ER violence

In my experience, drunks aren't usually too bad. Irate family members are usually more likely to create a problem, or patients who didn't get what they wanted. Family members pitching tantrums are the worst; they'll shout, swear and threaten violence.

I've worked in ER for four years, and in that time I've seen my coworkers threatened with knives and guns, I've been bitten, and I've known of a physician who was slapped in the face by a patient (she slapped him back, and more power to her!). ER is just like every other arean of nursing; there's always the possibility that trouble will break loose, and you just try to either defuse the situation or get the heck out of the way.

There is nothing worse than a drunk. They are usually belligerent, stinky & out of control. A video camera would do a lot to remind people why they are restrained, forbidden to use the phone & in the bad shape they are in when they wake up. But then, a drug overdose can be ugly too. We "saved" a guy from an OD & all he could say when he came to, after Narcan was, "I didn't ask you to save me." A family member found him at home nearly dead from heroin & called the EMS people. Then he walked out. Good riddance. :angryfire Sorry, if I sound unsympathetic, but sometimes it a relief to acutally take care of truly ill people. At least they are thankful for what you do for them.

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

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.

Where I live, the old drunks are usually not that violent, just silly. Its the sober people who are in the ER for their weekly(or daily) shot of demerol/nubain/stadol/dilaudid. They think just because they have been coming to the ER for years, they should just come right on back and get their shot and leave. When they are told( for the 1000th) time that we see pt on the level of severity of illness they go ballistic! That or the person who came to the ER for the hang nail or some minor problem. I want to just scream :angryfire back when they are at my desk swearing and threatening to call and administrator. I usually just tell them "If thats What you want then heres the phone, but the way you spell my name...." :)

In my experience, drunks aren't usually too bad. Irate family members are usually more likely to create a problem, or patients who didn't get what they wanted. Family members pitching tantrums are the worst; they'll shout, swear and threaten violence.

Family members are our main problem too. Luckily the hospital that I work in is small, privately owned and in an upscale neighborhood so we don't see the drunks like they do at other hospitals. We are pretty much a one organ hospital too so we have limited EMS traffic. We are on EMS rotation with the other hospitals but we do not take trauma, ortho or neuro patients, we don't have the docs on staff to care for them or the equipment. I think that this just all adds up to a differnet type of clientel.

We do get our fair share or beligerent seekers though, but that is another thread....LOL!

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.

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

I worked in an ER for a whole 3 months - got hit with injuries by a kid showing off how "high" he was supposed to be (drug screen clear except for MJ). Decided to get back into psych, where I felt safer, believe it or not :chuckle

I agree with all of the responses regarding ED violence so far....drunks..druggies....sat night knife and gun club(every night in Level 1 trauma center) ....long waits (even though we have 51 rooms and 11 hall stretchers)....etc., we see it all. But, we do have a zero tolerance for violence in our ED and our Med Center PD arrest folks or show them off the premises. On another note, have you ever noticed that when things are tense at work, a good 'fight' with one of these unruly folks can release endorphins and you feel great afterward?? :-)

I find that most of our drunks are annoying at best but usually not violent...We do get alot of psych, a few of our nurses were assaulted in our old ED before security sat at the doors...One had a gun pulled on him in triage about 2 years ago...We do have our share of unruly family members being that we are a trauma center. However in the last two years, we rarely have a violent issue because of the attentiveness of our staff and security and the utilization of panic alarms at every nurses station and portable panic buttons for triage...Our local city police are also VERY supportive...despite being a large city we have very quick response to the ED by police when they are needed....

Just went to a boring mandatory class that included a section on restraints. The person conducting the class said she'd been a mock-surveyor for JCAHO.

One of the places she surveyed was in Colorado Springs, where when asked to see their patient restraint policy (in ER) was told they didn't have one because they didn't use them. What? No, they use tasers. And have a written protocol and those who carry them are fully taser-certified. She said the Gangs had proclaimed the ER a no weapon zone, and there was a place to put guns and knives. Also said that employee injuries from patient violence had plummetted since the use of tasers when into effect.

To which I say: THEY ROCK!

Anybody from Colorado Springs who can verify this? And if it's all true, then I certainly hope JCAHO is bright enough to bless the whole thing. I wouldn't bet the farm on that (them being bright enough or that they'll bless it) but I applaud the facility for taking a stand on the health and well-being of their employees.

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!

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 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!!!! 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: