ER violence

Specialties Emergency

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Hi

I'm interested in knowing what types of violent situations you may have been exposed to in the ER. Does a lot of it come from drunks?

Thanks

Matt

Specializes in ER.
Hi

I'm interested in knowing what types of violent situations you may have been exposed to in the ER. Does a lot of it come from drunks?

Thanks

Matt

Usually not, though just last week we had someone mix copious amounts of etoh with her xanax, and for some reason, her rxn tended to be quite violent. The EMS who brought her in radioed ahead and requested the the police be called to meet them there, as this 5ft 2 chick was so pi$$ed off she had already broken through all the restraints they had, and she was biting everyone in site, gave two of them black eyes, and 5 grown men still could not hold her down. After seeing some of the cases our EMS brings in and the abuse they put up with, I have to say that I have a great deal of respect for the EMS in our area. The region we live in has an all volunteer EMS (not only in our city, but in all of the outlying small towns who transport to us) and not a single one of them are paid anything for their services. To put up with the folks who use them as a taxi service, as well as the violent ones and to still be ready to answer every one of the 6000+ calls they get every year, I think they are total angels!

But back to the original topic, a lot of the more violent pts we get in our ED are psych patients who are off their meds. Not to mention family members - hate to say it, but living in the rural area with lots and lots of rednecks and trailer parks nearby, we end up with a lot of domestic violence, and just because someone is the next of kin does not mean that they should go back to the pt's room after they have been stabilized after their stabbing - no matter how innocent said next of kin looks, they are often on their way to finish the job they started :eek: Fortunately in the 2 years I've been there, the police occifers have always made it to the ER in time to diffuse any real dangerous situation - good thing too, because as much as I love our security guys, they aren't even allowed to cary mace!! no billy club, no taser, no nothing!!!! :madface: I'm afraid it will take something really bad to happen to one of us here in the trenches before such an action would be taken by our lovely administration. :chair:

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wish i could quote a specific study, but after being a recent victim of assault in the ED setting, my review of online literature showed a majority of assaults were due to amphetamines and such drugs.

Each of you has mentioned scenarios that are also very high risk for escalation to violence in ED setting.

Time for us to wise up and learn to deal with it.

hoorah for no tolerance and police coverage!

Tasers! Cool! I'd carry one

but would love to see each ED person trained in de-escalation skills, physical management of aggressive behavior, as well as self defense techniques.

The wrong response from staff and every one is in jeopardy! I've seen alot of smooth tongued devils divert the anger and bring normalcy slowly out of choas.

Ask your education dept to provide these learning ops. The local occifers of the law would be approachable to teach, am sure.

We're just getting officers in uniform on nights & weekends, and it has decreased violence then...... but I work days and know the creepies don't just come out at night!

sometimes i have that smooth tongue. but sometimes i just hold the door. i have done this job for a long time. i am so sick of the childish behavior from those special folks. i will not put my self or my patients in jeopardy.

once they are out the door, they will have to deal with the police.

i do agree that there shoudl be some great education in the er. (we should all have tasers and a black belt) i also feel that there should be proper security staff. i worked in a hospital that had only one security officer for the whole hospital (about 200 beds). a pt went off and he came. the patient was overcoming the security officer and a pts visitor jumped in to help. that was very kind of the visitor but can you say "i'm rich b....? what a law suit that would have been! :uhoh3: :uhoh21:

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I'm not a nurse yet (almost a CNA though and then on to finish the rest of my pre-reqs for the ADN!), but one thing I've always noticed in our ER when I've been there is homeless people. Security is always having to run homeless men off for hanging out in the ER waiting room. I guess it must be the same people all the time because the security guard seems to recognize them immediately. The last time, one homeless guy was refusing to leave, but finally he did.

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Specializes in ER.
wish i could quote a specific study, but after being a recent victim of assault in the ED setting, my review of online literature showed a majority of assaults were due to amphetamines and such drugs.

Each of you has mentioned scenarios that are also very high risk for escalation to violence in ED setting.

Time for us to wise up and learn to deal with it.

hoorah for no tolerance and police coverage!

Tasers! Cool! I'd carry one

but would love to see each ED person trained in de-escalation skills, physical management of aggressive behavior, as well as self defense techniques.

The wrong response from staff and every one is in jeopardy! I've seen alot of smooth tongued devils divert the anger and bring normalcy slowly out of choas.

Ask your education dept to provide these learning ops. The local occifers of the law would be approachable to teach, am sure.

We're just getting officers in uniform on nights & weekends, and it has decreased violence then...... but I work days and know the creepies don't just come out at night!

We actually have a mandatory attendance program at my hospital, it's called "Handle with Care"...We are taught how to physically manage aggressive patients...how to safely take down people that are 5 times bigger than us...and self defense...laugh...but it works...All patient care staff in high risk areas have to go to it..ie psych, ER, ICU, it was a piloted program last year, I believe this year we are extending it to all patient care staff. Tazers....hmm...the things I could do if I had a Tazer...There was just an article I read on the high rise in deaths from tazer use in police departments...They are not benign and the thought of nursing staff carrying them scares me, because I could just see how inappropriate the use could be...I can name 5 people off the top of my head who could use a good shot in the butt to get them moving...anyhow...our security officers carry pepper spray...never seen them have to use it though....Just their presence can be intimidating...most of them are large strapping men...I feel very safe within my ER...

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Specializes in ER.

Our drunks usually fall over on their own before they can contact one of us!

They're not our big problem. The big city problems (guns, gangs, and drugs) are starting to reach our small city. We've had two shootings in the last month on my shift - and didn't have one on nights for the previous five or six years. Homicide in the community is up too.

I came from the big city (which is why I make silly little comments like "It's beginning to look a lot like Brooklyn, every room I go...") so it's nothing for me to deal with this stuff, but some of the locals are having problems.

I did identify a problem during last week's shooting. We don't have a way to lock down the ER. It's being addressed now. Our EMS entrance (right into the department) doesn't even have a lock on it!

Chip

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Pt's in the ER as a result of violence - shootings, stabbings, beatings, etc...when their enemies come to the ER to try to finish off the job.

Does that happen ?? Please tell me more!

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I could fill up pages with stories of the violence I've seen just in the past year. I personally am waiting to go to court over a patient who attempted to kill me. I've seen co-workers lose body parts to human bites, I've had shooting victims come in through the lobby only to have the shooter to come in later - looking to finish the job. I've had Hep C patients spitting at us, nurses grabbed by the throats, etc. Why? Drugs, anger, drunk, just plain stupid. I truly believe that ED nurses deserve hazard pay. It is scary and frustrating when it happens, but it does make for some great stories later on. And yes - there are some nights where you just *need* someone to act the fool.

Not at my ED, but recently there was a nurse who was assaulted at work - the guy tried to rip out her vocal cords - literally. He was caught, but I haven't heard any more about the case.

Do I love what I do? You bet. Why? Because of all the lovely patients I have the good fortune to take care of when I'm not fighting with the idiots. I've come in contact with some great people and have learned a lot about myself and life in general. That makes it all worth it.

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Specializes in Trauma, Teaching.

Most of our most violent ones are pysch patients acting out, and are the most dangerous because they don't always start out violently. The ones that come in kicking and screaming (usually ETOH) are dealt with quickly by both PD and security. (love those injectable vitamin H and A's)

As for deescalating with talk, that's the time I got slugged a couple of months ago, by having security back off on a panic stricken psych pt once I'd talked her down, got verbal agreements to cooperate etc. They let go, she stopped a moment, then BAM! I got it right in the face, full force. Never again! once security is there and hanging on, never let go.

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Alcohol and drugs are a big problem where I have worked. A good falling down drunk is not the problem, but the ones who can still walk can be. Yes, everyone I know has at least been verbally threatened, if not phycially assaulted in some way. It has become more and more of a problem in the past few years.

Another area for violence is related to long waits for service. Sometimes the waits are 4-6 hours or more. Sometimes we are so busy, we can't even triage soemone for close to 2 hours. I consider that unsafe and unacceptable, but what is a staff nurse to do??? We do have a tech sitting at the window to at least look at each person who walks in and we try to get the worst ones back first, but not always.

Men who are frustrated over their wife or childs pain is a frequent trigger for anger. I do understand their frustration when their loved one is crying or in pain. Unfortunately, in triage, you must juggle people in pain with people who have an immediate life threatening situation, and no everyone understands or cares about the process.

I think as staffing continues to be dangerously bad, health care becomes more expensive and ellusive to some, we are going to see more workplace violence. I just hope I can retire to the farm before it hits a flashpoint.

I once had a frequent flyer psych pt pull out a knife, proceed to slit his forearms multilpe times and then point the knife at me. Thank god for a brave male tech that came to my rescue. Ugh, security sucks at my ER.

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most of our most violent ones are pysch patients acting out, and are the most dangerous because they don't always start out violently. the ones that come in kicking and screaming (usually etoh) are dealt with quickly by both pd and security. (love those injectable vitamin h and a's)

as for deescalating with talk, that's the time i got slugged a couple of months ago, by having security back off on a panic stricken psych pt once i'd talked her down, got verbal agreements to cooperate etc. they let go, she stopped a moment, then bam! i got it right in the face, full force. never again! once security is there and hanging on, never let go.

hi, jbudd. do you mean haldol and ativan? i'm still a student.

how badly were you hurt when she punched you like that? i hope you don't have any long term damage!

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Yep, vitamins A and H are Ativan and Haldol. :)

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Specializes in ER.

We now use Vitamin G...good stuff!! Geodon!

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