If you spend too much time on YouTube, or worse, believe the constant stream of tactical PSD fantasy being pushed, you might think Executive Protection (EP) is all about skinny-jeans-wearing operators toting M4s while glaring menacingly from behind aviator sunglasses. The truth is far less glamorous and much more grounded.
Even if there were a perfect one-to-one correlation between physical attacks and medical emergencies for protectees or your team, you’d still have to account for pre-existing medical conditions and accidental injuries. Statistically, you’re at a much greater risk of encountering a medical issue than experiencing any “John Wick” moment. Sorry (not sorry), social media influencers. This reality is reflected in a growing trend among corporate security teams: training select personnel as EMTs in recognition of what the job demands.
As protectors, we plan for the worst and implement detailed mitigations to avoid or prevent every perceived threat. Whether you call it Travel Safety, Protective Advance, or simply Logistics, your operational planning may save lives. While every part of your planning is important, one of the most overlooked yet essential pieces is the Hospital Survey. While our protective operational planning is designed to prevent situations requiring medical care, sh!t happens, and we may end up in a hospital whether we want to or not.
Protective advances at hospitals, both domestic and international, present unique challenges for Executive Protection (EP) teams. Unlike government buildings or private venues, hospitals are publicly accessible, continuously operating environments that prioritize patient care, accessibility, and privacy, which can sometimes complicate and hinder protective operations. Whether the visit involves a public figure meeting with patients, a CEO receiving medical treatment, or a VIP touring a facility, conducting a thorough Hospital Survey is essential to ensure both safety and operational success.
This article outlines the key components of an effective hospital advance, from initial intelligence gathering to coordination with hospital security and emergency personnel. The goal is to create a safe and logistically efficient visit while minimizing disruptions to the hospital’s mission and maintaining discretion. With a structured, professional approach, EP teams can navigate the complexities of the changing medical environment while maintaining a posture of readiness for any contingency.
Pre-Advance Preparation
Prior to your protective visit, there is significant medical planning and logistics you can complete. Much of it is intelligence gathering and identifying available medical resources. Assuming you have your protectee’s medical history, current medications, and medical care preferences, your next step would be the selection of a primary hospital. Because of the internet, much of your selection process can now be done before you arrive.
I routinely use the free application “findERnow” to review possible hospital selections and service providers before a protective visit. The application is excellent in identifying routes from selected sites and identifying medical resources for the hospitals in a map format. This allows me to narrow hospital selection to one or two hospitals and saves valuable time on the ground. I conduct Hospital Surveys on every protective visit, despite time on the ground, and location, even when there are significant medical resources available through emergency systems like 911 (country-specific).
It’s important to understand that the system used in the United States to rate trauma hospitals based on their care is not always the same in overseas locations. A Level 1 Trauma Center (the highest care rating) in the Middle East may not be rated as a Level 5 Trauma Center in the U.S. (Trauma Center Levels Explained – American Trauma Society). There is also the consideration that many overseas hospitals are based on Social Medical Care systems. This means that your protectee waits in line behind 45 other patients in an ER until a doctor sees them. There is also the additional issue of payment for medical services. Some overseas hospitals will not accept American insurance coverage for services and require payment in cash or by credit card. It is imperative that you know the hospital system, services, and payment methods in the area you’re operating in.
On the Ground Walk-Through
I conduct the Hospital Survey during my route planning and after the Airport, RON, and Site Surveys. “When” you complete the survey is less important than just getting it done. I rarely make an appointment for Hospital Surveys and just conduct it as if I were going to the hospital from one of the scheduled venues in my visit. Protectors should always run the hospital route from “every” site in a protective visit and know the time and distance to the hospital for planning purposes. If you have ambulatory care near a venue, it doesn’t make sense to drive 20 minutes to an ER. Knowing the time and distance helps you make informed decisions before emergencies happen.
I always plan routes to the ER door/entrance of the hospital and have assigned security drivers to run the route with me. I am fortunate that everyone on my team is an EMT, but if I’m going to the hospital, it’s always a worst-case scenario. When planning your arrival:
- Select the primary arrival and entry point (ER)
- Know if the entrance is accessible for motorcade or vehicle drop-off
- Know if the entrance has ADA support and/or stretcher access
- Know if the entrance has a HAZMAT area before entry
- Know if the entrance has posted security or access control
- Know if the entrance is accessible only for emergency services
Once I arrive at the hospital, I initiate contact with the check-in receptionist or nurse and identify myself and the purpose of the visit. Explaining the purpose of your visit is sometimes confusing for the staff unless they’ve had a Presidential visit in their city, but eventually, I usually work my way to the Nurses Station and the Director of Nursing (DON). Most international hospitals have staff who speak English, but have a plan for translation services just in case. During this initial meeting with the DON, I identify the purpose and duration of my protective visit (without identifying my protectee) and request personal contact information (cell phones or direct lines) for:
- Hospital Director of Nursing
- Hospital Security Director or 24/7 Security SOC
- The Direct line for the ER Nurses Station — This is the most important number you can get. Calling this number to alert medical staff before your arrival, during a medical emergency, could save a life
- The Hospital Chief of Staff
- Contact Information for EMS Services that use the Hospital
Most hospital staff, including DON’s appreciate your attention to detail and pre-planning, and are usually very helpful unless they are very busy. Be organized before going to the hospital so you don’t waste anyone’s time. Remember, your interactions with hospital staff may impact future visits, so be courteous in all your communications.
During this initial visit, I usually ask for the DON or one of their staff to aid me in understanding the interior flow of the ER and the patient triage process. Knowing what happens and when is why we conduct the surveys in the first place. I also ask how payment for services is made and if priority treatment is available. I have been to countries where “dollars” determine your place in line, so it’s always good to know. During this initial walk-through, I evaluate the following areas:
1. Route to Immediate Emergency Medical Care
Triage area and HAZMAT (HAZMAT may be outside the ER)
Security presence at entry points
Path from entry to treatment area
Egress options in case of emergency
2. Secure Holding Area
Identify and assess a private, secure space for the protectee if needed
How many ER treatment areas are available
Communications capability and physical control of access to the ER
3. Elevators and Stairwells
Functionality, lockdown options, emergency override access
Identify non-public or service elevators, if possible
4. Onsite Medical Support and Resources
Level of trauma care available
How many Doctors are on staff working
How many nurses are on staff working
What are the hospitals’ capabilities for care?
Does the hospital have Air Care support onsite?
Pre-identify staff for emergency support (e.g., Code Blue teams)
Are there Pediatric, Psychiatric, or High-Risk Wards on site
Does the hospital have VIP or Politically Sensitive Policies
Does the hospital have a media management plan
5. Coordination with Hospital Emergency Protocols
Understand how lockdowns, fire alarms, or mass casualty events are handled by the hospital
6. Privacy Concerns
Ensure compliance with HIPAA and patient dignity
Avoid unnecessary disruption to ongoing care, but prioritize yours
7. Radio and Cell Signals
Assess team communication coverage inside the building (especially in basements or ICUs)
8. Surveillance System
Where are cameras located and monitored, and is the coverage recorded?
9. Motorcade Parking and Staging
Identify parking for primary and secondary vehicles after arrival
Egress routes and contingencies
10. Surveillance of the Hospital’s Exterior
Is the exterior of the hospital patrolled for threats
11. Drone or UAV Threat Assessment
Ask about the hospital’s drone detection/mitigation policies (if any)
After conducting the medical review of the hospital with the DON (or their designee), I conduct a physical security evaluation of the hospital. Most hospitals have a security director, and in some cases, are staffed with law enforcement officers to coordinate with. During this review, I evaluate:
- The roles/responsibilities of hospital security and local police
- How do Security teams communicate, and is there a centralized communication hub or SOC
- What are the roles and responsibilities of hospital security teams, and are they armed
- What is the staffing for hospital security teams 24/7
- Can EP teams maintain a 24/7 presence in the hospital
Documentation and Follow-Up
Most corporate EP teams have basic documentation for Hospital Surveys and record surveys for historical reference. The purpose of creating these documents is to inform team members who didn’t attend the walk-throughs and to give EP teams advanced information for previously visited regions. If you have existing documentation or are developing a new document, ensure you include annotated maps, floor plans, key contact lists and numbers, photos of important areas, and team recommendations. The Lead Advance for the protective visit should brief travelling team members and provide routes to the hospital and contingency plans as part of their protective advance.
Conclusion
Hospital Surveys are not just a box to check; they’re a mission-critical component of every protective advance. While the hope is that you’ll never need to implement your emergency medical plan, failing to prepare for that possibility is a gamble you can’t afford to take. From understanding entry points and medical capabilities to building relationships with hospital staff and knowing how to pay for services abroad, these details can make the difference between chaos and control during a crisis. EP professionals must approach Hospital Surveys with the same rigor and foresight as any other aspect of the advance. The lives of your protectees, teammates, or your own may depend on it.
