Cranky is one thing, yelling and screaming are attention getting tactics and when "rewarded" they do reinforce BAD BEHAVIOR. But, maybe I have a room full of potential "victims" to think about - so I'm not sure there is ONE RIGHT ANSWER.
Come on in with a weapon and DEMAND drugs - well, they are yours.
I'll empty the Pyxis and offer you a saline lock (for your convenience) as long as YOU GET OUT THE DOOR AND MY STAFF STAYS SAFE!
There are things worth risking your life for - THIS is NOT one of them.
I will not STOP any patient from WALKING OUT. I will document the whiz out of it, but STOP YOU - NO!!!!
As for patients being refused care. I have in 16 years known of a couple of facilities that have sent letters to the PROBLEM PATIENT outlining expectation that they are ONLY WELCOME to seek TRUE LIFE THREAT EMERGENCY CARE at the facility. These have been patients that have clearly exceeded any ability for the facility to create a safe environment - not frequent flyers, but a very few that have been VIOLENT. Is this risky for the facility? Maybe, but to what degree must a facility go to mitigate RISK to staff, other patients? I say let the LAWYERS sort it out, if necessary. DARWIN had a few things right!
Is there any way to absolutely STAY SAFE?
I think that we are living in a more violent society - so I'm not surprised that ED violence is increasing. I can name many incidents of firearm discharge in the ED in the past 5 years - AND several of these were with the POLICE in ATTENDANCE (a couple of fatalities in VA - police, security guard and one patients SO). Scary. Just goes to show - NEVER let your guard down.
I will be aware, alert, have a plan (or three), escape route, call security, call the police or if necessary DO WHATEVER I have to do to PROTECT myself, staff and other patients.
But other than AWARENESS and GOOD PLANNING - there are limited solutions. Just be aware - trust the "sixth sense" - avoid escalation with ANY patient...but, really there are limitations.
Do I feel better behind bullet proof glass? Sure, in some situations.
Will I call security/police "for a feeling"? Yep, in a heartbeat.
I do believe that SOMEONE who is INTENT on hurting you is not EASILY STOPPED. I just try to be consistent in the quest for safety. I'd rather explain why I exercised too much caution as opposed to too little.