African American hand pressing red SOS button
A better way to protect your field staff in uncontrolled workplaces
by Louis Kirby

At around 1 a.m., a home hospice worker had just pronounced her patient deceased. The patient’s husband, who had been drinking, was holding a large knife and screaming as he approached the worker. What did she do—and what options would your home health caregivers have under the same circumstances?

The default safety option for most home health providers is a cellphone. Do you think a phone-based solution would have worked in this situation? Even if the provider’s phone was within reach and she had the presence of mind to unlock it and deal with the screen, it could have escalated the confrontation. A cellphone is a great communication tool, but it’s not an effective safety solution when an emergency happens.

So what did this hospice provider do? She pressed an SOS button on a small safety device in her pocket without needing to look at it or lose eye contact with her patient’s husband. A call immediately went to a nationwide dispatch center operator, which listened in and immediately dispatched the police to the provider’s GPS location. Five minutes later, police arrived to diffuse the situation—and the hospice worker went home safe.

The Scope of the Problem

According to a 2016 article in the New England Journal of Medicine, “health care workplace violence is an underreported, ubiquitous and persistent problem that has been tolerated and largely ignored.” Employers are often unaware of the prevalence of threats because they are historically underreported. As few as one in five events are disclosed to the employer.

But the danger is real. A national study reported that 61% of home health care workers face violence ranging from verbal abuse and threats to assault. Home health workers also confront risks from the surrounding community, including robbery, car theft and vandalism.

To make matters worse, violence against health care and social service workers has been exacerbated by the COVID-19 pandemic. A 2020 survey conducted by National Nurses United found that 20% of registered nurses reported increased workplace violence during the public health emergency. The consequences of exposure to workplace violence over time can be severe, resulting in PTSD, depression, anxiety and loss of work.

Tools to Keep Workers Safe

New technologies are now available that substantially increase the safety of home health care providers and their sense of security. With the press of a button, an injured or threatened employee can immediately summon emergency services to their location. This can prevent or mitigate injury for field staff. Mobile worker safety systems have multiple capabilities that not only get emergency help to your mobile workforce quickly, but can also help you satisfy important regulatory and risk management requirements.

While mobile worker safety systems share one or two features in common with electronic medical record-based (EMR) GPS systems or electronic visit verification (EVV) systems, the functionality of these systems is entirely different. Even if you have a “check-in” option on your EMR or EVV app, a lot can happen before anyone notices your worker is delayed checking out.

A robust safety environment gives your mobile workforce an added sense of security, which can translate into tangible benefits for the company. One nationwide home health client stated that their turnover decreased from 34% annually to 17% after they rolled out a company-wide workforce safety plan, which included a safety solution for their mobile nursing workforce. They now view their workforce safety system as a strategic recruiting and retention tool and believe it differentiates them from other companies during the hiring process.

California has considerably stricter health care worker violence protection provisions than most other states or the federal government, but that may be about to change. The Workplace Violence Prevention in Health Care and Social Services Act 
(HR 1195) was introduced in the U.S. House in February 2021 and is expected to be passed into law. The act will require all health care organizations to adopt workplace violence prevention plans and techniques that enable them to respond in the event of a violent incident. The new federal legislation covers workforce violence prevention solutions for both home health care and social services workers in much the same way the California law does. Mobile worker safety solutions will be required to comply with these enhanced home health care provider regulations.

Some of the features your organization should look for in a mobile worker safety solution are outlined in the checklist below:

Ease of Activation

The best-in-class solutions use a simple SOS button press that can be triggered without looking, so caregivers can discretely signal for assistance without escalating a confrontation. In an emergency, a worker is under extreme stress and cannot remember an unlock code, where to pull up the emergency button on an app or how to deal with a screen.

Two-Way Voice Calling

Signaling for help with two-way voice communication enables the emergency operator to listen in and assess the situation. If they are able, the worker can give the operator more detailed information (“I’ve slipped and broken my leg”). Unlike with a cellphone, once a device is activated, the worker’s hands are free, which is important in dealing with whatever situation may arise, including working on a patient in acute medical distress.

Trained Emergency Dispatch Centers with PSAP Technology

The best-of-class monitoring centers are able to dispatch the appropriate emergency services to the worker’s exact location, saving critical time. Public-safety answering point technology, also used by 911 call centers, identifies the nearest EMS or police for the fastest response.

Companion Service

Some systems will allow a worker to call the dispatch center whenever they feel uncomfortable and have the operator stay on the line until they get to safety. A worker who is walking across a dark parking lot to their car at night can call the dispatch center and ask them to stay on the line until the worker gets into their car and feels safe.

Cloud-based Portal

This is the control center. Look for it to include a map with the current and past locations of your workers. In addition, the portal should be easy to use and offer customizable features including various settings for alerts, privacy options, notification zones and more.

Accurate GPS Location Transmitted Directly to a Monitoring Center

An important capability of the portal is that the GPS location is connected directly to the monitoring center’s screen to be displayed with an SOS call. Many 911 centers do not have this capability and must use far less accurate cell tower triangulation.

Risk Management Features

The best systems have the ability to simultaneously alert the designated managers through email or text message each time a worker signals distress. This is important for real-time follow up and
also aids in post-event analysis and regulatory reporting.

Privacy Options

The best safety solutions provide the organization with various location reporting options, including the ability to limit the time periods during which the employee’s location is monitored, or even to eliminate all location monitoring unless the employee initiates the reporting request by pressing the check-in or SOS button.

Zone Alerts/Threat Zones

The system should be capable of noting whenever the worker enters or exits zones that have been set by your company around specified areas, particularly areas of known danger. This type of proactive alerting notifies a worker of a potential hazard before entering a residence, mitigating risks and helping you satisfy Occupational Safety and Health Administration requirements.

Mass Notification

Some systems have mass notification capability built in. In an emergency situation, minutes matter, and a company’s immediate ability to communicate clear instructions to its workforce can make all the difference. Best-in-class systems will allow you to send critical messages to your entire organization within seconds.

Audible Alarm

The latest safety wearables will include a loud audible alarm that can be triggered by the worker if they want to draw attention.

Check In

Some safety wearables include check-in buttons so that the worker can check in with their manager from time to time.

Fall Detection

The safety wearable should be able to detect if the employee has fallen and trigger an automatic two-way voice call to the monitoring center.

Louis Kirby, MD, is a principal of AlertGPS, an innovator in connected enterprise safety technology ( He is a board-certified neurologist.