Violence in the ED?

[MRSAful Fate]

This topic has been on my mind lately after I visited LAC-USC and experienced the intense security environment they have. I imagine at hospitals like that the security presence is sufficent to handle most drunken/high/gang-affiliated/head injured/psycotic patients who might have an outburst and attack someone. But what about the rest of the hospitals where the security guards are usually 65 year old semi retired guys and gangly teenagers? I know nurses who have been injured by violent patients, and one of the docs I used to shadow loved to tell stories about judo-throwing rampaging patients and pinning them down. How often do you guys in the field deal with violent patients? And what is the legal context of this situation in regards to acting in self defence (i.e. judo-throwing a gang banger who is trying to punch you in the face)? Do you have the same rights as someone on the street or do the rules change since you are a doctor and they are a patient in your hospital?

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[pseudoknot]

I'm not a lawyer, but my understanding is that if it's self defense, you will be ok from a criminal perspective. As far as civil liability and the Joint Commission, you should let patients do what they please, including murdering you if they want.

 

[EctopicFetus]

I have some stories.. personally and of friends both getting hurt and nearly escaping serious stuff. Bottom line is lots of crazy people but even the old security folks will overwhelm the crazies by number. We have used 10+ people to pin some people down. Then its IM Haldol, Ativan, Benadryl.

 

[Birdstrike]

I don't try to be a hero with psychotic or violent patients. I turn around, walk out of the room, call security and/or police and order sedation. Next patient. I'm a doctor, not a cop. I carry a stethoscope not a weapon. It's not worth getting hurt over, or stabbed with an HIV/hepatitis positive needle.

 

[Interpolfanclub]

I don't try to be a hero with psychotic or violent patients. I turn around, walk out of the room, call security and/or police and order sedation. Next patient. I'm a doctor, not a cop. I carry a stethoscope not a weapon. It's not worth getting hurt over, or stabbed with an HIV/hepatitis positive needle.

This. I don't take any risks. Call security, 4 point restraints and haldol and ativan. I've got too much invested to risk getting hurt trying to wrestle some drunk.

 

[docB]

Even if you don't take risks it's a risky environment. I've been minorly injured a few times including getting some permanent scars from a patient who dug fingernails into me while getting restrained. It's a part of the job. And I agree with pseudo's point that as far as Joint Commission, civil lawyers and hospital administrators are concerned we are there to get hurt and are disposable.

 

[Pharmavixen]

In my workplace, a jail, if the doctor is seeing somebody who turns violent, several burly men will sit on that person until he is placated. Isn't the dr's job to judo-throw anybody.

 

[Birdstrike]

Even if you don't take risks it's a risky environment. I've been minorly injured a few times including getting some permanent scars from a patient who dug fingernails into me while getting restrained. It's a part of the job. And I agree with pseudo's point that as far as Joint Commission, civil lawyers and hospital administrators are concerned we are there to get hurt and are disposable.

I couldn't agree more.

 

[EctopicFetus]

I couldn't agree more.

Might be true but there are things we can and I believe should do to chill people out before hand.

1st I tie down people when necessary. No sandwich or other stuff about placating these people. Behave or get the treatment. Either chemical or physical restraints or both.

2) If they seem agitated but cooperative I ask them if i can give them something to help them relax while we work them up. usually a dose of ativan chills em out. The other advantage is if they then freak they are somewhat sedated already.

3) I imagine when the non drunk psych patients go kookoo it is like a guy having a STEMI, they cant control it and giving them some haldol etc is my way of calming them down (aka aspiriin, heparin etc in STEMI).

 

[Farmer2DO]

One of the hospitals we transport to, our busy level 1 trauma center, is also affiliated with a private university. Their hospital security is all the same force as the university security. The hospital hog ties the security with their "hands off" policies. When we bring in someone who has been cooperative, and they start to fight, or worse, a patient that isn't ours and is waiting in EMS triage, and decides they want to fight with us, security will literally sit and watch while these people go after us (EMS). Our employees have been assaulted by patients on hospital property, and they won't get involved, because they don't have a doctor's order.

Their union is fighting to get them equipment and training as peace officers, to be used on campus and at the hospital. Our union is backing them up. For now, they are pretty useless.

 

[namethatsmell]

Echoing the above statement, I have found no rhyme or reason to the way some EDs have their security set up. The most intimidating hospital security I've ever seen was at a tiny hospital in a 2nd tier suburb in a pretty nice/safe metro--I only ever ran a few patients in there, but these guys were all off-duty cops allowed to carry all their guns/toys. While guns in the ED is bad/dangerous, I do like the idea of having off-duty cops in the ED...granted, this opens up an ethical can of worms...

The most surprising set-up was at the shop I worked at before med school. Major level 1 powerhouse on the edge of a dicey area in a huge city. There were only a couple nights per week when there was actually a guard posted inside the ED...any other time you could hit a button and eventually a squad of security guys would enter the ED...but it would still take them a few minutes to arrive. More than a few times it was me lying on top of a patient while the doc pushed chemical restraints. I totally dig EM but have no desire to do that again.