Dayton VA hospital was thwarted; however, a rocket launcher tube was found in a dumpster on the hospital grounds…”

“…Notwithstanding the threats described herein, most US hospitals have done little to address the risk of direct terrorist attacks, and in many cases do not even acknowledge the threat . Simply put, hospitals are private corporations with little business incentive to invest scarce funds to mitigate against an attack that has not occurred …”

Information Technology and Medical Technology Personnel´s Perception Regarding Segmentation of Medical Devices: A Focus Group Study

“…Cybersecurity is today one of the most important security-related challenges for all countries, but its visibility and awareness are still limited to the public, although almost everyone has heard something about it [9]. There is a substantial security risk posed by outsiders identifying potential interactions between the interconnected elements in hospital systems and computing infrastructures, and taking advantage of poor cybersecurity to steal medical health records, deny access to health services, or cause intentional harm with these [10,11]. In relation to medical devices, it may be possible for hackers to use these in order to gain access to confidential patient data and to reprogram them to send harmful commands [12].…”

Framing the UK’s counter-terrorism policy within the context of a wicked problem

“…The result is an ongoing 'arms race' between attackers and defenders in which the terrorists seek to find gaps within organizational controls and the defenders attempt to close those gaps and further strengthen their control processes (Faria, 2006;English, 2013). In this context, terrorists are innovative and, increasingly, devoid of a constraining ethical basis for behaviour, which means that the potential range of targets that has to be defended is considerable and this impacts upon information-sharing and analysis (Drake, 1998;Boin and Smith, 2006;Asal et al, 2009 Fischbacher-Smith and Fischbacher-Smith, 2013;Fischbacher-Smith et al, 2010;Gill et al, 2013). As a result, terrorism could be seen as the ultimate wicked problem for public management due to the adaptive nature of the principal actors, the nature of communication and informationgathering, and the capability development and learning around attack strategies that has been generated in other conflict zones (and disseminated to interested parties) (Denning, 2010;English, 2013;Byman, 2014Byman, , 2015.…”