Healthcare Security Guards Need De-Escalation Certifications

The tragic death of Andrea Merrell, a 43-year-old security guard at M Health Fairview Lakes Medical Center in Minnesota, has brought this crisis into sharp focus. On Christmas Day 2025, Merrell was fatally assaulted by a patient fleeing a medical hold. She died two days later from severe head trauma. Her death is a stark reminder that hospital security guards face dangers that require more than just a uniform and a radio—they need specialized training, proper certifications, and the skills to handle psychiatric emergencies and aggressive patients.

What Happened to Andrea Merrell

On December 25, 2025, Andrea Merrell was working her shift at M Health Fairview Lakes Medical Center in Wyoming, Minnesota. A 35-year-old patient, Jonathan Winch, had been placed on a medical hold in the emergency department. Around 5:25 p.m., Winch pushed past magnetic doors and fled the facility.

Merrell, a valued member of the hospital’s security team, responded. Surveillance footage captured Winch pinning her to the pavement in the parking lot, repeatedly striking her head. By the time first responders arrived, Merrell had severe head trauma, agonal breathing, and a very weak pulse. She was transported to Regions Hospital, where she died on December 27. The Ramsey County Medical Examiner ruled her death a homicide caused by traumatic head injuries from physical assault.

Winch was arrested after resisting officers, attempting to steal Merrell’s security vehicle, and jumping onto a police cruiser’s windshield. During his arrest, he reportedly shouted, “I didn’t mean to hurt her.” He has been charged with second-degree murder and is being held on $2 million bail while undergoing a mental competency evaluation.

Andrea Merrell was more than a security guard. She was a former corrections officer, a reserve police officer with the White Bear Lake Police Department, and a former member of the city’s fire department. Friends described her as someone who “showed up with courage, professionalism and heart” and who made patients and staff “feel safe and welcome.”

Why Hospital Security Guards Face Unique and Growing Dangers

Healthcare workers account for approximately 50% of all workplace violence victims, according to OSHA. But while nurses and doctors often receive attention when violence occurs, security guards are on the front lines of every incident—and they’re being injured at unprecedented rates.

Hospital Security Guards Are Injured Nearly Every Other Day

WorkSafeBC data from British Columbia shows that hospital security guards filed nearly 170 accepted injury claims in 2024 alone. That means a security guard working in a hospital was injured nearly every other day. Guards interviewed by CBC News described being “punched, kicked, spat on, headbutted, and bitten by violent patients” regularly.

These aren’t isolated incidents. From 2020 to 2023, simple assaults on healthcare facility staff more than doubled—from 10 incidents per 100 hospital beds to 22 incidents per 100 beds, according to the International Association for Healthcare Security and Safety’s 2023 Healthcare Crime Survey.

Psychiatric Patients and Medical Holds Create High-Risk Situations

Patients placed on medical or psychiatric holds are often experiencing mental health crises, substance abuse emergencies, or severe psychological distress. These individuals may be confused, agitated, paranoid, or violent. When they attempt to flee—as Jonathan Winch did—security guards are expected to intervene.

But many hospital security guards lack the specialized training needed to safely manage these situations. Unlike psychiatric nurses or crisis intervention specialists, guards may not have certifications in de-escalation, mental health crisis response, or trauma-informed security practices.

Healthcare Facilities Are Microcosms of Community Violence

Jeff Hauk, director of public safety for Michigan-based Memorial Healthcare, told Campus Safety Magazine that “hospitals are microcosms of the communities they serve.” Whatever crime or violence occurs on the streets—drug-related violence, domestic disputes, gang conflicts—also occurs inside hospitals.

Security guards must be prepared to handle not just patients, but also family members who become aggressive, domestic violence situations that follow patients into emergency rooms, and targeted attacks from individuals dissatisfied with medical outcomes.

What Security Guard Certifications Are Essential for Healthcare Settings

Not all security guards are prepared for healthcare environments. Hospital security demands a completely different skill set than retail loss prevention or office building patrols. That’s why security guard certifications focused on de-escalation, mental health response, and healthcare-specific threats are critical.

De-Escalation Training and Crisis Intervention Certifications

De-escalation training teaches security guards how to calm agitated individuals using verbal techniques, body language, and environmental awareness. This is the most important certification for hospital security because most violent incidents can be prevented or minimized if the guard knows how to de-escalate before the situation becomes physical.

Crisis Intervention Team (CIT) training, originally developed for law enforcement, teaches guards how to recognize signs of mental illness, understand psychiatric emergencies, and respond in ways that reduce harm. Guards with CIT certification are better equipped to handle patients like Jonathan Winch—individuals in acute mental health crises who may be confused, paranoid, or combative.

Trauma-Informed Security Practices

Trauma-informed training helps security guards understand that many patients exhibiting aggressive behavior are responding to fear, pain, or past trauma. This approach emphasizes empathy, clear communication, and creating a sense of safety rather than immediately resorting to physical restraint.

British Columbia introduced “relational security officers” in 2023 specifically to focus on trauma-informed, de-escalation-centered hospital security. However, even these specially trained officers report being injured regularly because they’re not given adequate tools or backup support.

Learn how IronWatch Security delivers resident-friendly armed guard security services and residential security patrol options that support your property’s day-to-day operations.

Our Armed Security Solutions

First Aid, CPR, and Emergency Medical Response

Hospital security guards often arrive at medical emergencies before clinical staff. Guards with First Aid and CPR certifications can provide life-saving interventions during cardiac arrests, overdoses, choking incidents, or severe injuries until nurses and doctors arrive.

In Andrea Merrell’s case, she was the first responder to a fleeing psychiatric patient. If more guards had been available, if de-escalation protocols had been in place, if backup had arrived sooner, the outcome might have been different.

Physical Restraint and Defensive Tactics Certifications

When de-escalation fails, security guards need proper training in safe physical restraint techniques. Many hospitals prohibit guards from using certain holds or force levels, yet expect them to manage violent patients. This creates a dangerous gap where guards are put at risk without the tools to protect themselves.

Proper defensive tactics training—certified by organizations like the International Association for Healthcare Security and Safety (IAHSS)—teaches guards how to safely restrain aggressive individuals while minimizing injury to both the patient and the guard.

Workplace Violence Prevention and Hazard Recognition

Many states, including California and Ohio, now require hospitals to have formal workplace violence prevention plans. Security guards should receive training on how to identify environmental risk factors (poorly lit areas, unsecured exits, inadequate staffing), patient-specific risk factors (history of violence, substance abuse, psychiatric diagnoses), and how to implement corrective measures quickly.

At Iron Watch Security, every hospital security guard holds certifications in hazard recognition, emergency response coordination, and workplace violence prevention. These certifications ensure that when a crisis occurs—whether it’s a fleeing psychiatric patient, an aggressive family member, or a targeted attack—our guards respond with the skills and judgment needed to protect everyone involved.

Targeted Attacks Are Increasing

Unlike random mass shootings, most hospital violence is targeted. A family member blames a doctor for a loved one’s death. A patient dissatisfied with treatment returns with a weapon. A domestic violence situation follows a victim into the emergency room.

In 2022, a gunman killed two doctors at Tulsa’s Saint Francis Hospital after blaming one physician for pain from a back surgery. In 2023, a security guard at a New Hampshire psychiatric hospital was fatally shot. In 2024, a physician in California was shot and killed in a targeted attack outside his medical practice.

Eric Clay, vice president of security services at Memorial Hermann Health System in Houston and past president of IAHSS, told CNN that hospitals must conduct risk assessments to determine whether arming security officers is appropriate. “There is no one solution,” Clay said. Hospitals need “layered plans” that include armed officers, weapons detection systems, access control, and strong training programs.

When Armed Guards Make Sense for Healthcare Facilities

Armed security makes sense for hospitals with:

High rates of violence in surrounding communities Emergency departments in urban areas with gang activity or drug-related crime Psychiatric units that treat violent offenders or criminally insane patients Facilities that have experienced targeted attacks or credible threats Isolated locations where law enforcement response times are long

At IronWatch Security, we provide both armed and unarmed security guards for healthcare facilities. Our armed guards receive specialized healthcare training in addition to firearms certifications, ensuring they understand the unique legal and ethical considerations of using force in a medical environment.

The Cost of Inadequate Hospital Security

Workplace violence in healthcare costs U.S. businesses over $130 billion annually due to lost productivity, medical expenses, legal fees, workers’ compensation claims, and employee turnover. But the human cost is even higher.

Employee Retention and Morale Suffer

Hospital security guards are leaving the industry at alarming rates. In 2023, hospitals averaged just 9.5 full-time security employees per 100 beds—down from 10.7 in previous surveys. High injury rates, inadequate training, insufficient staffing, and lack of support are driving guards away from healthcare security.

When experienced guards leave, hospitals are left with undertrained, inexperienced personnel who are even more vulnerable to violence. This creates a dangerous cycle where the facilities that need the best security have the weakest coverage.

Medical Staff Cannot Focus on Patient Care

Nurses, doctors, and clinical staff cannot provide quality care when they’re worried about violence. Studies show that workplace violence increases anxiety, reduces job satisfaction, and contributes to burnout among healthcare workers. When security is inadequate, medical professionals spend mental energy on personal safety instead of patient outcomes.

Eric Clay told CNN that a good security management plan “strengthens employee retention and reduces the anxiety of caregivers, which allows them to focus on care.” Security isn’t just about preventing incidents—it’s about creating an environment where healing can happen.

Legal Liability and Regulatory Compliance

Hospitals have a legal duty to protect patients, visitors, and employees from foreseeable harm. When violence occurs and security is found to be inadequate, hospitals face negligence lawsuits, OSHA violations, and regulatory scrutiny.

New state laws in Ohio, New York, California, and Washington now require hospitals to have workplace violence prevention plans, security risk assessments, and trained security personnel. Hospitals that fail to comply face fines, citations, and increased liability exposure.

What Hospitals Should Look for in a Security Provider

When evaluating security providers for healthcare facilities, hospitals should ask specific questions about training, certifications, and healthcare experience.

Do Your Guards Have Healthcare-Specific Certifications?

Generic security training isn’t enough. Look for providers whose guards hold certifications from the International Association for Healthcare Security and Safety (IAHSS), Crisis Intervention Team (CIT) training, de-escalation certifications, and trauma-informed security credentials.

What Is Your Response Protocol for Psychiatric Emergencies?

Providers should have detailed, written procedures for managing patients on medical holds, psychiatric emergencies, elopement attempts (patients fleeing the facility), and aggressive or violent behavior. These protocols should emphasize de-escalation first, physical intervention only when necessary, and immediate communication with clinical staff.

How Do You Support Guards After Violent Incidents?

Security guards who experience violence need mental health support, debriefing, and access to counseling. Providers should have employee assistance programs, post-incident review processes, and a culture that prioritizes guard safety and well-being.

Can You Provide Adequate Staffing Levels?

Understaffing is one of the biggest risk factors for workplace violence. Hospitals need enough guards to cover emergency departments, psychiatric units, parking areas, and building entrances simultaneously. During high-risk periods—nights, weekends, holidays—staffing should increase.

What Technology Do You Use to Enhance Guard Safety?

Modern hospital security incorporates panic buttons, real-time GPS tracking, body-worn cameras, and instant communication systems. Guards should never be isolated without backup or a way to call for help immediately.

Honoring Andrea Merrell’s Legacy Through Better Security

Andrea Merrell’s death should never have happened. She was a trained professional doing her job—protecting patients and staff. She deserved backup, proper protocols, and a system that prioritized her safety as much as she prioritized the safety of others.

Her tragic loss highlights what happens when hospital security is treated as an afterthought instead of a critical component of patient care. Hospitals cannot continue to place undertrained, understaffed, and undersupported security guards in high-risk situations and expect different outcomes.

At IronWatch Security, we believe every healthcare facility deserves security professionals who are trained, certified, and equipped to handle the unique dangers of hospital environments. Our guards receive ongoing training in de-escalation, mental health crisis response, emergency medical procedures, and workplace violence prevention.

We know that hospital security isn’t just about preventing theft or controlling access—it’s about protecting the people who dedicate their lives to healing others.

Protect Your Healthcare Facility With IronWatch Security

Security in healthcare settings should feel like a professional extension of your clinical team, not a reactive response to incidents. At IronWatch Security, we build plans around how your facility actually operates, then staff it with professionals who prioritize patient safety, de-escalation, and evidence-based response protocols.

Reach out to our team today to discuss your facility’s risk areas, staffing needs, and how the right security model can strengthen workplace violence prevention while supporting your mission of care.

Why Healthcare Facilities Need Security Guards with De-Escalation Certifications: Lessons from a Tragic Loss