Violence in your ER - what do you do???

Specialties Emergency


Okay, situation: Had ambulance roll in w/female involved in altercation - two lacs that needed suturing, ETOH on board (of course). Went in, assessed her, no bleeding, stable, etc.. Ten minutes later, two sons come in - began at the triage desk to demand (with all expletives) that their mother had to be first and had to be taken care of immediately!!! Security let them back into room where they began to threaten staff, security w/them. Verbal altercation between them and security to include threats of violence to us. Security totally ineffective. I called police (they responded w/in three minutes, arrest one and let the other one go. The one let go p4romptly went to gas station and began shooting people!!!!

Nursing staff very concerned that they had guns while here in ER and they will come back. (I have to add that they are two of our sickle cell pts and know the layout well!!!)

Anyone w/experience in this area? What has worked? We are inner city level I trauma center and I'm the night charge RN.


772 Posts

This certainly is a delemma. Have you spoke with your NM yet? Don't let this go until you get a satisfactory answer.. I know it is very hard......OUr security is nearly useless, primarily due to the way it is set up to function.... In my personal experience, admin. doesn't care.. I have been considering hiring an attourney to send a registered letter to CEO...That way if something happens, you have proof they knew there was a situation...If enough of your nurses are willing to do this with you perhaps you will have more pull....I too am very interested to hear replys to this thread as our ER has had several 'delemmas'. One of our MD's beat a pt off of him with a 3-hole punch one night...If this Md had been a female I don't know what would have happened because no males were present at this time of night......Good luck and be careful.......LR

Specializes in ER, ICU, L&D, OR.

Howdy yall

from deep in the heart of Texas

Violence in the ER and in the hospital, is on the increase nationwide. I certainly can vouch for it here. The large majority of hospitals have woefully inadequate security forces, and I dont see that changing anytime in the near future for most places. The hospital Im at has a woefully inadequate security force also. This has been a subject brought up to administration numerous times, like most other places I would imagine. Except for hospitals like Parkland in Dallas that has its own police force there 24/7. We do have a hotline to the police department faster than the 911 calls. With a good response time from the police. The security force here is strictly hands off, they will radio for help if you are being assaulted but that is all. They do drive people out to their cars in their little golf carts. But thats about all they are good for.

Our fastest option is a code rush, where all the males in the hospital respong to the distubance, hoping to defuse a situation by a show of numbers. This will usually work. We do have signs posted stating that violence.or weapons in the hospital are not allowed. But the most important thing is to be constantly aware of your surroundings and what is happening on your unit. If you anticipate a problem you can usually keep it from flaring out of control, hopefully anyway.

Of course this comes from a nurse who has sustained several job related injuries from this in the last decade and a half, and m sorely aware of the problem. But people out there are getting crazier all the time, but hopefully things will ease off, I hope.

good luck to you, I really am very sympathetic tp ypur plight.


35 Posts

Emergency rooms are very very dangerous places to work in. In our department we had so many assaults on staff and other incidents we have police 24/7 and you have to be buzzed in and all vistors must go through a metal detector. You should let your adminstration know you work in a unsafe enviorment which became evident with the incident you described, and ask them what are they going to do about it.


177 Posts

Everyone goes through the Metal detector here, and our security is actual Police, a special unit that has officers always in the ER. I have never had a problem as the oficers get rather protective over the nurses, and will quickly take down anyone. one time I had a pt's husband start to call me some horrid name, and before I could turn around, our PD person was there and ready to escot the fellow out. This is supported by our management and I think thats the key.

Metal detectors? We the heck do you guys live? I understand in Texas, because you are allowed to carry a concealed gun. Those at greatest risk in my ED would be registration and the triage nurse. Our security is right there. As the triage nurse, I would have never let the sons back, security would have escorted them out, by force if neccessary. If she arrived by ambulance, did the not call they were enroute? All of our assaults are visited by Pittsburgh's finest, this a mandatory rule. I would have had the police remove the son's from our area. If the patient became a problem she would have ended up restrained (leathers probably) and a mask to prevent biting or spitting, because we all love when that happens. Then she would have met some Droperidol, so that my doc could fix that lac's. Usually they sleep off their drunk and are discharged ASAP.


33 Posts

jmcclellanprofrn, Texas does allow concealed guns, but only with training and passing a test. Trust me, the criminals don't take this test and they are in every city, town, and suburb.. The metal detecters are necessary to keep out the criminal packing visitors, not just the legal ones that are trying to protect themselves from the other. I agree with you about not allowing the two irate sons back at all. Our security would have also hauled them out. The metal detectors are only for walk in people. I wish we had them for the ambulance stretchers to pass thru. We have pulled guns out of pockets in the shock rooms.


583 Posts

Metal detectors? We the heck do you guys live? I understand in Texas, because you are allowed to carry a concealed gun.

Pull your head out of the sand! The detectors are there to stop the people who have no respect for the law from bringing in a weapon. A person with a concealed carry license is very law-abiding. He/She has been tested, and had a background check completed, and had fingerprints run through the FBI prior to receiving the concealed carry license. These same people also understand the grvity of using their weapon, ask almost any peson who has a concealed weapon what they should do if in a situation not requiring deadly force and they will say leave or deescalate the situation before it becomes necessary to use deadly force. There are very specific instances where you can use deadly force, law abiding peole who carry guns know them. I would much rather let every law abiding citizen exercise their 2nd Amendment right to bear arms at all times than disarm them,while the criminals still stay armed.

In our ER, everyone that enters the hospital after 9p gets wanded with a metal detector. Our sister hospital downtown has a walk through detector.

In this situation, the two sons should have been escorted from the building. If they refused to leave a call to the police would have been in order. That is what would have happened where I work. I have had more then one person removed from my ER in handcuffs.

BTW, I live in Eastern Washington, not exactly a place known for its gang activity, or number of people who carry concealed weapons.


Trauma Columnist

traumaRUs, MSN, APRN

97 Articles; 21,237 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

I thank you all for the answers. I would discuss it with NM, but we neither NM, nor asst manager nor educator at this time. I am the night charge RN and so the dept is my responsibility at that time. I have worked in other states where police are present - in Las Vegas (early 90's) they had police substation inside the ER. It is very scary. I'm not someone easily intimadated and was able to get these guys out of the ER , (while security stood around!!).

However, my husband is concerned for my safety and wants me off of nights. So, we will see. Again, I really appreciate the answers. Thanks.


95 Posts

Originally posted by shootemrn

we have police 24/7 and you have to be buzzed in and all vistors must go through a metal detector.

That really frightens me. We have security 24/7, but they are just hospital hired rent-a-cops as we call them. I would hope that we'd never have to resort to metal detectors. Most of the violence I have witnessed has come from pts. We call an orderly code, sedate, restrain. I work in a large hospital, close to the downtown, so a lot of our pts aren't upper eschelon per say. We have had nurses with black eyes, I got my cheek cracked. You learn to duck, you learn to call codes quick, before anything happens, and we now charge the pts with assault. You become very astute at interpreting body language to avoid any altercations. I wish you all safety. It's a scary world out there!



8 Posts

it was interesting to me to read this, as I am just coming off of a shift today where a patient threw a phone at a doctor. the patient was disconnected from a call and blamed it on the MD who was making a call on another line. Security did basically nothing. i am from the south, and worked in several ERs in florida/georgia where even obscenities were rare. Now I am in Brooklyn, NY in a level one ED where violence is an everyday occurrence. Last shift I worked, a patient who was obviously very ill got angry over the wait time, picked up his stretcher and threw it. I thought it was just my neck of the woods, but I see I am wrong!


15 Posts

Where I work the security guards are actually "special police" with arrest powers and guns. Just last night a patient's husband got frustrated and decided to hit a nurse. It's a good thing he was in the ER. Security kicked the $%^# out of him.

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