Every worry about your safety in the ED?

[Tiger26]

---

Members do not see this ad.

I always been interested in ER medicine (never really watched the show, but had a couple personal experiences there) and I was wondering if you guys ever worry about your health/safety in the ED. The reason I ask is that one of my roommates had to go in today because he was experiencing symptoms of menengitis (though it from what I hear he should be alright and probably has something else). Have any of you ever contracted any highly contageous disease working or been in a threatening situation? Just wondering.

 

[beanbean]

I have spent many years riding ambulances and hanging out in the ED. I have been fortunate to never been physically threatened by a patient. There have been a handful of patients that have made me very uncomfortable to be in the room with them. The last was a prisoner who was at the ED to get a splint for his wrist which he broke punching something or someone. We knew he was prone to violent outbursts, but it was his general affect that was disturbing. He was nice as pie to all of us, but there was something "Silence of the Lambs" about him. Creepy guy, must have been a bad boy since he had a posse of about 10 COs with him.

Anyways, I feel very safe in the ED. The environment keeps you on your toes. Upon initial contact you don't know if that coughing patient has TB, who has HepB, who is a sociopath, etc. Be sensible, trust your instincts and use precautions no matter where you are working. Contagious pts and threatening patients are found all over the hospital, not just the ED.

 

[docB]

...I was wondering if you guys ever worry about your health/safety in the ED.

Frequently. I've been assaulted twice and punched, kicked and head butted by pts who were flailing around many times. I've had 3 needle sticks where I initiated the protocol (the testing, not the meds). Never been injured, lucky so far. All things considered I'd guess that the risk of getting hurt in an assault or turning + for HIV or Hep C are about equal but they both pale in comparison to injuring your back moving a patient. And, as always, the nurses face a much higher risk of all of these things than we do.

 

[heldicus]

Frequently. I've been assaulted twice and punched, kicked and head butted by pts who were flailing around many times. I've had 3 needle sticks where I initiated the protocol (the testing, not the meds). Never been injured, lucky so far. All things considered I'd guess that the risk of getting hurt in an assault or turning + for HIV or Hep C are about equal but they both pale in comparison to injuring your back moving a patient. And, as always, the nurses face a much higher risk of all of these things than we do.

The first time I get stuck because of something stupid a pt does (and not something stupid I do) I'm initiating the whoop-ass protocol

 

[EMIMG]

Yes, I have felt uncomfortable. During residency had a patient that was probably intoxicated. Could not fully examine as he was still fully clothed and needed to ensure he had no bruises/holes. SO, asked the nursing staff to get him undressed. As they were getting him undressed a gun fell out of his pants. He must not have been too intoxicated as he got up and left with the gun. But the thing that irked me was that this guy was originally brought in a car to the main entrance where we have metal detectors. Our armed security officers did not want to help take him out of the car so told them to pull to the ambulance entrance where there are no permanent metal detectors but are wands. But, he was never wanded down.

Had another situation where 2 people who were involved in an altercaiton outside were placed near each other in the ED. ANother altercation ensued. They were basically kicked out but things escelated. One of the patients came back in after being shot by one of our officers.

Other thigns dealing with safety is to learn to put yourself in safer situations. For instance, one thing that comes to mind is if you have a patient that has one arm restrained, stand on his unrestrained arm side. A straight jab packs less of a whollop than a cross-body roundhouse.

 

[Doczilla]

I've felt pretty safe in the ED. It's not that things don't happen (once saw a guy cut himself out of 4 point leathers with a 5" knife in the ED), and I've certainly been in my share of scrapes, but in general, there is comfort in the fact that there are always people around. You might have to hold someone down as you get the restraints on (as docB says, while patients are flailing around) and may get smacked once or twice. There certainly are incidents where a patient gets a good swing or kick in and can do some damage, but there's almost always help when you need it. On the 'bolance, things are a little different. I have wrestled alone with several patients on the scene or in the truck (including one guy with an 8" knife), intubated belly down in the street during a riot, and found myself in some very unruly crowds. While the ER is not exactly a "controlled environment", the chances of you getting killed there (by someone other than the nurses or physicians providing care) are small.

Experience is a good teacher in these things. If a hispanic man gets very quiet and takes his hat off, he's getting ready to fight. If the patient can't take their eyes off the door, they're getting ready to run. A person without physical disability who walks with one arm swinging but the other one close to their waist (without being hooked on the belt or in the pocket) is armed. Physical and psychological clues will tell you a lot, and your instincts will save your butt many times. Patients are very rarely unpredictable when they become assaultive. Usually there is a lead-up period of escalating physical activity, voice, and emotion before they start swinging. Also beware any sudden change in mood. The annoyed patient who suddenly becomes very quiet or very cooperative is up to something. EMIMG has a good point about not putting yourself in unsafe situations. Don't let the patient get between you and the door. Leave the door open if you suspect a patient may become a problem for you. If a patient is suicidal, they sure don't care about your life either. If they came in wearing handcuffs, the cuffs stay on.

As far as the contagious diseases go, it's perhaps only a little bit more likely in the ER than elsewhere that you'll catch something. Just remember to put a mask on the cachectic homeless HIV drug abuser with the unstoppable cough. Waiting for your PPD to convert is no fun at all.



'zilla

 

[NeuroSync]

Had another situation where 2 people who were involved in an altercaiton outside were placed near each other in the ED. ANother altercation ensued. They were basically kicked out but things escelated. One of the patients came back in after being shot by one of our officers.

That's crazy...

 

[sparky5]

Don't let the patient get between you and the door. Leave the door open if you suspect a patient may become a problem for you.

i thought with psych patients you were supposed to let them sit closer to the door so they don't feel trapped. Is this just a setting difference? Psychiatrists let patients sit near the door, and EM docs care more about their safety and less about the mental health of the patient so the doc sits closer to the door?

 

[beriberi]

No psychiatrist I know who works with acutely ill patients lets them sit close to the door. Maybe in a nice private practice where you are recovering bits and pieces from your childhood, but not seriously ill/psychotic pts.

I do worry about my safety. I was surprised to find out that it is wounded children that tend to cause the most violence in our ED (a thirty five year old grandpa will come in to teach the parents a lesson about not watching their kids--sometimes packing heat.) I think I am going to take up karate--I don't watch close enough or move fast enough. Really.

 

[irrka]

Any time i've talked to any psychiatrists, everyone always says that if you have even THE SLIGHTEST feeling of something being off or that something COULD become dangerous for you, you always make sure you're closer to the door than the patient is!

 

[wook]

Sparky:

You should ALWAYS be thinking safety, especially in situations that might get ugly fast. You'll realize this the first time something ugly goes down and you recognize how close you were to meeting your maker.

Wook

 

[jazz]

Psychiatrists let patients sit near the door, and EM docs care more about their safety and less about the mental health of the patient so the doc sits closer to the door?

yea, i do care more about my safety than the mental health of the patient. once you see the kind of psych that comes in the er, there is no way that i am going to let the patient be between me and the door. wait until you get to your clinical years, you'll agree i think.

 

[FoughtFyr]

i thought with psych patients you were supposed to let them sit closer to the door so they don't feel trapped. Is this just a setting difference? Psychiatrists let patients sit near the door, and EM docs care more about their safety and less about the mental health of the patient so the doc sits closer to the door?

Actually, where I went to medical school we did an 8 week psych rotation at a state run, long term, mental health facility. At least one of the clinical instructors threatened an instant failure of the rotation if he ever saw you allow the patient to be between you and the door. And that rotation remains the only time since I started medical school that a patient attacked me.

So no, I don't think psychiatrists always allow the patient the "door side" of the room. In some limited outpatient settings with an established patient maybe. But in the ED it is a completely different story.

- H

 

[doctordan]

One piece of advice I will give you is it's not smart to try and grab a 6 knife off an extremely intoxicated and anrgy patient- you will probably end up hurt. I learnt that the hard way but it's difficult to know what the hell to do when someone's threatening a kid. Fortunately it's not that common to be as badly hurt as I was.

Unsuprsingly I am now worried about my safety a lot of the time.

 

[sparky5]

Thanks for the comments, I thought there was something a little wierd about that advice a prof gave the class. I bet they were talking about outpatient controlled patients, not ppl. who are unknown and could pose a significant threat. My gut instinct from martial arts (aikido) training and working with law enforcement on a search and rescue team would be to have an exit available, and I am glad you all confirmed that the advice i got was kind of bogus advice for the EM field, and anything outside a controlled experience.

Thanks everyone!! you all keep me saine.

-d

 

[mikecwru]

Thanks for the comments, I thought there was something a little wierd about that advice a prof gave the class. I bet they were talking about outpatient controlled patients, not ppl. who are unknown and could pose a significant threat. My gut instinct from martial arts (aikido) training and working with law enforcement on a search and rescue team would be to have an exit available, and I am glad you all confirmed that the advice i got was kind of bogus advice for the EM field, and anything outside a controlled experience.

Thanks everyone!! you all keep me saine.

-d

Next life lesson: Everyone is a psych patient. I don't let any patient get between me and the door. I don't care if it's outpatient, inpatient, psych, non psych. Another time to worry about your safety is in giving patients bad news. Doctors have gotten their asses kicked telling people their families have died. I consider security sometimes when you're telling 8-10 family members of a trauma patient that appear all revved up. There's something to be said for being slightly paranoid.

mike

 

[Kalrik]

My dad was poked with a scalpel that had been exposed to his HIV patient, don't know how it happened. He was on meds for six months but tested negative at the end. One of his friends was stabbed in the eye by a psych patient with the doc's own pen. I probably only hear the worst stories though, and he works in Henry Ford Main Hospital Detroit.

 

[DarkChild]

huh.
we were told to never be between the patient and the door. most psyche patients dont have a beef with you personally, but if you're standing in their way...

Any time i've talked to any psychiatrists, everyone always says that if you have even THE SLIGHTEST feeling of something being off or that something COULD become dangerous for you, you always make sure you're closer to the door than the patient is!

 

[Apollyon]

huh.
we were told to never be between the patient and the door. most psyche patients dont have a beef with you personally, but if you're standing in their way...

Whomever told you that is patently wrong. All you need is the one psych patient that isn't "most" to ruin your day. If you know who that is before going in, there's a line of people that will hire you right now.