Protecting staff retrieving GSW patients from outside

[skylark, BSN, RN]

So after a few recent incidents that left our department with bullet holes in the windows, its been decided that management will review the safety aspects of the front of the ER.

How do you protect staff who go outside to retrieve GSW patients?

If they are from a gang violence incident, often we get the original shooter hanging around, wanting to have another go.

If the patient has been dropped off by their associates, they are usually just pushed out the car and lying on the sidewalk in front of the ER, or they might just be laid out in the back of their friend's car. Either way, staff are expected to go out there with a cart and bring them in.

 

Does your hospital have safety features to protect the area in front of the ER?

Do you have a strict "no retrieval" policy, and how does that work out when you can see them lying on the sidewalk?

Do you call for police cover before going out there?

 

Tell me what you have, so I can take it to our next meeting with management!

 

TIA

[JKL33]

14 hours ago, skylark said:

Do you have a strict "no retrieval" policy, and how does that work out when you can see them lying on the sidewalk?

Just FYI, this is going to be problematic because these patients fall under EMTALA. I will be interested/impressed if someone posts that they have this policy.

As much as I understand that hospital staff should not have to endanger themselves in order to provide care, this scenario really isn't clearly and officially addressed anywhere that I can find.

Your main hope for some sort of assistance here is simply to all stand together and refuse to put yourselves in significant danger.

If the hospital's premises are not secure enough to meet their EMTALA obligations, it is probably their responsibility to make things safer. But that would cost money and be a big PITA, so if they just tell you guys you have to do it, then they can go on with the status quo.

 

[FiremedicMike, RN, EMT-P]

21 hours ago, JKL33 said:

Just FYI, this is going to be problematic because these patients fall under EMTALA. I will be interested/impressed if someone posts that they have this policy.

As much as I understand that hospital staff should not have to endanger themselves in order to provide care, this scenario really isn't clearly and officially addressed anywhere that I can find.

Your main hope for some sort of assistance here is simply to all stand together and refuse to put yourselves in significant danger.

If the hospital's premises are not secure enough to meet their EMTALA obligations, it is probably their responsibility to make things safer. But that would cost money and be a big PITA, so if they just tell you guys you have to do it, then they can go on with the status quo.

 

I think a lot of these types of “is it technically legal” or “will this hurt my license” type questions, in this case to leave them in the parking lot, are more academic and far more thought out than they need to be. 

If your threat assessment reveals there’s still an active incident outside, it’s fairly easy to articulate why you didn’t go outside to pick up the patient because there was still shots, mobs, fighting, etc, and I can’t imagine a reality where that’s not an acceptable answer.

As a side note, I’ve been to a fair number of shooting scenes over the years, I’ve never personally seen anyone stick around to keep shooting it out.  It obviously happens, we read about it in the news, but it certainly seems to be statistically (extremely) unlikely.

Do your threat assessment, don’t hyper focus on anything, and make your best judgement. 

[JKL33]

13 hours ago, FiremedicMike said:

If your threat assessment reveals there’s still an active incident outside, it’s fairly easy to articulate why you didn’t go outside to pick up the patient because there was still shots, mobs, fighting, etc, and I can’t imagine a reality where that’s not an acceptable answer.

Oh I do think it's a completely acceptable answer. I really can't speak to whether admins would think so. TBH I think overall their pattern is make rules and state their expectations while leaving the nuts and bolts of it for everyone else to worry about; and then they criticize after the fact. I have seen them stand right in huddle with a straight face and *demand* processes that a kindergartner or anyone with a brain could think of why it was a very bad idea (for safety reasons) but there they are threatening to discipline people if their new process isn't followed; then when the obvious happens they turn around and say that people should have used (different) "nursing judgment."

I would argue, though, that an appropriate threat assessment might be a little different if one is running out a hospital door than taking in the scene while rolling up with bird's eye view and at least the protection of a vehicle. I'd argue that there's no good way to make a decent threat assessment in the first scenario without it being (potentially) too late. E.g. You could find out it isn't safe right at the moment you're trying to assess for safety.

I agree with you that the likelihood may be statistically low.

[NRSKarenRN, BSN, RN]

Check out this article about saving Philly gunshot victims brought by car --often police car! Includes procedures they've developed for safety of those involved at Penn Presbyterian Medical Center.  Other Philly hospital procedures discussed.

Saving Philly gunshot victims starts outside the hospital door — with a heavy lift

When police bring patients to the E.R. by 'scoop and run,' lifting them from the car can be tricky. City trauma centers have worked to make it easier.
 

Quote

...Glatts and colleagues started developing the new patient extrication plan soon after the September 2016 shooting, and the final version has been in place for several years. The reason they publicized it this year is because they recently conducted timed simulations, determining that the practice shaves 9 seconds off the typical 60-second extraction time. That may not sound like much, but when someone is bleeding from a major artery, every second helps, Glatts said.

The five improvements are as follows:

• Identifying the best spot for non-ambulance drop-offs, at the emergency entrance near N. 38th Street and Powelton Avenue. (It is labeled with a sign in red capital letters: “POLICE EMERGENCY DROP-OFF HERE.”)
• Spelling out roles for a team of three extricators. The team leader opens the door and speaks to the patient, determining if the person is able to stand or otherwise help in getting onto the stretcher. If not, the leader directs the two other team members to place the stretcher on the side of the car with the patient’s head. (In simulations, the study authors determined it was easier to pull out patients headfirst, typically by grabbing them under the armpits.)
• Redesigning the emergency entrance to allow quick access to gowns, gloves, and other protective gear.
• Developing two extraction methods. One is the “bridge” technique, in which team members use a rigid backboard as a bridge to slide the patient onto the waiting stretcher. But if the patient is heavy or the seat is low, the team uses the ground technique — lowering the patient to a backboard on the pavement, then lifting it to the stretcher.
• Mandating a 10-second “hard stop” to pat down all injured people for weapons. (The staff can’t use metal detectors because stretchers have metal components, so it’s hard to tell them apart from any guns or knives.)

See Penn Presby staff results in their article published in the May 2022 Journal of Emergency Nursing:  

Patient Extraction Process for Urban Emergency Departments

[LML131, RN]

I see this is an old post.. but such a super topic. I have usually always worked level 1, inner city and really never thought too much about our EMTALA/ 250 yd rule. But I'm now at a level 3, inner city ED and we are seeing an increase in gang related "dumps". Haven't stopped to think about it, until I saw your post. Ty reading up and following