Violence in the ED

[southerndoc]

I'm just starting this thread to discuss issues of violence in the ER. Does your facility have metal detectors? Are any of you wearing ballistic vests? Practicing active shooter scenarios?

Police fatally shoot patient who had gun at Texas hospital

Authorities say officers fatally shot a patient at a Dallas-area hospital who had a gun in an emergency room

abcnews.go.com

Man charged in LA hospital stabbing of doctor, nurses

Prosecutors have charged a man with attempted murder after they say he stabbed a doctor and two nurses inside a Southern California hospital emergency ward last week

abcnews.go.com

Family dispute outside Grady Hospital connected to deadly Kroger shooting

A shooting at a hospital in Downtown Atlanta has left one person dead and another critically injured in what police are calling a family dispute.

www.wtoc.com

News: The Aftermath of the Shooting at Chicago's Mercy... : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

Dayton Police: Security guard dies after being shot at Miami Valley Hospital

DAYTON, Ohio (WKEF) -- Montgomery County Sheriff Rob Streck said Wednesday afternoon that the inmate accused of stealing a security guard's gun, killing the guard and them himself at Miami Valley Hospital on Wednesday morning, showed signs of violent behavior before the incident. Earlier in the...

dayton247now.com

Alleged Bronx hospital shooter indicted in brazen act of gunplay caught on video

Keber Martinez, who allegedly shot Ruben Perez in the Jacobi Medical Center ER on Jan. 25, has been indicted for the brazen act of gun violence seen on video.

nypost.com

Man killed by police officer at Duke Hospital in January was shot three times in back, documents reveal

Law enforcement told Jones to put the gun down, but Jones “ignored their orders and was subsequently shot several times in the back,” according to the investigation report. Jones’ autopsy reveals that he was shot three times, resulting in damage to his heart and other internal organs.

www.dukechronicle.com

Not really in the ER, but healthcare related:

https://www.washingtonpost.com/nation/2022/06/02/tulsa-shooting-news-medical-center/

Shooting at Detroit hospital connected to I-94 shooting on city’s east side

More than a dozen shots were fired into a crowd outside Ascension St. John Hospital on Moross Road, officials say. Police are now connecting the shooting at the hospital to another shooting that happened on I-94 Monday (June 13) afternoon.

www.clickondetroit.com

I'm sure there are quite a few more out there...

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[BoardingDoc]

No, no and no.

The first one I would like but don't have.

The second I personally think is excessive, but to each their own.

The third isn't something which we rehearse, but I know precisely which way I would run to escape from any of the various areas in my ED.

 

[Dred Pirate]

1. We have metal detectors (and we are what some refer to as a "country club hospital" - definitely not even close to inner city)
2. nope
3. - we have training and online modules for what that is worth,

 

[The Knife & Gun Club]

Metal detector, armed security guards/on site police, no bullet proof stuff.

Inner city hospital.

Honestly I worry less about my low SES patients causing problems - usually they’re just on drugs/drunk or have mental illness so decompensated they can’t get into much trouble that haldol/ativan/Benadryl can’t fix.

 

[RustedFox]

I used to work at Country Club Medical Center. Now, I work at White Trash Memorial Hospital.
The people are much nicer, but super methed up. "A Florida Man" all day every day.

No metal detectors.
Security is a pudgy boomer with a stern glare as his primary weapon.

Cops are never far away.

 

[wook]

Does your facility have metal detectors?
No

Are any of you wearing ballistic vests?
Yes, including ceramic plates to help address long gun threats and shrapnel (explosions)

Practicing active shooter scenarios?
No (but I do this with my EMS work with various agencies/organizations)

 

[wholeheartedly]

Does your facility have metal detectors?
No

Are any of you wearing ballistic vests?
Yes, including ceramic plates to help address long gun threats and shrapnel (explosions)

Practicing active shooter scenarios?
No (but I do this with my EMS work with various agencies/organizations)

What does this vest look like?

 

[Tenk]

You need at LEAST level 3 plates to stop the most common stuff, and level 4 if your shooter knows anything about guns and ammo which luckily most don’t. If you’ve never worn plates, they are heavy, cumbersome, and you’d probably need bilateral knee replacements after several years of wearing them every shift with all the up and down we do.

 

[southerndoc]

You need at LEAST level 3 plates to stop the most common stuff, and level 4 if your shooter knows anything about guns and ammo which luckily most don’t. If you’ve never worn plates, they are heavy, cumbersome, and you’d probably need bilateral knee replacements after several years of wearing them every shift with all the up and down we do.

How does our up and down compare to a police officer getting in and out of their car?

My IIIa with the fire department has some hard plates in it (it's an outer vest). Some of the police officers I know wear soft IIIa that is pretty much undetectable underneath clothing and only weighs about 5 pounds. My fire vest gets pretty hot.

 

[RustedFox]

You guys are wearing body armor inside the ER??

 

[Mount Asclepius]

I don't think it'll be worth doing this job any more if it's going to require wearing body armor. Not worth the risk. May also not be worth living in this country any more if the expectation is more so that those in health care need to protect themselves rather than removing guns from an environment focused on healing.

 

[Dred Pirate]

I had a friend in the ED during the Duke shooting- said it was scary as hell. If you read the article, a metal detector wouldn’t have prevented that one (patient stole gun for arresting officer). I have never felt unsafe from a firearm perspective, but maybe that is blissfully arrogance.

 

[Tenk]

How does our up and down compare to a police officer getting in and out of their car?

My IIIa with the fire department has some hard plates in it (it's an outer vest). Some of the police officers I know wear soft IIIa that is pretty much undetectable underneath clothing and only weighs about 5 pounds. My fire vest gets pretty hot.

Ask any older police officer or veteran how their knees and back are. There’s your answer.

I don’t know if I’d trust soft 3a to make a difference because if they are using a rifle you’re dead anyways, and most close quarters handguns would knock you to the ground and they can just shoot you again.

Which brings me to my next reason on why plates are not super useful in the ED: you have no way to return fire and they can just walk up to you and shoot you again.

You’re far better off just running like hell turning corridors in the opposite direction of gunfire as the perp won’t match your speed. If anything body armor will just slow you down.

 

[Brigade4Radiant]

The thing is ER isn’t really that much different than risk at a gas station or mall

 

[Dred Pirate]

The thing is ER isn’t really that much different than risk at a gas station or mall

Or school

 

[wook]

What does this vest look like?

I choose concealable with plates under my scrubs. Often people don't notice.

It can be uncomfortable. I have been wearing armor for over 30 years (my first career was not in medicine and was useful in that role), so it does not bother me. I can put in a central and intubate without difficulty. LPs have also not been a problem. If you have not worn armor before, it may feel cumbersome on you, especially if doing procedures.

 

[wook]

You guys are wearing body armor inside the ER??

Fox:

Yeah. Wore it in my first career, and been wearing it ever since. It is almost second nature. It does make me look fluffy, but I roll with it. It's really nice when it's cold out! LOL!


Wook

 

[RustedFox]

What do our military servicemembers wear in terms of armor?

Asking because I know nothing about armor, etc.

 

[wook]

https://www.ojp.gov/pdffiles1/nij/nlectc/250144.pdf

 

[wook]

What does this vest look like?

Galls GL Body Armor Threat Level IIIA NIJ Number KXPIIIA

Shop Galls GL Body Armor Threat Level IIIA NIJ Number KXPIIIA and other quality Body Armor, Tactical Vests & Ballistic Protection from Galls.

www.galls.com

 

[alpinism]

All of the Detroit ERs with residencies have metal detectors.

Multiple attendings are well known to carry handguns on shifts.

 

[southerndoc]

Ask any older police officer or veteran how their knees and back are. There’s your answer.

I don’t know if I’d trust soft 3a to make a difference because if they are using a rifle you’re dead anyways, and most close quarters handguns would knock you to the ground and they can just shoot you again.

Which brings me to my next reason on why plates are not super useful in the ED: you have no way to return fire and they can just walk up to you and shoot you again.

You’re far better off just running like hell turning corridors in the opposite direction of gunfire as the perp won’t match your speed. If anything body armor will just slow you down.

Ask any older police officer or veteran about their knees, and a lot of their problems are probably more to do with their weight than with their vests and frequently exiting cars. I know many police officers who are not overweight, are older, and not a single one of them has hip/knee/back problems.

IIIa is better than nothing and can be concealed quite easily. Most people can't conceal a rifle. You will know they are coming. Concealing a handgun, however, is a totally different story, and a IIIa vest may protect you from it.

I don't think anyone wearing body armor is going to jump in front of gunfire.

Multiple attendings are well known to carry handguns on shifts.

Not sure many healthcare systems would approve of physicians carrying handguns on duty.

I still believe metal detectors should be standard at all ERs.

 

[emergentmd]

The thing is ER isn’t really that much different than risk at a gas station or mall

I think the big difference is people comes to the ER with problems and already hyper stressed/pissed such as druggies.

ERs are inherently more dangerous. I have seen a few nurses with broken ribs. Psych pts going crazy.

Violence is my biggest fear working in the ER.

 

[wook]

I think the big difference is people comes to the ER with problems and already hyper stressed/pissed such as druggies.

ERs are inherently more dangerous. I have seen a few nurses with broken ribs. Psych pts going crazy.

Violence is my biggest fear working in the ER.

I would tend to agree with you. In every ED I have worked there has been substantial violence with employees hurt by a patient. With that being said, I mostly work in urban EDs, but even at some of the more rural EDs I have worked there have been injuries and violence.

 

[emergentmd]

I have had 3 drop off shootings in my community ER. Every time this happens, the risk of the shooter coming to finish the job is high.

I have had Psych pts spitting, fighting, threatening to kill someone/staff

I have had a women go crazy and throw her menstrual blood throughout the ER.

I have had Psych pts, have weapons on them when they came to the ER.

I would say ERs are hyper dangerous.

 

[bravotwozero]

No metal detectors.
Security is a pudgy boomer with a stern glare as his primary weapon

One of our security guards showed up to work while I was on shift with chest pain, had a big honking NSTEMI with a sky high trop. Obese hypertensive diabetic who hadn’t even cracked age 50.

Another got beat up by a psych patient who then trashed his cellphone…

 

[lp430]

At my current shop, our active shooter plan is calling maintenance and the police. I work in an area where I assume at least half my patients/families are carrying. But seriously, what is maintenance gonna do?

 

[Siggy]

At my current shop, our active shooter plan is calling maintenance and the police. I work in an area where I assume at least half my patients/families are carrying. But seriously, what is maintenance gonna do?

Take the Uvalde route and contain the shooter.

We thank you for your sacrifice for the thin blue line’s safety.

 

[alpinism]

Ask any older police officer or veteran about their knees, and a lot of their problems are probably more to do with their weight than with their vests and frequently exiting cars. I know many police officers who are not overweight, are older, and not a single one of them has hip/knee/back problems.

IIIa is better than nothing and can be concealed quite easily. Most people can't conceal a rifle. You will know they are coming. Concealing a handgun, however, is a totally different story, and a IIIa vest may protect you from it.

I don't think anyone wearing body armor is going to jump in front of gunfire.


Not sure many healthcare systems would approve of physicians carrying handguns on duty.

I still believe metal detectors should be standard at all ERs.

They’re all senior faculty who’ve been there over 20 years and work night shifts.

Detroit was a very different place even 10 years ago when the city went into bankruptcy and lost half its police force. The average response time was something like an hour even for serious calls like stabbings and gunshots. Depending on how busy they were some days you could literally be completely on your own for a very long a time before any help arrived.

 

[CoolDoc1729]

They’re all senior faculty who’ve been there over 20 years and work night shifts.

Detroit was a very different place even 10 years ago when the city went into bankruptcy and lost half its police force. The average response time was something like an hour even for serious calls like stabbings and gunshots. Depending on how busy they were some days you could literally be completely on your own for a very long a time before any help arrived.

I remember one time when I left a mid shift in Detroit. I was driving down the street and there was a parked van on fire. I called 911 to call it in. The dispatchers response… “is there anyone in it?” Yeah .. I’m not sure .. I didn’t get that close, because it’s on fire… “ok we’ll try to get someone out” 😬

 

[Groove]

You guys are wearing body armor inside the ER??

I don't but I totally would if I worked in an inner city hospital with lots of violence. I wouldn't even be opposed to wearing my concealed carry if hospital policy allowed it but almost all hospitals don't regardless of whether the state has any laws prohibiting concealed firearms.

Some of that new Engarde soft body armor looks pretty comfortable and much easier to wear than traditional kevlar vests.

 

[Groove]

All of the Detroit ERs with residencies have metal detectors.

Multiple attendings are well known to carry handguns on shifts.

There's no way your hospital has a policy that allows this and getting caught with a firearm as a physician is a sure fire way to get fired and have your privileges terminated as well as get reported to the state board for punitive action. While I'm a firm supporter in docs being allowed to carry firearms, the risk has never been worth it to me since almost all hospitals (regardless of state) have strict policies against it and the repercussions of being caught can seriously jeopardize your career.

 

[Brigade4Radiant]

There's no way your hospital has a policy that allows this and getting caught with a firearm as a physician is a sure fire way to get fired and have your privileges terminated as well as get reported to the state board for punitive action. While I'm a firm supporter in docs being allowed to carry firearms, the risk has never been worth it to me since almost all hospitals (regardless of state) have strict policies against it and the repercussions of being caught can seriously jeopardize your career.

Yeah but it's not like that doctor couldn't win any case against him with a state medical board. Hospital you can be fired but if the board wants to act it's not like the doctor is powerless.

 

[Groove]

Yeah but it's not like that doctor couldn't win any case against him with a state medical board. Hospital you can be fired but if the board wants to act it's not like the doctor is powerless.

Yeah but you’ve got to report it forever on state renewal/new state applications and future hospital priv applications.

 

[Dr Mantis Toboggan]

Yeah but you’ve got to report it forever on state renewal/new state applications and future hospital priv applications.

On the other hand, you’re still alive…

 

[southerndoc]

I don't but I totally would if I worked in an inner city hospital with lots of violence. I wouldn't even be opposed to wearing my concealed carry if hospital policy allowed it but almost all hospitals don't regardless of whether the state has any laws prohibiting concealed firearms.

Some of that new Engarde soft body armor looks pretty comfortable and much easier to wear than traditional kevlar vests.

There's all kinds of concealable soft armor. Even some that are just t-shirts with support straps and soft plates front/back. No side protection though.

I wonder how that would hold up in court if a hospital fired you for carrying a gun in a state that has pretty liberal gun laws. I'm betting they couldn't enforce it and would likely lose a bunch of money in litigation. Of course, that means testing it and having the time to fight it.

 

[RustedFox]

I wonder how the board would feel if THEY were involved in an active shooter situation.

Just saying. "Rules for thee..."

 

[Brigade4Radiant]

Yeah but you’ve got to report it forever on state renewal/new state applications and future hospital priv applications.

But you have to do that with being listed on a malpractice lawsuit and expired licenses. You also just save the letter your lawyer wrote and send it.

Why do we as physicians dread this outcome when there isn’t any serious data stating that this affects job prospects

Hospitals should have a database on if they’ve been accused of Medicare fraud (HCA) or sexual harassment

 

[southerndoc]

But you have to do that with being listed on a malpractice lawsuit and expired licenses. You also just save the letter your lawyer wrote and send it.

Why do we as physicians dread this outcome when there isn’t any serious data stating that this affects job prospects

Hospitals should have a database on if they’ve been accused of Medicare fraud (HCA) or sexual harassment

It does affect job prospects. I know of some groups who won't hire you if you've been sued more than once (even if you were dropped from them).

 

[Angry Birds]

Galls GL Body Armor Threat Level IIIA NIJ Number KXPIIIA

Shop Galls GL Body Armor Threat Level IIIA NIJ Number KXPIIIA and other quality Body Armor, Tactical Vests & Ballistic Protection from Galls.

www.galls.com

View attachment 356778

I wear a Patagonia fleece. About the same thing?

 

[southerndoc]

I wear a Patagonia fleece. About the same thing?

Patagonia fleece with a ceramic plate?

 

[Brigade4Radiant]

It does affect job prospects. I know of some groups who won't hire you if you've been sued more than once (even if you were dropped from them).

Yeah sometimes that happens but okay a few groups. Are these unicorn jobs? It's not like you will be unemployed and it certainly isn't worth worrying about it. This also would depend on the state as well.

 

[southerndoc]

Yeah sometimes that happens but okay a few groups. Are these unicorn jobs? It's not like you will be unemployed and it certainly isn't worth worrying about it. This also would depend on the state as well.

Perhaps you've forgotten about the oversupply of residents eager for jobs. If given a choice and all things are equal, would you prefer the fresh new grad without malpractice history or the middle-aged doc that's been sued 3 times?

I think I might follow @wook's lead and start wearing a vest at work. Life is way more important than comfort of not having some sort of protection.

 

[Angry Birds]

I think I might follow @wook's lead and start wearing a vest at work. Life is way more important than comfort of not having some sort of protection.

Seems nuts to me.

 

[southerndoc]

Seems nuts to me.

Probably is. Better safe than sorry. Some people use the same reasoning for not wearing seat belts. Chances are you won't be in a crash, but chance is still there. I recognize the likelihood of being in a car accident is higher than being stabbed/shot at work.

 

[Brigade4Radiant]

Perhaps you've forgotten about the oversupply of residents eager for jobs. If given a choice and all things are equal, would you prefer the fresh new grad without malpractice history or the middle-aged doc that's been sued 3 times?

I think I might follow @wook's lead and start wearing a vest at work. Life is way more important than comfort of not having some sort of protection.

Depends on RVU's and the oversupply will affect people in multiple ways like press ganey. Anyway you can do telehealth or primary care. I'd rather be alive

 

[WilcoWorld]

Better safe than sorry.

Up to a point. I don't know enough about these vests to have an opinion on this specific decision, but "better safe than sorry" could be used to argue that I should never leave my home again, and I'm not going to do that.

 

[WuMedic]

1. In my healthcare system, the inner city EDs have metal detectors as do some of the suburban ones. At this time Freestandings may or may not have metal detectors or even security depending on where they are located. Some smaller country club hospital EDs do not have metal detectors but those that don’t have 24/7 security (though sometimes only one guy on overnight). Based on recent events, this is changing and the goal is 100% of Hospital EDs and FSEDs to have 24/7 security and metal detectors by the end of the year with inner city hospitals having metal detectors at all public entrances (for general hospital visitors and patients, not going to the ED).

2. I keep mine in my car, which I understand is just as useful as having a life jacket on the other side of the boat. I only use it when I respond with EMS. Mine’s a IIIA. Used to have a III with hard plates when I did more EMS response but it was bulky. My mother would appreciate me wearing it all the time and continues to gently suggest such every time something hits the headlines but I have yet to feel the need. Hospital security here are pretty good at screening patients and visitors and both instances where security have had to open fire in the hospital were at sites without metal detectors for general hospital entry and not sites I work at. If by some fluke I was assigned to one of those sites (which are in really bad neighborhoods), I probably would wear my vest since it’s just be for that one shift that one time and I wouldn’t mind the discomfort for a few hours. I haven’t tested it, but upsizing one scrub top size should do the trick since the hospital scrubs are super baggy.

3. Yes, mandatory annual training.

 

[miacomet]

We don't even have security

 

[wook]

Probably is. Better safe than sorry. Some people use the same reasoning for not wearing seat belts. Chances are you won't be in a crash, but chance is still there. I recognize the likelihood of being in a car accident is higher than being stabbed/shot at work.

I like wearing the plate inserts over the soft armor. The times I've been punched or pushed, the plates along with soft armor soften the effects. The facial expression on the perpetrator was priceless.....