Jeff Hamilton 2016 200x300The following is part of a larger paper by Firestorm Principal and Nexis Preparedness Systems CEO Jeffrey Hamilton. To read the full paper, please download here.

California Senate Bill 1299

The new law provides more comprehensive work place violence plan requirements for health care facilities with an emphasis on reporting, education/awareness, and systems for investigating incidents with coverage beyond just emergency rooms and other high risk areas.   These elements are focused on prevention and identifying areas for improvement.

It seems more frequently we are seeing instances of workplace violence in the news, especially those that involve an active shooter that are sensationalized in the headlines. The media and Internet coverage of recent events have amplified the fear level and the expectation that the workplace can respond appropriately to keep employees safe. As the news reporters descend, people seem to emerge from the woodwork with anecdotal observations of “clues” that seem to show hindsight is 20/20. Could these instances of violence be mitigated or addressed before they result in violence?

Patient attacks with pipePeople do not just snap. There are warning signs, red flags, cues, signals – but often they are not considered to be of a serious nature, so they are not reported. Whether violence or cyber-bullying, warning signs and indicators exist. Missing recognition of behaviors of concern or failing to listen to what is being said empowers escalation to violence. Preventing a gun from entering the workplace and thwarting an act of violence before one occurs is a critical intelligence planning responsibility for every company. The earlier a problem is detected, the less impact it will have.

The Critical Incident Response Group of the FBI categorizes workplace violence into four main areas, specifically:

  • Type 1-Violent acts by criminals – perpetrators with no apparent connection to the workplace whose intent is to commit robbery or some other crime.
  • Type 2- Violence directed at employees by customers- those include clients, patients, students, inmates or any others for whom an organization provides services.
  • Type 3- Violence from current or former employees directed at a co-worker, supervisor or manager.
  • Type 4- Violence from a non-employee that has a personal relationship with an employee.

Health care workers are especially at risk for Type 2 events, nurses in particular.

Healthcare workers and social workers, according to the Bureau of Labor Statistics, are five times more likely to be a victim of workplace violence assaults than any of the other major industries combined.

Of those acts, almost 75 percent are from a patient of the facility. The violence has moved beyond the Emergency Room and Psychiatric Units to all areas of the health care facility.

15_0702_S4_july4In October of 2014, California Senator Alex Padilla introduced SB 1299 that was sponsored by California Nurses Association/National Nurses United and was signed into law by Governor Jerry Brown. Currently, final standards are being developed and due out October 2016. Previously, safety training was only required for emergency department staff, while violence prevention programs were only required for emergency departments and other high-risk areas. The new law provides more comprehensive requirements with an emphasis on reporting, education/awareness and systems for investigating incidents with coverage beyond just emergency rooms and other high risk areas. These elements are focused on prevention and identifying areas for improvement.

The aim of every health care facility should be to create a culture where safety from violence is a common goal of both employees and leadership. To achieve such a culture, warning signs must be recognized and understood; everyone must know how to report behaviors of concern; there must be procedures in place to investigate when there are concerns; and trained employees must know when to conduct a behavioral risk assessment and possess the necessary resources. These are key elements that CA SB 1299 seeks to put in place.

This full paper discusses in greater detail:

Elements of A Robust Workplace Violence Prevention Program

Security in HospitalsFor an overall program to be effective and act as a solution, the following components need to work together as an integrated and comprehensive solution:

Awareness – First and foremost, creating overall awareness within the organization is essential. Training employees and supervisors to recognize behaviors of concern will assist in identifying issues and key indicators before they become an issue that manifests itself in a violent act. Equally important will be to not only identify behaviors that result in violent or aggressive behavior, but to identify those behaviors that are indicators of emotional and suicidal issues. CA SB1299 specifically calls for “education and training policies” to “recognize potential for violence.”

Intelligence Network – Through awareness, it is important staff members recognize behaviors of concern and also feel there is a culture of “see something, say something.” Establishing an Intelligence Network will provide a source for identifying and documenting behaviors of concern. One of the provisions in CA SB 1299 specifically addresses “prohibiting hospitals from disallowing an employee from, or taking punitive or retaliatory action against and employee for seeking” outside assistance from law enforcement.

Repository of Information – A critical weakness in many programs is the inability to assess multiple reports to identify patterns of behaviors of concern or see early indicators of future events. CA SB 1299 specifically calls for annual reporting accessible to everyone.

Investigation and Threat Assessment – Left to an individual supervisor and without the proper training of assessing threats, a situation may not be handled correctly or recognized in terms of severity.

Case Management – Action Plan and Monitoring

The Threat Assessment Team should be responsible for gathering the necessary information to develop and implement interventions that will address behaviors of concern. Strategies selected will have the highest potential for long-term prevention.

Other Key Program Elements

HR Policy & Procedures that are specific requirements of CA SB 1299.


Site Security Assessment – A thorough review of the site’s physical security and procedures is an important aspect to control access of non-approved individuals on site and to monitor employee’s safety entering and exiting the facility.

Emergency Response Plan – As with any emergency response plan, training and drills are essential in orienting staff on how to act during a crisis and to identify areas of improvement from post-event, after-action reviews.

To read the full paper, please download it here, and thank you!



Since 2005, Firestorm has assisted clients by responding to some of the largest and most complex critical incidents. Our highly-trained team is an industry leader in providing custom safety and security solutions. Firestorm empowers its clients to manage security risks through assessments, audits, program development, training and advisory services using our PREDICT.PLAN.PERFORM.® methodology.