Guns in the ED

[LostTommyGuns]

I don't know about this one. This would be a good case for EBM or equivalent. I have read quite a bit on this subject. Unlike a lot of issues that are politicized, there is a lot of data on the subject.

I believe the above argument is very flawed. Most of those oft-quoted statements and "facts" contain serious errors, omissions and statistical manipulation. Journal club topic??? Anyway, the best analysis I have found on this topic suggests that less than 0.1% of defensive firearm use results in injury to the victim.

Kellerman, Protection or Peril, New Eng. J of M. 1557-60. 1986
Kleck, "Point Blank: Guns and Violence in America" New York, Aldine de Gruyter. 1991

There are many more if anyone is interested.

Dude - isn't that what I said? Anyway I agree and would love to see more articles, statistics and discussion.

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[polygonal]

By the way, I have conflicting feelings about CCW in the ED. I worked at a place (a “nice” private hospital in a good neighborhood) that had some guy walk into the ED and shoot a worker. The security guard didn’t know anything happened until after he noticed all the cop cars in the parking lot. After this, the department was still unsecured with five entrance points and one (yes one) unarmed, untrained, and usually one donut away from being in chest pain unit security guard at night.

I think most EDs should a least have secured entrances and full-time security (preferably an actual police officer).

 

[Hernandez]

If you pull a firearm in the ED, you will be putting a LOT of bystanders at risk. You better be a hell of a shot, because if you take down an innocent, you will be in some serious ****.

This a universal truth, and is not unique to the ED and the 4 rules of firearm handling should be observed. But consider this; there is data as researched by the DOJ which shows firearms are used 2.5 million times a year with 90something percent without a shot fired, so, what does that say to you?

Also, be aware that a large proportion of people that get shot is with their OWN gun. This includes cops as well. So although you carry one to protect yourself, there is a good chance that this gun may be the one taking your own life.

Besides police officers, this statement is blatantly false due to piss poor statistics. And if I remember my numbers correctly, the number is approximately 20% of police who are killed by their service weapon. The former about civilians is only true if you erroneously include suicides.

I also forgot to mention the civil suits that will follow if you take someone down

This is not a universal truth, it varies from state to state. I live in state where you have an affirmative defense in these type of situations as well as protection from civil suits if charges aren't filed.

And I'd rather have a cop who is trained on more that just how to handle a firearm to be at my back ANY day than some NRA nut that only knows how to pull a trigger, (albiet accurately).

More power to ya, but I'd prefer those who actively compete in IDPA/IPSC

 

[Ex-44E3A]

Gentlemen, gentlemen... settle down.

Hernandez, et al:

I wasn't referring to anyone's skill level... I don't doubt that some of you can shoot. My advice on carrying in the dept. has more to do with the aftermath. I'm an ex-military veteran, marksman decorations, former instructor, boku tactical schools, and multiple years of SWAT; I'll stack my CQB and small-arms skills up against any 'banger. Even with all that, I would seriously think twice about packing in the dept. Even if you're a Master-class IPSC shooter, and it's a clean shoot, you're still headed for some serious hurt when it's over.

Surviving the gunfight in the ER is only half of it... the other half will be fought in court and in front of the State Board of Medicine. You may avoid criminal charges, but you will be sued civilly, and you will be brought before the Board. You'll have to do all of this while unemployed, including hiring your own legal counsel (several hundred thousand $$). The police will also have confiscated your gun as evidence, so I hope you have another one for when the dead guy's gangbanger buddies show up at your house (the newspaper will publish your full name and home address).

As if the prospect of losing your job and your license isn't enough to prompt some caution, remember that your malpractice insurance isn't going to cover the civil suit. How do you like the prospect of everything you've ever worked for going into the pocket of some dirtbag drug-seeker, who pulled a gun because you wouldn't give him "Vic's or 3's?" Remember that the burden of proof is lower in civil court, and you could still be forced to pay out, even if you're found innocent of criminal charges (and this process may take 3-4 years).

If somebody holds up your ER with a gun (and he's not actively killing people), you might be able to legally justify shooting him, but why make the next 3-4 years of your life a living hell? Consider what happens if you miss, or the first few rounds aren't rapidly lethal and a gunfight starts... expect the plaintiff's attorneys (and there will be many, including a set for every person injured or "traumatized" by the incident) to focus on you, since you started the gunplay. Coincidently, you're also a "deep pocket."

Also expect the plaintiff's attorneys to intently focus on your care of the man you shot. You did treat him, right? Oh yes... you'll be expected to have provided care for the man as soon as he's no longer a threat. If you didn't, expect them to charge you with an EMTALA violation, and accuse you of failure to perform your duty as a physician. Also expect them to imply that you "allowed" him to die, or even used your art of medicine to "kill" him. You couldn't shoot him again, so you used your medical skills to finish him off. God help you if your care of his penetrating injuries is anything less than perfect.

While it may offend your dignity and grate on your pride to give some scumbag what he wants, consider your other options, including cooperating until the cavalry arrives. Let me give you an example from my SWAT days. This is an actual incident that my team resolved (I was working in the hospital that day, and couldn't get away for the call-out). A guy walked into one of our outpatient areas with a bomb made out of gas tanks, took a bunch of people hostage, and demanded a bunch of money and drugs. So what did we do? Our snipers didn't shoot him... we came up with a better idea. We gathered together a bunch of narcotics, wrapped them up with a nice pretty bow on top, and had our bomb robot deliver them to the suspect. He promptly shot them up, passed out from the overdose, the team made entry, we shot him up with Narcan, and he went to prison. Nobody got hurt, and everything was resolved satisfactorily.

Look, guys... I'm as pro-gun a physician as you're likely to find, and I fully support people's right to self-defense. I just want you folks to seriously consider the responsibility you're taking on... that's all. I wish the aftermath of self-defense wasn't so ugly, but unfortunately it's the reality.

 

[basementbeastie]

...and here i was thinking you guys were all talking about my biceps!!!!

 

[stoic]

you know, this is actually sort of an interesting thread. it mirrors decisions we must all make in our personal lives about what is justified and neccesary to protect ourselves and loved ones.

personally, i would own a gun to blast someone coming into my house. my family is there, i'd die for them, go to prision for them. all that.

would i give the same to work? no, i wouldn't. period. it's work. because as it's been pointed out, no matter what, you're going to be mired in deep **** for sometime to come. i doubt whether if you shot someone on the job you'd ever get your license back. no matter the situation.

i'm with docB in this one. it all comes down to odds. in your house, at night, what are the odds that somone is breaking in? not that high, really. most break-ins occur during the day (right?) and if they do come at night, they are likely after more than your property. it's a RARE but possible senario. It'd be interesting to see how it ranks against tornado's and stuff.

but in the ED, what are you protecting? it's not YOUR ED. chances are they want to kill someone else or they want drugs. and chances are they are going to go somewhere else first before the ED. honest i'd give them drugs and if forced to choose between my life and that of someone i've never met before, yea, i'd let the stranger die. i'm not a bad person here, i'm just being honest. your chances of ending up in a gunfight in the ED are LOW and for what? to keep a junkie from getting high? to keep someone from getting shot for the next 5 hours?

i'm not afraid to die for something i believe in, but the senario's i can think of in the ED are not one of them.

maybe that makes me a *****. i don't know, i don't care. i'm sure some people will rip me apart for being complaicent or uncarring. right now i just want to get through med school and have a chance to enjoy a nice salary and a little family time. whether that will ever happen or not is another thread. i just can't see dying to protect the emergency department.

 

[Febrifuge]

That's not entirely true, it's state dependent. While most states allow businesses to decide whether or not they want firearms on their property, most states do not provide any penalties for those who knowingly carry on their property.

Yep; I was insufficiently clear that when I said "our" attendings, I also meant "no exceptions" in the state where I happen to live. So that was just for the example I was attempting to give.

Me speak English goodly, much times.

 

[NKMU]

Nice to see so many replies. Personally, I'd never carry in the ED/hospital. As several posters already said more eloquently than can I, it's a bad idea all around. I'm all for CCW in other circumstances, but there's just no place for it at work as a physician. That pesky "First, do no harm" thing kinda gets in the way when you're taking aim to shoot your "patient." There are certainly instances that demand self defense in the ED, but a gun is the wrong choice unless you're an officer.

I was pleased to see the Glock Fohty video come up on SDN. It has to have officially been posted on every forum that ever existed by now. It's also interesting to read EM people's views on guns/concealed carry vs the views of those on the gun forums.

 

[Hernandez]

Hmmm... The tone of my post was that I disagree with the passive victim approach. However, I live in a society that does not value the doctrine of self defense any more than it cares for personal responsibility. I still feel that I would risk my career every instant I carried in the ED while I have a 1 in 100000 chance of being confronted by a situation in the ED where deadly force by me might be appropriate. This is contemporary America. I'd rather risk improbable death or maiming than probable loss of my livelihood, house, savings and probably freedom.

For the third time in this thread, this is highly state dependent. The states I'll more than likely end up in have built in civil and criminal protections for CCL holders who use their weapons in a justifiable manor. My home state's level of proof for a CCL holder is very low.

Here's some EBM (and I'm sure Hernandez can provide the citation): Cops shoot the wrong person (ie, innocent bystanders) something like 10x more often than non-cops.

I've seen that statistic, but I don't think I have it saved in my big file of gun stats.

I believe the above argument is very flawed. Most of those oft-quoted statements and "facts" contain serious errors, omissions and statistical manipulation. Journal club topic??? Anyway, the best analysis I have found on this topic suggests that less than 0.1% of defensive firearm use results in injury to the victim.
Kellerman, Protection or Peril, New Eng. J of M. 1557-60. 1986
Kleck, "Point Blank: Guns and Violence in America" New York, Aldine de Gruyter. 1991
There are many more if anyone is interested.

That there are, and I'd be interested in going through the literature and debating the points in a meaningful fashion, I'd be slow to respond as I'm on an away rotation and do not have immediate access to my files.

Gentlemen, gentlemen... settle down.
Hernandez, et al:

Surviving the gunfight in the ER is only half of it... the other half will be fought in court and in front of the State Board of Medicine. You may avoid criminal charges, but you will be sued civilly, and you will be brought before the Board. You'll have to do all of this while unemployed, including hiring your own legal counsel (several hundred thousand $$). The police will also have confiscated your gun as evidence, so I hope you have another one for when the dead guy's gangbanger buddies show up at your house (the newspaper will publish your full name and home address).

For the 4th time in this thread, this is highly state dependent. And nothing irritates me more than people like you who use these fear tactics to try and make a point. But if I assume your mentality to be in lines with what you're stated here, then your, your underlying argument will be that the police will protect you (and probably is since you appealed to allowing the Hospital security providing your protection) and if that's the case, you're arguments are non-sequatorial (yes, I believe I just invented a word) in nature since on one hand you have someone willing and able to protect you from these people, but if you dare defend yourself, then magically you're screwed because the police won't be able to protect you. and don't get me started on the mentality of relying on any police agency for preemptive protection. I've got whole threads on that very topic in the Sociopolitical forum.

As if the prospect of losing your job and your license isn't enough to prompt some caution, remember that your malpractice insurance isn't going to cover the civil suit. How do you like the prospect of everything you've ever worked for going into the pocket of some dirtbag drug-seeker, who pulled a gun because you wouldn't give him "Vic's or 3's?" Remember that the burden of proof is lower in civil court, and you could still be forced to pay out, even if you're found innocent of criminal charges (and this process may take 3-4 years).

For the 5th time in this thread, this is highly state dependent, so don't go telling me what is going to happen in my state.

My main reason that I would carry in the ED, wouldn't be because I didn't feel safe, (although there are many EDs were I probably wouldn't) but more so because I carry anyways, and it seems *****ic to live by a motto of always being prepared but then leaving the firearm in the car when stepping in to the ED considering that there is a higher statistical likelihood of something happening there or more importantly between the ED and my car.

Abuse of emergency department workers: An inherent career risk or a barometer of the evolving health care system?
Laurie J. Morrison, MD
Dr. Morrison is with the Division of Emergency Medicine, Department of Medicine, University of Toronto, and the Department of Emergency Services, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.
In this issue, Fernandes and colleagues1 report the results of a survey of health care workers at the Emergency Department of St. Paul's Hospital, in Vancouver. The survey was intended to define violence against health care workers, document the prevalence and rates of reporting, and suggest preventive strategies.
The respondents in this study reported a 1-year prevalence rate of 92% for physical assault and 97% for physical threats, and 66% reported being verbally abused at least once per shift. In a similar survey of 170 directors of emergency departments across the United States with annual volumes greater than 40 000, the directors reported a prevalence of 43% for at least one physical assault a month, 32% for at least one verbal threat a day and 18% for use of weapons to threaten staff at least once a month. Two hostage incidents at knifepoint were described, and 7% reported an act of violence within the previous 5 years that had resulted in death.2​

Granted, this is a Canadian based statistics, but it's the only one I could find that included actual violence broken down by type, all the other studies I've seen show "how threatened the ED workers felt" or the incidence of patient injury from being restrained after they became violent, and other perifpherial issues. But I will state that these numbers are actually lower than the American based studies that I've seen due to the per year based percentage instead of the per month based. After that, this article lost my interest with the bull**** editorial inserts such as "The US statistics may reflect a more violent society with easier access to firearms;"

Nice to see so many replies. Personally, I'd never carry in the ED/hospital. As several posters already said more eloquently than can I, it's a bad idea all around. I'm all for CCW in other circumstances, but there's just no place for it at work as a physician. That pesky "First, do no harm" thing kinda gets in the way when you're taking aim to shoot your "patient." There are certainly instances that demand self defense in the ED, but a gun is the wrong choice unless you're an officer. .

"Physician, heal thyself first." They Hippocratic oath is kinda worthless if you're dead.

 

[tncekm]

Those are canadian stats? What were the people pissed about who were causing all the ruckus? It appears free health won't make people happy, eh LOL.

 

[FISKUS]

I carried a concealed firearm for three years while I lived in NY ( not legal). Never in the ED or hospital. I never fired it at anyone - but I did pull it out on 3 occasions. In those situations, I am convinced the the display of a gun by a person who was willing to use it, had a great deterrent value and no doubt saved my life

 

[docB]

Why do you think we live in a contemporary America that does not value the doctrine of self defense or personal responsibility? (Cuz most people take the same position as above.)

Most people who have not made an effort to really educate themselves about this or are apathetic are conditioned by society to buy into passivity. Politicians and media stereotype anyone who carries or expresses a willingness to defend themselves as caricature hick gun nuts. Schools and colleges push an anti gun agenda for philosophical reasons. Law enforcement pushes an anti gun agenda because they feel that if no one but them has guns they'll be safer.

The philosophy that drives the left on this is based on pacifist dogma that it's never justified to use deadly force. They also believe that criminals are created by society (poverty, low self esteem, GW personally annoying them and so on) so society should just put up with whatever they do to us. It's crap, but that's what they believe.

 

[docB]

For the third time in this thread, this is highly state dependent. The states I'll more than likely end up in have built in civil and criminal protections for CCL holders who use their weapons in a justifiable manor. My home state's level of proof for a CCL holder is very low.

Your angry tone is uncalled for. First off everyone who has posted on this thread so far sounds pretty pro 2nd ammendment, which is amazing on a medical forum, so no one is challenging your right to CCW or to defend yourself. Second, we're not just talking about just you and your home state. If you can carry in your ED without fear of losing your job or medical license good for you. The rest of us are not in that position. The majority of us are not in that position. And this discussion goes byond you and your state.

“Physician, heal thyself first.” They Hippocratic oath is kinda worthless if you’re dead.

You are right. My position takes into account the fact that if I am confronted with a situation where I could have successfully defended myself but can't because I am unarmed I will be dead. I do not expect law enforcement to protect me. They have no obligation to do anything for me and unless they materialize in the ED in 1-2 seconds I'll be dead and they'll be cleaning up the mess as usual. Our "system" has swung so far to the left that I am unwilling to risk the penalties that I will face for carrying or using a gun in the ED. I don't like it. I don't have a philosophical problem with carrying a gun in the ED (although there are many logistical, patient relations and saftey issues).

 

[Hernandez]

Your angry tone is uncalled for.

If the tone sounds angry, then you're reading into it. The only portion that I thought would sound harsh I put the disclaimer up front to state that this was not my intention.

And this discussion goes byond you and your state.

Ah, but here's the rub. There are many making these broad based claims as if they are universal, not all of American has succumb to the pany-waste apathetic mentality that many of the Coastal Urban centers have.

Our "system" has swung so far to the left that I am unwilling to risk the penalties that I will face for carrying or using a gun in the ED. I don't like it. I don't have a philosophical problem with carrying a gun in the ED (although there are many logistical, patient relations and saftey issues).

This may sound harsh, and I probably mean it as such. This is a cope out, no offence but our nation was founded by people who didn't give a damn about the state of their current system and risked their lives to enact a system which protected their values, and I for one find this argument to be pathetic. How can you sit there and just say "c'est la vie"? Especially if you recognize that the turn our system has taken is more than likely not for the better? That in and of itself irks me to no end. There would be no penalties had people stepped up and put an end to this foolishness before it became so wide spread, but instead people sat back while these incremental infringements on our rights were implemented.

"Are we at last brought to such humiliating and debasing degradation that we cannot be trusted with arms for our defense? Where is the difference between having our arms in possession and under our direction, and having them under the management of Congress? If our defense be the real object of having those arms, in whose hands can they be trusted with more propriety, or equal safety to us, as in our own hands?" Patrick Henry

"Resistance to sudden violence, for the preservation not only of my person, my limbs, and life, but of my property, is an indisputable right of nature which I have never surrendered to the public by the compact of society, and which perhaps, I could not surrender if I would." John Adams

You are right. My position takes into account the fact that if I am confronted with a situation where I could have successfully defended myself but can't because I am unarmed I will be dead. I do not expect law enforcement to protect me. .

Just as long as you're not one of the sheep who believe that they will do so, your decision to not carry in the ED does not bother me.

 

[docB]

This may sound harsh, and I probably mean it as such. This is a cope out, no offence but our nation was founded by people who didn't give a damn about the state of their current system and risked their lives to enact a system which protected their values, and I for one find this argument to be pathetic. How can you sit there and just say “c'est la vie”? Especially if you recognize that the turn our system has taken is more than likely not for the better? That in and of itself irks me to no end. There would be no penalties had people stepped up and put an end to this foolishness before it became so wide spread, but instead people sat back while these incremental infringements on our rights were implemented.

I don't see how anyone could read this stuff without thinking you sound angry but whatever. How can I just sit here? Well, I vote second amendment, I moved to a second amendment friendly state, I pay my NRA dues or at least I did until I became an endowment member. If you are suggesting that I carry in the ED just to prove a point that will solve nothing and just result in me being in jail. So other than futile gestures of self destructive social disobedience which would put us on the same plane as the WTO protester nut jobs what do you suggest?

"Are we at last brought to such humiliating and debasing degradation that we cannot be trusted with arms for our defense? Where is the difference between having our arms in possession and under our direction, and having them under the management of Congress? If our defense be the real object of having those arms, in whose hands can they be trusted with more propriety, or equal safety to us, as in our own hands?" Patrick Henry

"Are we at last brought to..." Yup. That's where we are. The last election and the impending Hillary presidency I'd say we're clearly headed for badness.

 

[Hernandez]

I don't see how anyone could read this stuff without thinking you sound angry but whatever. How can I just sit here? Well, I vote second amendment, I moved to a second amendment friendly state, I pay my NRA dues or at least I did until I became an endowment member. If you are suggesting that I carry in the ED just to prove a point that will solve nothing and just result in me being in jail. So other than futile gestures of self destructive social disobedience which would put us on the same plane as the WTO protester nut jobs what do you suggest?

I've not suggested anyone violate laws which would land them in jail, but to capitulate and modify what you normally would do thanks to the hospital administration especially when you are not threatening anyone seems because of some perceived threat to your career is not something I agree with. Much in the same way that "alternative life styles" have become slowly accepted, it's going to take the same type of slow re-acclimation to desensitize our country to law-abiding people who wish to have the means to protect themselves, and you can't do that if you capitulate. You must do it in a level headed and purposeful fashion.

And if it sounds like anger, it's probably the overbearing arrogance I have on this topic coming through. I'm arrogent on this topic because I've studied and researched it so much that I'm more than a little sure that my opinions are correct and I can back my opinions up with data and sources. I'd normally insert more, but again, I'm not using my computer, and I'm typing on a PDA which makes even more difficult to forumlate long responces.

"Are we at last brought to..." Yup. That's where we are. The last election and the impending Hillary presidency I'd say we're clearly headed for badness.

Agreed, I wish FN would hurry up and release the ARM-H, I need something in 7.62x54 that isn't a FAL or M1a before they're banned.

 

[margaritaboy]

My cat's breath smells like cat food.

 

[flighterdoc]

I've not suggested anyone violate laws which would land them in jail, but to capitulate and modify what you normally would do thanks to the hospital administration especially when you are not threatening anyone seems because of some perceived threat to your career is not something I agree with. Much in the same way that "alternative life styles" have become slowly accepted, it's going to take the same type of slow re-acclimation to desensitize our country to law-abiding people who wish to have the means to protect themselves, and you can't do that if you capitulate. You must do it in a level headed and purposeful fashion.

And if it sounds like anger, it's probably the overbearing arrogance I have on this topic coming through. I'm arrogent on this topic because I've studied and researched it so much that I'm more than a little sure that my opinions are correct and I can back my opinions up with data and sources. I'd normally insert more, but again, I'm not using my computer, and I'm typing on a PDA which makes even more difficult to forumlate long responces.



Agreed, I wish FN would hurry up and release the ARM-H, I need something in 7.62x54 that isn't a FAL or M1a before they're banned.

There's nothing wrong with an M1A. As far as a FAL goes....92 or whatever countries used it, and the ONLY ones that ever used it in combat replaced it immediately afterwards (except Argentina, who lost with it). And it's 7.62x51.

Having said that, it's all a matter of taste. My wife actually prefers the FAL, it's what she was trained with first in the Canadian military (actually the C1A1, inch-pattern FN-FAL). So, she has her FAL's and I have the all American M1As (Fulton and LRB, I got rid of my last SA piece of junk).

 

[kate_g]

why not go with a syringe full of sux?

If Mr. Some Dude has a gun, I don't want to get close enough to him to give him an injection.

I have wondered for some time why ED security (or a designated nurse, since they may actually be tougher than the security guards) isn't trained in using an anesthetic dart gun. In medical documentary type shows when they have combative patients (like the one with the guy who breaks his restraints, grabs the sharps box, and throws dirty needles at anyone who tries to come into the room) they do things like try to rush the guy and give him an injection. More often than not at least one of the security or medical personnel are hurt. I've been guilty more than once of screaming at the TV "don't tackle him with a mattress you idiots, get a vet with a dart gun in there!" To minimize potential collateral damage (and being sued) you probably don't even need the kind with a C02 cartridge or an explosive charge, because humans have pretty thin skin and the distances are not great; I bet you could use a plain low-tech blow gun to really great effect most of the time.

I can think of a lot of reasons why a dart gun wouldn't work when Some Combative Dude pulls a gun, of course. Then again, I can think of a lot of reasons why having Some Combative Doctor ready to return fire is also a bad idea. I blame this on the fact that having a patient pull a gun in the ED is bad to start with. I guess it reflects on the places I've lived, but I didn't figure there were any EDs in the country *without* metal detectors at the entrance...

 

[deleted109597]

I guess it reflects on the places I've lived, but I didn't figure there were any EDs in the country *without* metal detectors at the entrance...

There's actually a buttload. And in worse places than you would expect. Although I know of at least one that is putting some in soon because of a shooting that happened there in the last 2 months.

 

[jvencius]

When I read the title, I immediately thought of last New Year's Eve, when Some Dude tried to gain access to the trauma bay to finish the job. He got close, but thankfully our security dudes were faster than he was. 'Twas an interesting night.

Was this "Some Dude" hooligan accompanied by his fellow knuckleheads "These Two Guys" and "That Bitch"?

 

[Hernandez]

And it's 7.62x51.

oops, typo I blame the PDA.

Having said that, it's all a matter of taste. My wife actually prefers the FAL, it's what she was trained with first in the Canadian military (actually the C1A1, inch-pattern FN-FAL). So, she has her FAL's and I have the all American M1As (Fulton and LRB, I got rid of my last SA piece of junk).

I know, and I had a nice FAL until I had to sell it for money reasons, but real M1As are getting expensive and hard to find and even the Norinco/Polytech chinese knock offs are getting expensive. and I'm learry of buying any more FALs because of all the crappy homebuilt ones I've seen. So I like the idea of the new SCAR and it's going to be modular and supposidly interchangable between calibers.

 

[Hernandez]

There's actually a buttload. And in worse places than you would expect. Although I know of at least one that is putting some in soon because of a shooting that happened there in the last 2 months.

and don't upwards of half of all EDs lack 24 hour security as well?

 

[JackBauERfan]

so back to talking about guns

i read some parts of the country has teenagers making guns from plastic and aerosol cans that shoot potato balls as bullets? They say you can shoot them to 200 mph??? how do I make one of these suckers, that way you can get around the whole legality of keeping it in the er with you.

i doubt you go to jail for having a 'tater' gun.

 

[NotANurse]

I have a permit for my Dan Wesson .357 with a 4" barrel. I'm good on the range (better than my 'marksman' ex actually), and wouldn't dream of carrying in the hospital. It wasn't an easy decision, because if you have a gun, you have to be prepared to handle killing someone. That said, those funny rounds with the little crosses on the tips are what's in the gun unless I'm target shooting. Less collateral damage that way.
Where in the heck do you conceal a weapon while working?

 

[BeatrixKiddo]

Carrying a gun to work is an important tool let let folks know that you can 'speak the language of the people,' so to speak.

Lol

 

[Sessamoid]

Where in the heck do you conceal a weapon while working?

You'll have to go without the Pocket Pharmacopeia, I guess.

 

[logos]

I'm the only one in this room professional enough, that I know of, to carry the glock 40 ....Kaboom...

Haha

4 Simple Rules

In Ohio every hospital i've been in (n=2) is posted. Additionally, the university is off limits by statute.

On the bright side they just made a bunch of improvements to ohio law. No more assault weapon bans, no more strange car rules...

 

[Ex-44E3A]

For the 4th time in this thread, this is highly state dependent.

Sure.... except I wasn't referring specifically to your state, Hernandez... plenty of people live in states where civil immunity isn't in the law. Also, that immunity prevents the felon from suing... it won't protect you from injured or "traumatized" bystanders suing the hospital and you for their injuries/PTSD. Incidently, depending on how the law defines the immunity, that shield can be pierced, so don't count on it protecting you from a malpractice suit if you "fail," in even the tiniest way, to fulfill your medicolegal duty to treat the perp after the shooting. Remember, once the shooting stops, the perp is no longer a violent felon... he's a critically-injured man in need of medical care. Coincidently, he's already on hospital property, so EMTALA is in full force. This is a unique and unfortunate drawback for a physician shooting a person in the ED. You will be expected to immediately provide care for the man you just shot... and it better be good. So much for immunity...

And nothing irritates me more than people like you who use these fear tactics to try and make a point... And if it sounds like anger, it's probably the overbearing arrogance I have on this topic coming through. I'm arrogent on this topic because I've studied and researched it so much that I'm more than a little sure that my opinions are correct

Fear? I'd say it's being fully informed about the potential risks you're facing. You do engage in risk/benefit discussions with patients you're consenting for procedures, right? This is no different, and nothing is more counterproductive than gun owners (like you) being nasty, abrasive, and confrontative about the issue. When you go off like you have in this thread, attacking people as "sheep" and "pany-waste" [sic], you piss people off who would otherwise be inclined to agree with your position.

I don't care if you carry in the ED... go on and get down with your bad, fight-the-power, civil-disobedient self... but be discrete, and try not to be such a curmudgeon about the issue that you bring down the heat on your fellow gun owners.

 

[tkim]

I'm the only one in this room professional enough, that I know of, to carry the glock 40 ....Kaboom...

I thought that was only with reloads and not factory ammo?

 

[logos]

I thought that was only with reloads and not factory ammo?

I was simply imitating the noise. Did you watch the video? Funny stuff. "Bang" would also be appropriate.

But yes. There is a specific thing known as a kaboom that that occurs when, among other things, you double charge a round when reloading or use a weak case. Glocks are famous for it, but it can happen in any gun. It can even happen with factory ammo, but its pretty rare. I guess glocks are a little more open around the base of the cartridge than most guns (to facilitate efficient feeding...which glocks are also known for...) and that makes them more prone to it.

Edit:
Here is a video of one:
http://www.youtube.com/watch?v=Vceh44UK-8I

 

[Hernandez]

Fear? I'd say it's being fully informed about the potential risks you're facing. You do engage in risk/benefit discussions with patients you're consenting for procedures, right?

no offence, but this is a bogus argument. You’re either backpedaling or you’re being intellectually dishonest about how this conversation has gone. Neither you or any of the other people who were against the idea of carrying were touting benefits, you were stating matter-of-factly that you'd be sued, you'd be fired, you're career would be over. Or do I need to remind you what you said And you were stating this as if it were absolute, and that simply is not true and you still can't seem to grasp that. And yes, you were using fear as a tactic to dissuade this act and you were doing so without a complete disclosure of the details, I hope you do a better job of discussing risk-benefit with your patients instead of just throwing your bias and beliefs into it without an honest appraisal of the counter view point. So to throw your argument back at you, there was no discussion of risk benefits, you and the others were stoutly entrenched in your positions without giving any credence to the counter position and you'd made up your mind what the appropriate approach was without giving anyone else the full story. So don’t sit there and lecture me about how I practice medicine based on this thread when you’re guilty of the same thing you’re trying to pin on me, especially when in the end this doesn’t even have a damn bit to do with the discussion at hand.

 

[Hernandez]

so EMTALA is in full force. This is a unique and unfortunate drawback for a physician shooting a person in the ED. You will be expected to immediately provide care for the man you just shot... and it better be good. So much for immunity...

I'm hearing lots of if's and perhaps, but not seeing any case law or precedence. I might take a big crap tonight and valsalva myself into v-tach and die, but that doesn't stop me from defecating. So the point is, I refuse to sit here and play the what if games with you. It's a tired game which would never end and is only supported by opinions. Now if you want to make a point that isn't based on fear of what might happen and have an honest discussion about the probability of what could happen, you might have a point since the incidence is fairly low (but still higher than the general public), but please make that argument with backing. Because in the end, all we really have to go on is statistics of past incidences and trends of past acts, which I'm damn well sure backs up my view point that it's better to be prepared just in case, in stead of up ****-creek and unprepared if the worst does happen.

 

[Hernandez]

Where in the heck do you conceal a weapon while working?

It's about time someone asked that, I think it would be difficult to impossible to carry in scrubs, the only option I could be would be a shoulder holster under a scrub top, but that isn't very convenient if you needed it quickly.

 

[logos]

It's about time someone asked that, I think it would be difficult to impossible to carry in scrubs, the only option I could be would be a shoulder holster under a scrub top, but that isn't very convenient if you needed it quickly.

Well there is always smart carry. I havent seen one in person but i hear it does work pretty well.

 

[Hernandez]

Well there is always smart carry. I havent seen one in person but i hear it does work pretty well.

I wasn't that impressed with it when I tried it, and besides, I have a hard enough time with scrub pants as it is. If I wore that, I'd be printing frequently.

 

[Hard24Get]

I wasn't that impressed with it when I tried it, and besides, I have a hard enough time with scrub pants as it is. If I wore that, I'd be printing frequently.

Out of curiousity, did you just come to this forum to talk about guns? And what specialty are you in?

BTW, MDs don't need guns in the ED because we have, in addition to security, several real cops waiting to take Some Dude, Two Guys, and That Bitch back to jail, and mean-a$$ RNs

 

[docB]

Neither you or any of the other people who were against the idea of carrying were touting benefits, you were stating matter-of-factly that you'd be sued, you'd be fired, you're career would be over.

Not true...

I don't carry because I feel that the possibility of running into trouble over it is quite likely while the possibility of actually using a gun to successfully defend myself is vanishingly small.

I still feel that I would risk my career every instant I carried in the ED while I have a 1 in 100000 chance of being confronted by a situation in the ED where deadly force by me might be appropriate.

This whole thing is about the risks of carrying vs. the benefit of carrying and has been presented as such. You just don't want to hear that others have analyzed the same situation and come to the opposite conclusion.

 

[yamaniakit]

http://www.elpasotimes.com/search/ci_4840771

 

[Hernandez]

Not true...

I guess I should have not been sloppy with my punctuation.

Neither you or any of the other people who were against the idea of carrying were touting benefits. you (Ex-44E3A)were stating matter-of-factly that you'd be sued, you'd be fired, you're career would be over.

Is that better? And did I miss where you were touting benefits?

This whole thing is about the risks of carrying vs. the benefit of carrying and has been presented as such. You just don't want to hear that others have analyzed the same situation and come to the opposite conclusion.

That's just my point, you've analyzed it with incomplete information and based some important points on assumptions that aren't universally true. I was only pointing out some flaws in your arguments especially to try and emphasis that people should be aware of their local politics and laws. I believe you have valid points that would be plenty to justify not carrying in 1) violates state law, 2) a clause in the contract you signed, 3) you are not comfortable handling or carrying a firearm (until you get more training). I believe it is also a valid point to talk about the potential consequences, but jumping to the extreme conclusion that have reached is a stretch and without backing. I'd be more than willing to discuss in possibilities if you're willing to not use the absolutes that you can not back up.

 

[Hernandez]

BTW, MDs don't need guns in the ED because we have, in addition to security, several real cops waiting to take Some Dude, Two Guys, and That Bitch back to jail, and mean-a$$ RNs

Now this type of deferral of responsibility for self safety is a personal pet peeve and I've got several threads and rather long threads in the Sociopolitical forum.

http://www.elpasotimes.com/search/ci_4840771

Man survives shooting, is slain at hospital

A man who narrowly survived a street shooting in Juárez only to be followed by his attackers inside a hospital and killed Tuesday was one of the men who was videotaped unloading drugs from a crashed SUV during a standoff in Hudspeth County in January.​

For those who couldn't open the link, but I have no delusion that this is typical or would have mandated the use of a firearm by a physician.

 

[doctor7]

think about it...no more fighting over procedures.

 

[jvencius]

Where in the heck do you conceal a weapon while working?

One of THESE would work IMO...

 

[Ex-44E3A]

How is your side of the story not being told, Hernandez? Have I deleted any of your posts? Self-defense is the obvious benefit of carrying a weapon; you've been trumpeting that from the start, so spare me the contention that I'm shouting you down in this thread. The largest benefit is intuitively obvious; surviving a lethal confrontation is not a small thing, but the story doesn't end with the last round you fire, and people should know that. I'm sorry you don't like my pointing it out, but the fact is that you will NOT be greeted with a ticker-tape parade and a "citizen of the year" medal from the local Chamber of Commerce.

I've treated you with respect despite your rhetoric, and I'd appreciate the same courtesy in return. Your angry tone and personal attacks are totally inappropriate. Don't be the kind of gun owner that makes the rest of us roll our eyes and leave the room. You don't persuade by insulting people, you don't gain influence by accusing them of being "panty-waste"s when they disagree, and you don't win converts by creating a virtual testicle-measuring contest and implying that your rhetorical opponents are cowards. The simple fact is that some of us have simply reached a different conclusion than you. We're not constraining your rights... simply choosing something different for ourselves.

I have the advantage of having personally seen the process go wrong. As a former instructor (long before I was an ER doc), I've had students use their weapons in self-defense. One in particular was prosecuted by an activist DA, nearly bankrupted his business defending himself, and went through a year or so of complete hell. After all that, it took the jury only an hour to find him innocent of the second-degree murder charge (Massad Ayoob assisted in the defense), and he spent 100K defending himself from the criminal charges alone.

I'm glad you live in a civil-immunity state, but many don't, and if you don't think civil suits are common after self-defense shootings, then you should ask Mr. Ayoob. There's a lawyer attached to every bullet we fire.

I'll throw you this bone: If you're lucky, you might not be charged or civilly sued (if you're fortunate enough to live in a state with such pre-emption)... but I'd argue that the odds that you, the "rich doctor," will be legally attacked in every way possible by the family are far greater than the family simply saying "aww shucks... paw paw got killed" and walking away. If, as an ER physician, you don't already know the pain of being a lawsuit target, then there's nothing more I can say to convince you... I hope you never have to learn the hard way.

no offence, but this is a bogus argument. You’re either backpedaling or you’re being intellectually dishonest about how this conversation has gone.

That's a totally unnecessary questioning of my integrity.

Neither you or any of the other people who were against the idea of carrying were touting benefits... So to throw your argument back at you, there was no discussion of risk benefits

What benefits? Beyond the fact that you're still alive (which is certainly great), there's a whole mess 'o bad. Psychological costs of having pulled the trigger (unless you're a sociopath), financial costs, job difficulties, vengeful relatives and friends of the deceased, etc.

If there are a bunch of benefits that I'm missing, please let me in on them.

 

[Hernandez]

How is your side of the story not being told, Hernandez? Have I deleted any of your posts? Self-defense is the obvious benefit of carrying a weapon; you've been trumpeting that from the start, so spare me the contention that I'm shouting you down in this thread.

I'm baffled where you got the impression that I was stating in any way that my views were being repressed, they were being ignored repeatidly when I keep pointing out that there are holes in your arguments that you started initially.

The largest benefit is intuitively obvious; surviving a lethal confrontation is not a small thing, but the story doesn't end with the last round you fire, and people should know that. I'm sorry you don't like my pointing it out, but the fact is that you will NOT be greeted with a ticker-tape parade and a "citizen of the year" medal from the local Chamber of Commerce.

I agree, people should be aware that there could be consequences, but I fail to see why worrying about the consequences if the whole reason and objective of the use would be solely to save your life. Surviving is a damn good benefit and is not over shadowed by any consequences that could happen in any means.

The simple fact is that some of us have simply reached a different conclusion than you. We're not constraining your rights... simply choosing something different for ourselves.

I'm not admonishing you for choosing something different, I'm admonishing you for putting forth your ideas as the end all of the discussion and presenting it as if it were the only valid choice. And I did criticize you for basing your conclusions on the fear of what might happen afterwards, especially if the situation which we're talking about truly was the epitome of saving your own butt from harm. I don't know about you, but i'd much rather be alive to raise my family and be with my wife than dead because I was too afraid of loosing my job and my career. I'm not of the mind set and I'll be up front, while I love my career choice, my family comes first. And I can not put my family first if I'm dead.

I have the advantage of having personally seen the process go wrong. As a former instructor (long before I was an ER doc), I've had students use their weapons in self-defense. One in particular was prosecuted by an activist DA, nearly bankrupted his business defending himself, and went through a year or so of complete hell. After all that, it took the jury only an hour to find him innocent of the second-degree murder charge (Massad Ayoob assisted in the defense), and he spent 100K defending himself from the criminal charges alone.

I'm assuming you're saying Ayoob was a witness for the defense, yes? And this again is a good point, and it ties in that people should know their state laws. In my home state, or the states surrounding me, this has never happened, I know of 8 or 9 cases in the last 8 years back in my home state of self defense shootings, and only 1 was brought to trial and rightfully so. That particular story made national news because he chased them off his land and then was involved in a car chase when he ran them off the road and shot them, he deserved what he got.

I'm glad you live in a civil-immunity state, but many don't, and if you don't think civil suits are common after self-defense shootings, then you should ask Mr. Ayoob. There's a lawyer attached to every bullet we fire.

While I respect Ayoob's articles and expertises, he's an alarmist on many things. Ayoob is of the mind set that you shouldn't carry reloaded ammunition or exotic calibers because you'll be sued for that, you shouldn't do this and that. And while many of his points are valid,

I'll throw you this bone: If you're lucky, you might not be charged or civilly sued (if you're fortunate enough to live in a state with such pre-emption)... but I'd argue that the odds that you, the "rich doctor," will be legally attacked in every way possible by the family are far greater than the family simply saying "aww shucks... paw paw got killed" and walking away. If, as an ER physician, you don't already know the pain of being a lawsuit target, then there's nothing more I can say to convince you... I hope you never have to learn the hard way.

Agreed, but just to emphasis, this is highly state dependent. Anyone who wishes to carry should be familiar with their state laws on the subject.

That's a totally unnecessary questioning of my integrity.

And this is worse than questioning how I practice medicine how? You made an example that had nothing to do with this conversation and your own example could be said of everything that you've stated in this thread, so I ask, what was the purpose of bringing pt interaction into the thread? You're either trying to back peddle and deny that everything you had said had been negative or you are deluding yourself by reinventing what was said in this thread prior to that comment. So I'll break it down, you came in with nothing but negative comments and opinions that carrying was universally a bad idea, I countered, you countered still nothing but bad, etc, etc, then you bring in this comment, to try and make it seem as you are being honest and discussing both sides of the argument and giving readers choices, this is simply false, you never endorsed any benefits until this last post.

What benefits? Beyond the fact that you're still alive (which is certainly great), there's a whole mess 'o bad. Psychological costs of having pulled the trigger (unless you're a sociopath), financial costs, job difficulties, vengeful relatives and friends of the deceased, etc.

If there are a bunch of benefits that I'm missing, please let me in on them.

Of course, you're right, we should just keel over and let the people who are willing to use violence do whatever the hell they wish. That's a great way to run the country and live life. As Patrick Henry asked, "Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery?" I'm not of the opinion that it is, and I definitely do not think that peace is so sweet that I'd not defend my family and myself for the fear of retaliation. "Resistance to sudden violence, for the preservation not only of my person, my limbs, and life, but of my property, is an indisputable right of nature which I have never surrendered to the public by the compact of society, and which perhaps, I could not surrender if I would." John Adams

So yes, I loath this argument, that you'd rather die (because that's the situation I'm talking about, the one where the use of a firearm to defend yourself is undeniable as proper) than face the difficulties afterwards. And if you're not willing to defend your life with violence because of fear of what might happen afterwards, why should anyone else, even the police? But, if you were to tell me that you're a pacifist, especially given your background, I'd not have a problem with that, because have the ability to make that choice, there is an old saying that goes something like "you're not really a pacifist if you don't know how to make war" or something to that effect, but that doesn't seem to be the argument that you're making.

 

[Flopotomist]

I guess the questions I have about this - 1. Where the heck do you comfortably carry the gun while working such that it isn't "in the way?"

2. How do you prevent your normal sweet little old lady patients from seeing the gun and being uncomfortable around you? I certainly don't think I would have a positive doctor patient relationship with a doc that walked into a room packing.

 

[jvencius]

I guess the questions I have about this - 1. Where the heck do you comfortably carry the gun while working such that it isn't "in the way?"

2. How do you prevent your normal sweet little old lady patients from seeing the gun and being uncomfortable around you? I certainly don't think I would have a positive doctor patient relationship with a doc that walked into a room packing.

Reposting from a few posts ago:

One of THESE would work IMO...

 

[Dr.Evil1]

I have been waiting and wondering when anyone would mention the incident that happened in my ED just 2 weeks ago. The link to the article in the Detroit Free Press is below:
http://www.freep.com/apps/pbcs.dll/article?AID=/20061207/NEWS01/612070356/1001/NEWS

So what about this situation, when the unarmed patient suddenly becomes armed because he stole a police officer's weapon? What the story doesn't say is that the officer's partner basically ran away, knocking over a mayo stand.

BTW there is an attending that works in our ED that I am absolutely convinced carries who was actually working when this happened. The only person who got off a shot was a Wayne County Sheriff after the guy had ditched his hostage.

I used to be OK with our security and police carrying guns in the ED, now I am not so sure. It seems like there should be guns at the door to prevent dangerous people from getting in but once inside the ED there doesn't seem to be a need for firearms. As pointed out many times in the tread there are many risks with carrying guns in the ED. I am all for walking from the car to the ED with a gun but once inside store it in your locker until the walk back to the car.

 

[a_ditchdoc]

I wasn't going to reply to this thread, but I figured I would throw in my .02 since their is so much discussion. I am a firm supporter of the second amendment, have shot for sport since I was a child, and have collected quite a few weapons. In my off time I have often carried a weapon for self defense (.45 Gold Cup/Beretta 92FS). Working as aparamedic for years I saw many innocent people brutalized by people that had no compassion or humanity left for their fellow man. Of course, I always showed up after the fact to try to stop the bleeding, which was far too often before the police arrived. Thus, I never left it in the hands of others to defend me. It simply is not possible for police to prevent violent crime. As much as I love people, I reached the decision that if it ever became a matter of me, or another, to be lying on the cold pavement bleeding to death, it would be the other. I would have no qualms about defending myself. My conscience would have to make it's own amends later. That said, I have never carried a firearm on an ambulance. Although I often went to crime scenes, where sometimes dozens of people screamed and yelled at me, the very fact that I was there to help, protected me. In those times that it didn't, there were those in the crowd with a moral compass that stood up to defend me (along with law enforcement). It is great to believe in your second amendment rights, but there are some that carry it too far. In my opinion there are few places where a physician needs to carry a weapon. The belief that you need to carry one on duty in an emergency room is rooted more in bravado and insecurity than any legitimate reason or philosophy than you can provide. After spending several years in a country perpetually at war, where I was not allowed to carry a gun, I no longer feel the need to carry one now that I am home. I came to realize that my constant exposure to violence made me feel threatened much more than the average person; "It happens every day." The incidence of violence in an emergency room requiring a firearm for resolution is extraordinarily rare. And although I have removed firearms and knives from many of my patients, none of them were actively threatening me (Ok, save one...he was swinging a loaded rifle around in grief). Perhaps some of you need to reevaluate why you feel the need to carry a weapon while on duty. I think the answer lies more within you than any real threat from the outside....

Anyway, just my .02

 

[Ex-44E3A]

Hernandez,

What I'm honestly trying to do is prompt some caution, and get people to plan for the aftermath. I don't have a problem with appropriately-trained people carrying weapons for their own defense... I've done it myself, and I wish more people did it. What I want people to do is plan for the worst case. Think about this: surviving the incident on the street, only to die in prison after years of confinement and regular sodomy. Failing to anticipate the legal fallout could land you in that latter circumstance

A person who carries a weapon needs to have a specific plan for the moments and days immediately after the shooting. This list is not all-inclusive... all of us have the financial means to consult an attorney, and there's no excuse for not doing so. I am not an attorney, so don't take this as legal advice.

• They should know what to say, not only to bystanders to create solid witnesses for their own defense, but what not to say. Ayoob's courses come highly recommended in this regard.
  
  
• They should consider that they may be arrested, and could even spend the night/weekend in jail. Getting put in cuffs and placed in the back of a cruiser is a new, frightening, and humiliating experience if one has never been there. They'll be fingerprinted, and depending on the police department, may be treated just like a criminal. That's a very disconcerting and intimidating experience for most physicians. Don't crack... it's only temporary.
  
  
• They should otherwise immediately shut up, lawyer-up, and only discuss the incident with people who cannot be compelled to testify against them (this varies by state, but "priviledged communications" generally includes their lawyer, and can include psychiatrist, spouse, minister, etc). The police may or may not use various ploys to loosen them up and get them to talk about it, but while heresay is generally not admissable, "spontaneous utterances" are. When given the option to "remain silent," always take it.
  
  
• They should have a personal attorney they can call 24/7, and they should have sufficient "disaster funds" to be able to post bail (if necessary) and retain specialty counsel if needed.
  
  
• They should have an exact duplicate of their carry pistol in their safe at home, complete with carry rigs (remember, the police will have confiscated the one used in the shooting). When vengeful relatives or fellow gang members are skulking about looking for revenge, that's not the time to be learning a new pistol... it pays to have a duplicate of that with which one is most expert.
  
  
• They should expect some psychological effects after the shooting. Unless one has some underlying sociopathy, killing another human being at close range is going to shake them up. I'd recommend two books to help understand. This one, and this one. If your state "privileges" psychologists or psychiatrists, consider consulting one if you're having problems.
  
  
• They should expect to be smeared in the press. If the local bird-cage liner is anti-gun in any way (most metropolitan newspapers), expect the paper to splash lurid details of any bad things in the shooter's past across their pages, and they may even write sympathetic portrayals of the deceased. Ex-wives may come crawling out of the woodwork for TV interviews... one should not count on being perrmitted, either by the paper or their attorney, to tell their side of the story.
  
  
• They should expect job difficulties. As we're all painfully aware, hospitals in general are very sensitive to bad publicity. If one is a contract physician or independent contractor, that physician basically works "at will," and can be terminated very easily. Even if partners in a democratic group, the hospital may come to that group and force the partners to buy out the shooter and invoke their "60 day clause" or lose their contract. As ED physicians, the bottom line is that there we have very little job security.

In short, a person who shoots another in self-defense should expect to be attacked in every possible way, particularly if they're a high-profile public figure like a physician. The likelihood that ANY of us are going to find ourselves in that circumstance is vanishly small... but you'd hate to be that fraction of a percent, and not have planned for it. You'll be stressed enough after the incident itself without having improvise all of this on-the-fly.

If, after considering all of this, you decide to carry... by all means do so, but know what you're doing, and take steps to prepare.