# If the ER isn't safe, how safe are our scenes?



## ffemt8978 (Jan 8, 2008)

http://www.emsresponder.com/online/article.jsp?siteSection=1&id=6817

Man Brings Grenade into Detroit ER



> DETROIT     --
> The emergency room at Detroit Receiving Hospital was given the all clear Saturday after a man tried to enter the hospital with what police said was a live grenade.


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## VentMedic (Jan 8, 2008)

It is sad when hosptials, which should be safe places to heal,  must have metal detectors.

Actually, it is probably a lot safer on the ambulances.  EMS usually arrives within 8 minutes whereas a wait in the ER could be 8 hours.  Is it a mystery why pts get a little angry in the ER?

EMS may sense danger and wait for backup. Then, whatever you load into your ambulance is brought to the hospital and dropped off. 

If EMS and the patient had a confrontation and the patient is now angry, the ER will have to deal with it while EMS rides off. 

If EMS promised the patient a "whole pharmacy" at the ER to get the patient to cooperate, the ER will then have to deal with a very angry patient who feels they have been lied to later.  

Sometimes EMS workers don't understand the effect their words, actions and jokes have on the patient.  They can literally turn that patient into a ticking time bomb.

If the patient is a walk in and demands either attention or drugs and doesn't get his/her way, we have a very angry situation. 

If the patient presents a danger to himself or others, he have to be restrained and held for observation. Since this may be against his/her will, just doing regular care and hygiene on the patient will be a battle.

If the patient comes in by ambulance on a stretcher, they will bypass the metal detector.

Hospitals usually have a secured lock box for weapons that are taken regularly off the patients.  The police are notified to see what is legal or not since Florida is a concealed weapons state.  Even the senior citizens have to be searched and relieved of their weapons.  My mother and her condo pals carried guns for many years as senior citizens.  

Many times EMS bring these patients to the ED and did not notice the weapon under their jacket or in their pants or ankle strap.  It would probably be wise to kept personal bags in view but out of arms reach when transporting.   

EMS may spend 30 minutes with the patient. Hospital staff will be stuck with the patient through their illness/injury and long enough for them to go through detox/withdrawal.   A 12 hour shift can seem like an eternity if you are the primary nurse with 3 - 4 patients who are considered violent or detoxing along with 3 other patients to care for.  Even in the ICU with only 2 - 3 patients, it is a challenge.    It may take what seems like the whole pharmacy to keep the patient down. And then, we are supposed to give the patient a "sedation vacation" each shift.  That's can make a very bad 30 minutes. 

If the patient is a substance abuser is kept in the hospital for medical, hospital staff will have to deal with the violence of detox.  Not every one can tolerate heavy chemical restraint for long periods of time unless they are placed on a ventilator and then that can present more problems. 

I have seen way more violent patients in the ED and throughout the hospital in 1 shift than I saw in a month or two of working ground EMS in the city during the drug wars and riots.   With many ambulances bringing several patients who display violent behavior plus the walk ins demanding service RIGHT NOW, it can get scary. 

In the hospital, we always have to worry about gang retaliation.  Pts of violent crime are not admitted under their real name and the password given to the family is changed daily and sometimes every shift.  If a 12 y/o who may have gang affiliations is shot, they are sent to the adult ICU which is locked and has heavy security.  These "kids" can no longer be considered pediatric.  These pts may require lengthy hospital stays and sometimes are placed in nursing homes or vent facilities for the long term under another identity. 

And, sometimes we have more problems from the families, "well-meaning" friends and neighbors.  If you pick up a pt injured in violent confrontation, the whole neighborhood may appear soon at the hospital.  Yes, that could happen at scene but if it is a shooting, PD should be rolling also. 

We recently had a hospital ER stampeded with only 1 LEO at the hospital with the pt. and was helpless against a mob.  

We also deal with very angry parents who believe we didn't do enough.  Terminating life support on a child can sometimes go very bad with different families of different cultures and beliefs.  Emotions can get out of control. 

My hospital had 2 bomb alerts last year and numerous armed pt/visitor alerts.  And, I can not even begin to count the violent patient alerts I hear called.  It is pretty common for the area and no longer news worthy or the hospital is on good terms with the media.

Hospitals also have contracts with prisons and jails. Even with a guard there, it can be a challenge to draw blood and insert a foley into an inmate.  

It's not just the young, strong street wise gangstas, but also geriatric psysch issues due to illness or psychotic disease are difficult to deal with and many of our hospital staff have been severely injured just trying to do basic care for these patients. 

Some hospitals have a police force securing them.  Some have security guards who are working a "little extra since retiring". 

It seems like whatever precautions hospital staff tries to take there is some rule, regulation or internal/external legal watch dog group that cries foul. In the street, the police can use the law to their benefit in the immediate scene securing and assist in controlling the custody of the patient.

EMS will also not need to worry about the q1 hour documentation while a patient is in the hospital in restraints and risk reprimand or lawsuit for missing a check.  Sometimes that presents more danger to the caregivers' well-being than the patient if one's job security is threatened. 

In recent years, Florida has had at least 4 violent deaths to health care workers inside the hospital even in the secured areas.

And, of course, we've had the patients who have jumped to their deaths. If they can not find a way out the window, they usually jump down the center of the stairwell from the top floor.  A few have gotten scapels and have sliced wrists or throats.  Some have gotten matches or lighters and have tried to burn the hospital down.   

You don't have to work in a large city hospital to see the things I mentioned.  Rural U.S.A is not immune to these problems even if they don't have the patient volume. 

But yes, it is dangerous for EMS if they are inexperienced or lack communication skills or don't know when to call backup or think they can handle it themselves or don't watch each others' back.  Sometimes it is the calls that don't present as violent that can be the most dangerous.  If you don't know what you have on a call, then yes it is dangerous.  If you know the patient is armed and/or dangerous, back off until help arrives.  Don't play the hero in the face of danger. Others may get hurt by your actions.


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