Tuesday, September 16, 2008

Violence in the ER

I know it happens in every ER; someone gets the shit kicked out of them by a patient or visitor who is unruly and abusive, usually under the influence of drugs or alcohol, or because the voices tell them to do it. Granted it is an unpleasant and inevitable aspect of the job, but it sucks to go to work and fear for your physical safety particularly if the security guards are elderly and not in the best shape. I thank the Psuedo City PD for their always prompt response to our 911 calls.

It's no different anywhere. At my last job at Utopia Med Center, we had a 3 room psych corner which I referred to as Area 51. Each room was equipped with 1. a bed, 2. a TV behind a plexiglass screen mounted out of reach near the ceiling, and 3. a closed circuit TV. It was nice and quiet, all three rooms located behind a sliding glass door that we rarely used. Each of the three individual rooms had a door with safety glass, and internal louvers for privay that could only be operated from the outside. The only design flaw that I could see was that it was a little out of the way for the stupendously drunk, but we did have a good crop of behavioral techs or security (strapping young lads all)to assist us when required.

The integrity of the plexiglass was tested on the very first night Area 51 was opened for business. One of the frequent psychotic flyers picked up a chair and heaved it at the TV...yep, plexiglass remained intact, but the chair broke in half creating a nice little weapon. Miss Thang was treated to four point restraints with a face shield since she was unable to curtail the spewing of spit in our general direction.

One night, another patient literally launched herself at the plexiglass window in the door and...you guessed it...blew it out completely. This thing must have weighed close to 40 pounds. The window struck one of my nurses on the back of the leg, causing a very deep and painful laceration and damage to her achilles tendon which put her out of work for 1o days.

I don't know if these things run in cycles, because here at Pseudo City Med Center there has been a proliferation of violent acts. One nurse was choked near to unconciousness by a crayzee. Another lashed out with a heavily booted foot at a pregnant nurse; fortunately his aim sucked. A couple of the chronic paineurs have become bored with the usual whining and become quite threatening; one actually went nose to nose with the security guard (an ex cop, bless him) and shoved him. This act just bought him a ticket to Psuedo City police station.

This increase in violence has spread to the inpatient units. Yesterday there was an overhead page for a code green, for employee distress up on one of the floors. One of the chronic insincere detox / suicidal regulars threatened a nurse and got up in her face. She was backed into a corner of the room; this is a paricularly tough cookie, so for her to push the panic button must have meant she was shaken to the core. When an employee distress code is called, the plan is for every able bodied male in the place to respond. Unfortunately, the only able bodied males who didn't respond was security. The individual was subdued and the nurse was safe, so it all worked out.


There is a problem here. Clearly, security is used to responding to the ER, but not to the inpatient units. With more crayzees and violent individuals being admitted medically instead of to a forensic psych unit where they belong (and where there is adequate trained staff to deal with them SAFELY) the security staff is stretched pretty thin. Assuring the safety of the staff does not seem to be a priority for the the Bean counters; when an incident occurs, they are all about damage control, but it seems to be more of a case of following protocol than actually caring about what happens. Having a nurse choked nearly to unconciousness was not enough of an incentive to clamp down on violent offenders nor was the sign in the waiting room "Zero Tolerance Policy for Physical or Verbal Abuse of Hospital Personnel" much of a deterrent.

I would be happy with a Taser purchase for ER use PRN. With proper instruction, of course.