Security Guards

Aidey said:
I think the RN had a valid reason for getting upset. The patient was intubted and unconscious after all. If the patient had been conscious, or the flight crew didn't have IDs, so the identity of the whole group was in question I would understand it better.
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I take it you haven't been around many intubated patients. One minute they can be on a paralytic and then next minute they can be trying to jump out of the bed depending on the other meds and the titration skills of the RN.

This has also been the controvesey with Paramedics and RSI or even doing CCT in some areas. They don't alsways have the protocols to keep a patient adequately sedated with an ETT and ventilator. Hopefully this RN did have this capability but then she probably only knew the patient for a few minutes and may not know the tolerace for the medications.

The rules should be for all and not selective nor should one assume anything about a patient's condition especially if that patient is known to the provider for only a short time.

Again, this Security Officer has the responsibility of many when it comes to safety and not just one patient.
 
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Apologies for the typos in the previous post.

Sapphyre said:
Hey, Jon, not hating on ALL security guards (99% of the ones I've encountered at hospitals, and elsewhere are great), but, there's the crop at the particular hospital that are, um, well, I guess DENSE is the best way to describe them. Yes, we all understand when we go in there, names are taken and patients are searched. But it shouldn't take the providers 5-10 minutes to convince the guard of the patient's name. It shouldn't take the guard having to walk out to look at the side of your rig to convince them of the name of your company, and they SHOULD be looking at you enough during this extremely long interaction, to recognize you when you come BACK out to clean and put your gurney away so that they're not trying to get yet another patient name out of you.

I have had 1 smooth entrance at this particular hospital. The guard handed over the board, let us put down the name of the patient, and the company, while he wanded the patient, and in we went, simple.
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This depends on the size of the hospital and the requirements of their security. Just our ED will see over 100 ambulance in a 12 hour shift on some days. That might even be considered a slow day. That doesn't include the numerous transfers with many different services of all types to many areas of the hospital including dialyisis. We have ambulances, fire rescues, medi-vans, wheel chair coaches, community assist transport etc all coming and going from many entrances. Some may enter one way and exit another way if they want a cup of coffee or to take the scenic route back to their vehicle. We also get many out of county, out of state and out of the country transport teams that may not understand life in the big city or the reasons for our security. However, our LEOs will not allow abusive behavior against our Security Officers regardless of your title and will not hesitate to step in to settle the matter. When you are arguing with people who are also trying to do their job and fail to respect the ways of that facility, you probably don't have the best interest of your patient in mind but rather your own ego agenda to settle. This may not be the case every where and there will be some in every profession to muddy the procedure.

For our patients, we have a large variety, some of which use fictious names. While those will still get medical care, they will be entered into the system for followup with the LEOs and whatever agency that might be interested.

BTW, we do get patients transferred to our facility that should have been taken elsewhere. We've even gotten STEMI pts going to the cath lab...just not ours but the one in another hospital a few blocks away. An alert Security Officer caught the mistake at the entrance. We've had patients almost taken mistakenly from our ED by transport/transfer services but fortunately someone did their job and double checked the numbers including the birthdate and not just the name.

I personally value the job the Security Officers and LEOs do at our hospital. When you see as many injuries as we do in one shift come through our ED on some days, you must respect the potential for anything at any time from some patients and even the health care providers.
 
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Hey, Jon, not hating on ALL security guards (99% of the ones I've encountered at hospitals, and elsewhere are great), but, there's the crop at the particular hospital that are, um, well, I guess DENSE is the best way to describe them. Yes, we all understand when we go in there, names are taken and patients are searched. But it shouldn't take the providers 5-10 minutes to convince the guard of the patient's name. It shouldn't take the guard having to walk out to look at the side of your rig to convince them of the name of your company, and they SHOULD be looking at you enough during this extremely long interaction, to recognize you when you come BACK out to clean and put your gurney away so that they're not trying to get yet another patient name out of you.

I have had 1 smooth entrance at this particular hospital. The guard handed over the board, let us put down the name of the patient, and the company, while he wanded the patient, and in we went, simple.
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I agree. Most of the time no problems. BTW, Sapphyre was able to, in one guess, name the particular hospital which held up the CCT crew. In this case, I go to Dr. Charles Mayo, who has said that which is the best interest of the patient, is the only interest to be considered.

I disagree with stopping a critical patient at the door for security purposes. I disagree with uneducated guards attempting to interfere with a CCT crew. It is funny that the education advocates so willingly step up to bat for guards, who need a GED and an age of 18. Apparently, the upper echelons of management at my service agree and so did the cath lab nurses.
 
I agree with you Daedalus. Maybe the guards at that particular hospital need some additional education so they can tell the difference between a security risk and a dying patient who needs to get the heck out of there ASAP.

While someone may screw up the dosages on the medication thus enabling a sedated patient to wake up, wanding them for weapons is absurd. Yes they may be a security risk if they wake up, but there is a difference between a patient that may freak out and one that is likely to have gun. There is something to be said for accurately assessing the level of risk a patient poses.
 
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quote by daedalus
I disagree with stopping a critical patient at the door for security purposes. I disagree with uneducated guards attempting to interfere with a CCT crew. It is funny that the education advocates so willingly step up to bat for guards, a GED and an age of 18. Apparently, the upper echelons of management at my service agree and so did the cath lab nurses.
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Aidey said:
I agree with you Daedalus. Maybe the guards at that particular hospital need some additional education so they can tell the difference between a security risk and a dying patient who needs to get the heck out of there ASAP.
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Is this how you treat scene safety in the field?
As for the education, EMT requirements are the same with all you need is who need a GED, an age of 18 and a whopping 110 hours of training. Many hospital security guards may get much more training than that.

If your nurse is so insecure that she/he can not allow a few seconds for a quick scan to happen, it is time for that person to go back to the ICUs for more training/education. Even doctors in a trauma bay will step back to allow security and LEOs ensure there are no weapons being brought in inadvertently by rescue or flight. Many times we will find weapons in the clothes that have been removed which would go with the patient to whatever room later. Luckily our Security Guards are aware of this and try everything they can to prevent this from happening and allowing someone in the hospital to be severely injured even by not knowing the weapon is in the bag when someone handles it. Even when coming in by flight from a night scene, a weapon might be missed by the crew. I will admit I myself have missed a couple of weapons on patients with the baggy britches that we cut off and tossed aside. It is not fun to see a gun hit the floor.

Perhaps DT4EMS can join in here and give you some stats on how many hospital healthcare workers are injured each year, many by weapons that get brought in. There are reasons things are done the way they are. The security officers can not and should not just racially profile or only scan those that look real mean.

When I was on the ground ambulances, I have turned over enough weapons to PD or security at the hospital door to arm a small country. I have seen even more retrieved by our security at the doors of the hospital. At least they aren't making it to the ED treatment areas. Right now I am looking at a prisoner restrained to the bed with 2 armed C.O.s at his side. Our own Security are also making more frequent rounds. And yes, the patient is well sedated and on a ventilator. It doesn't matter when it comes to the safety of our staff.

Some you may live in Pleasantville where everything is black and white but even there it has potential to have grey areas. Just like any other scene safety, rule on the side of caution. It the patient is critical, just tell the guard you are in a hurry with showing your arse by pitching a fit and wasting more time. If your lack of respect for the safety of others gets a member of the hospital staff severely injured or killed, while you may not care, that person still had a family to go home to.

daedalus,
In California, the term CCT is used even when a heplock or room air trached patient is being transported. Thus, just because they are CCT does not necessary mean they are transporting a crtical patient. So, if you try to toss that out with each of your transports to expedite things, it would be like crying wolf each time. That gets old with many people and not just the Security Guards.

There is a good phrase to remember for any type of scene safety:
"Fools rush in".

Be glad you don't work in some hospitals like those I work at or take patients to because we do not tolerate people pitching a fit or endangering the medical staff. We would probably be saying when are those EMT(P)s
need some additional education
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to know what a security risk is and respect the hosptial staff enough to ensure their environment is safe.
 
I don't think I'm the one looking at this as a black and white situation here.
 
When does the best interest of one patient outweigh the safety of patients and staff?
 
It's a matter of properly assessing that risk Sasha. Pt John Doe picked up off the side of the street from behind the ole 1 hour motel with an ALOC is a different risk than Pt Mark Smith, information known, being transferred by a CCT from ICU room 123 at Hospital ABC to the Cath Lab at Hospital QRS.
 
Aidey said:
It's a matter of properly assessing that risk Sasha. Pt John Doe picked up off the side of the street from behind the ole 1 hour motel with an ALOC is a different risk than Pt Mark Smith, information known, being transferred by a CCT from ICU room 123 at Hospital ABC to the Cath Lab at Hospital QRS.
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okay. an assesment of the risk. but lets do an assesment of the benefit. will the time you are stopped to clear security make a difference with the patient? if they are seriously that critical, aren't they pretty much dead anyway?
 
Whats that rule in EMS? Oh yeah my safety, my partners safety, etc, patient is down the list. Perhaps the security guards have something similar and again our patient is way down the list.
 
Aidey said:
I don't think I'm the one looking at this as a black and white situation here.
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Have you not ever been in a situation that involved weapons?

It just takes a split second to make the wrong decision that can cost you your life or the life of others.

Do you think those 4 dead Oakland Police Officers might have done something differently or been more cautious with a "routine traffic stop" if they could retake the past and be alive again?

Don't play roulette with your partner's life or the lives of others by thinking only with your ego. Get more comfortable with CCT by trying to observe in an ICU. Go to a large city ED and see what types of patients they see everyday. You may not even have to go to a big city to see some of these things. Being cocky and bypassing safeguards that are in place for a reason is not a wise idea. You can just tell the security guard you are in a rush and need him/her to get the necessities out of the quickly. You don't have to be a **** about it or start pitching a fit. A few seconds is not that much time when it can prevent the staff from being injured.

Safety first.
 
And this ladies and gentlemen is exactaly where we get when people become so deeply entrenched into seeing something as black and white that all common sense flies right out the window.
 
Exactly. I do not disagree with VentMedic, but lets flip the situation around. What if the patient went into cardiac arrest, very possible since had a hx of arrest at the sending hospital. Would we wait as the guard searched the patient, interrupting compressions to do so? This patient was too close to risk waiting around, according to my interpretation of the situation. Would the guard be in trouble, civilly? You bet...
 
Safety is definitely important, I don't disagree with that at all.

This scenario can be applied to how we do things in the field. The police do not clear every single scene before we enter. They respond based upon the information gathered during the dispatch and the nature of the call. Essentially each call is evaluated for the need for police, if the assessment indicates police are needed they respond.

I think it would be much more appropriate if hospital security guards did the same thing. Having a security guard wand every single patient, even the CCT and IFT transfers, is just as impractical as having the police clear the scene of every single 911 call.
 
Aidey said:
I think it would be much more appropriate if hospital security guards did the same thing. Having a security guard wand every single patient, even the CCT and IFT transfers, is just as impractical as having the police clear the scene of every single 911 call.
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So what do you suggest? Just wand those from the bad neighborhoods? Maybe just the blacks? Or the hispanics? Are you going to "profile" the patients by race and economic status? Are you going to give the address of each patient so the security guard can determine if that address is one that falls into the guidelines of "clearing the scene"? So no, this should not be a black and white issue.

No, you treat every one the same. It will be the ones you least suspect that will be the problem.

Ever wonder why the ambulances were used to carry the bombs in the earlier examples? Ever wonder why some EMT(P)s used their jobs to transport drugs? They can usually go places without question.

Have a little respect for the facilities and their staff that you are transporting to. Your comments lead me to believe you are still very inexperienced and may not have seen much violence so your judge of character might be a little off. I don't boast to always be a good judge of character because I have had those that were not in any of the above mentioned groups but instead were white, all American, middle or upper class come in with some impressive weapons. Thus, I do rely on our security or LEOs to do their jobs.

The two of you probably complain about the entrance codes at the EDs also. Maybe you also complain when an LEO tells you to move your truck to a safer area at a scene.

The hospital can control their own environment better that the PDs can covering a huge area. Patients and staff have a right to feel reasonably safe within the walls of a hospital. It is a shame that the biggest threat to them may be EMT(P)s with attitudes that don't care about them because they are not their patients. So, yes, the liability issue has been examined and it is in favor of safety for all, not just a few whom you believe to be worthy of it.

If you don't agree, just see if you can tell the doctor at the sending facility to get the patient accepted at another hospital so that mean Security Guard won't ask you where you are going and wand your patient if this small but important inconvenience bothers you so much that you can not see why some hospitals must follow this procedure. Or, just work in the nice neighborhoods so crime and violence won't be an issue for you.

Would we wait as the guard searched the patient, interrupting compressions to do so? This patient was too close to risk waiting around, according to my interpretation of the situation. Would the guard be in trouble, civilly? You bet...
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In our facility, the patient in a code situation will have their clothes removed with Security ready to wand and/or take possession of any weapons. You don't need to be working two codes if a gun accidentally discharges. I have seen this happen and it is not a good thing. You can continue to do your job but don't interfere with the job security and the LEOs have. I already gave you other examples of patients coming into trauma and from the helipad.

Visitors accompanying the patient will pass through a metal detector and must show ID before being allowed anywhere past the front door. NO exceptions. Patients entering the ED main entrance will pass through a Security check with a metal detector.

Surprising, no one in EMS transporting to our facility has ever complained about our standards because they also know it is for their protection also.
 
We are talking about the difference between someone coming in off the street and a critical IFT! Whether you want to admit it or not, there is a difference between those two patients and the risk they pose. I never said NO patients should be checked out, just that the security guards should use a little sense and assess who truly poses a risk or not.

I don't have an issue with door codes, or people wearing ID badges, or having all visitors provide ID and pass through a metal detector. I don't even have a problem with telling a security guard what part of the hospital I'm going to and giving him the Pts initials so he can compare it with the inpatient patch paperwork. (When we are doing direct admits we call ahead with the patch and the nurse fills out a form verifying they talked to us).

What I do have a huge issue with are people who have no sense and who only see this as a black and white issue with no room for deviation.

I fully expect you to never ever ever go on another call without having the police clear the scene first Vent. After all, that is the only acceptable thing to do since it's apparently not appropriate to assess each situation individually and they all need to be handled exactaly the same. Even the nursing homes and school. After all, it will be the ones you least expect.

Right now if I was in Southern California I'm a heck of a lot more worried about dying outside the door of the hospital as the security guard triple checks my ID than being mistreated by an EMT or MICP.
 
Aidey said:
It's a matter of properly assessing that risk Sasha. Pt John Doe picked up off the side of the street from behind the ole 1 hour motel with an ALOC is a different risk than Pt Mark Smith, information known, being transferred by a CCT from ICU room 123 at Hospital ABC to the Cath Lab at Hospital QRS.
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Profiling?

But we can't do that anymore... because it makes people want to sue you!


In all seriousness, when there are exceptions, the rules become easier to break. If all entering patients must be screened, ALL are screened. Even if screening is done IN the trauma resusitation bay by Security going through clothing after the Pt. is naked.
 
Aidey said:
I fully expect you to never ever ever go on another call without having the police clear the scene first Vent. After all, that is the only acceptable thing to do since it's apparently not appropriate to assess each situation individually and they all need to be handled exactaly the same. Even the nursing homes and school. After all, it will be the ones you least expect.

Right now if I was in Southern California I'm a heck of a lot more worried about dying outside the door of the hospital as the security guard triple checks my ID than being mistreated by an EMT or MICP.
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You don't seem to understand the difference between a controlled environment and the scene. You talk about CCT and IFT but then keep referring to what police do at an outside scene.

The hospital can and will control its environment. A CCT or IFT is also controlled. Often the time you waste during a CCT or IFT chit chatting with the nurses, getting a cup of coffee or trying to gather all the paperwork because your company may have a chaotic system will be a lot longer than what it takes a Security Guard to do their job. You standing there pitching a fit and yelling at a Security Guard will waste even more time.

And, as I have said and Jon has said, you treat everyone equally. You don't just allow the checks because of their race or economic status because those are more likely to be the criminals.

On an ambulance you know very little about a patient. If you have met a patient for the first time on a CCT or if this is their first hospital visit to that ED, you have no idea if Mark Smith is his real name or anything about him. The ED will not initially run fingerprints and do a background check.

You seem to be going by a lot of assumptions based on your own limited experience. You may also have not done enough CCTs to know what type of patients that are transported. You may also not have enough IFT experience to know what even patients in nursing homes are capable of. Some of these patients may be transferred from the ED after medical clearance to a geriatric psych floor for violent tendencies some of which can be assaults with some type of weapon such as a knife. And, do you know why some schools have LEOs on their campus?

Understanding patient care well enough to be comfortable with critical patients, being cautious, allowing others to do their job, respecting others who have a job to do, following safety rules and understanding why some things are done certain ways have kept me safe and not burnt out after 30 years.

Getting angry at others for doing their job or pitching a fit at every chance you get because you don't respect the rules at a facility will not help to extend your life in EMS. You seem to be running under the impression that all CCT and EMS is lights and sirens with every thing STAT like you see on TV. Also, profiling patients by race and economic status to determine how they should be treated is not good patient care.
 
Here is a good article in the current EMS magazine:

Pistol-Packin' Patients

What to know about legally armed patients and handling handguns safely

Updated: March 25th, 2009 02:06 AM EDT
From the March 2009 Issue of EMS Magazine

http://www.emsresponder.com/publication/article.jsp?pubId=1&id=9126

Here's an interesting website with various news articles about hospital security from around the world.
http://www.saione.com/hospsecurity.htm

Yes, there are good and bad in every profession just like the EMS newswires show. But, this should give some an idea about the concerns within a hospital and what Security Guards must deal with both from inside and outside of the hospital.
 
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