Physical Abuse in EM

[gahessd]

I haven't personally felt/experienced/heard of any doctor/student being physically assaulted during a patient encounter, but being a prospective MS4 5'4" 120lb female I thought I would ask if any of you have had any experience with an aggressive patient. And how common is it in your work place or in the specialty in general? Security at my ED does a good job of creating a safe environment.

I am well aware of and can comfortably handle the rampant verbal abuse.

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[DeadCactus]

I would describe it as not unheard of but rare. Be polite, practice sound personal protection (keep distance, position yourself with an exit, leave if you feel uncomfortable, have security if needed, etc), and remember that you are paid and trained to think not to wrestle combative patients. Frankly, I worry about my personal safety more when out in public (or even on other services) where I don't have a security team and swarm of co-workers to back me up if a drunk gets belligerent. The only major security issue I've been around to see was not in the ED and even then it was a lot of drama but no one was hurt...

 

[julie29524]

Been in ED for 3 years now. Never had an incident, always see psych patient with a RN/tech if security is not already by bedside.

And in a angry patient with underlying psychiatric problems who is stretching like he is about to fight you, I've found offering them something or doing something nice for them usually calms them down by 50%, like offering them a blanket, some food, etc. etc.

Had a case in my shop when psych patient grabbed a ED doctor's hair and wouldn't let go, luckily, surgery resident and attending tackled the psych patient and controlled the situation pretty fast. So don't be out of sight with the door closed, or in a blind spot, etc. etc.

What worries me daily in EM a lot more than violence is:
- stepping in pee (happened multiple times)
- needlestick injury
- pus in eye, hair, or any place really
- blood get on scrubs

Violence is a distant last, but should still be prepared.

 

[Birdstrike]

Just google, "doctor assaulted in er" and enjoy the reading. Then try, "nurse assaulted in ER."

For me it never has gotten beyond threats, having to get security/PD involved or the typical Friday night "spitter," but you have to realize that when the world converges on a psychotic, cracked-out, violent, drunken, homicidal manic, they do in fact call 911.

That's you.

 

[gahessd]

Thanks for the responses. I assumed as much. Usually its pretty easy to spot the violent px and get security.

 

[Old_Mil]

Security these days tends to be unarmed rent a cops. Near where I used to work a disgruntled patient shot and killed a nurse and fired on an ep after their shift.

Although they are in the minority, there is a population of people who are crazy, drug users, and drug dealers who view you as their supplier.

Working in this field, I think it is important to keep your home address off your state licenses, federal / state DEA and so on. You can either use your work address or a PO box.

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[emtthink]

I'm still working in EMS during my 3rd year of medical school. Last night I had a psych pt try to back hand me in the face, luckily I saw it coming and was able to get control of his arm before he made contact. That being said it is rare for this to happen, but you learn to never let your guard down.

 

[Birdstrike]

Security these days tends to be unarmed rent a cops.

If you tried to tell me some of these rent-a-cops were on a work release program from the nearest nursing home, I would not question it for a second. One place I worked at, admin had as an official policy that the one thing security couldn't do, was to actually touch a patient. They were worried about liability, and getting sued if a patient was hurt. So many patients try to sue cops with the typical, "I have chronic wrist pain after I was handcuffed" or "I have chronic back pain after they restrained me."

Regardless, I generally always felt as safe or safer in an ED than anywhere else. That being said, when you're alone in the room with a psychotic patient, all bets are off. If a patient is drunk, high or coked up...all bets are off. But generally, everyone is so used to the malarkey that's it's snuffed out right away.

I think you're in as much danger in an ED as you are in a Walmart. The problem is that is a non-zero level of danger, unfortunately.

There are crazies everywhere, but in the ED, you're ready. What I worry about more is being in some public place, with my kids and everyone's guard is down and some lunatic tries to pull some shenanigans or go postal.

 

[gro2001]

I haven't personally felt/experienced/heard of any doctor/student being physically assaulted during a patient encounter, but being a prospective MS4 5'4" 120lb female I thought I would ask if any of you have had any experience with an aggressive patient. And how common is it in your work place or in the specialty in general? Security at my ED does a good job of creating a safe environment.

I am well aware of and can comfortably handle the rampant verbal abuse.

Situational awareness is key. Same as mentioned above: don't let a patient stand between you and the exit. Keep a distance greater than the patient's arm span when they are drunk/high/psychotic/belligerent. Don't get into shouting matches with people. Have a relatively low threshold to treat someone's anxiety/agitation/psychosis with medications. Don't let angry belligerents endanger you or your staff: either security escort out the door or if it's not an option (because they need medical attention) then sedate them. Become comfortable with a wide array of sedating medications and have your go-to drugs for various situations. Don't negotiate with terrorists. Make friends with the security guards. Stay safe.