Violence in the ER

[TraumaSTAT]

I am currently a charge RN working at level 1 Trauma Center in a major city and I am trying to develop a policy to protect our staff when victims of violent crimes come in to our ER (EX: GSWs, Stab Wounds, ETC). For some reason when this type of pt comes in our ER becomes flooded with people and it is difficult to control.

I was thinking of some sort of "lock down procedure" where a security officer would be placed at both the squad enterance and front door enterance. Flow in and out of the ER would be tightly secured until the pt had been stabalized.

Any thoughts on this issue or does your ER already have some sort of policy in place?

Thanks

[Urban_Durga]

In our hospital, access to the patient care area of the ED (Urgent Care/Emergency/Level 1 Trauma) can only be gained by having the doors unlocked by staff, either via badge swipe or someone at the desk that can actually see who is waiting to go through. Of course, there is a large waiting room for patient triage, families and friends, and both Support Svc. staff and Chaplains round on people waiting to make sure they're comfortable (we even give out snacks!). There's also a 2 visitor max. for the general ED rooms (I'm not sure about Trauma, it could be the same or less, depending on their Trauma designation).

Of course, if someone's not paying attention, there's the possibility that an extra person or two could sneak in every once in a while, but not a writhing sea of people all at once.

[karrncen]

We also restrict access to the ED with a visitor policy (one except in special circumstances) and access requires swiping our IDs at doors. Security assigns a dedicated officer per shift. We are not a trauma center, but have had trauma victims, fire victims, etc arrive at our facility followed by police and press. We have also required police assistance to remove individuals when they don't leave when asked. Discuss policy development with your manager. Once written, it must be posted clearly, placed in patient brochures/info sheets, and enforced. If access to the hospital proper is gained through your ED, I suggest you have serious safety issues and they need to be addressed by your administration. Good luck.

[SGT>Moody68w]

yep, same here, staff only, and depending on the pt c/o and circumstances, and BEHAVIOR of the pt/visitor 1-2 visitor max.

And if anyone decides to get a little out of hand while in the treatment area, myself, or one of the other rather able bodied "murses" or radiology techs or resp tech. are always more than happy to assist in the restraint and submission of any "code black"

[dixeechicken]

Our entire hospital goes on lockdown when we get a pt that is victim of a violent crime (GSW, stab, etc). At that time nobody, including staff is allowed in or out of the hospital and every department/floor has their doors closed until the lockdown is lifted. Our policy was implemented because we had a shooting in our parking lot that was on the premises as retaliation for a patient that had just arrived with a GSW. One of our nurses happened to be in the parking lot when the shooting started and was quite lucky to have made it back inside. Security is posted at all the doors until the lockdown is lifted.

[vroe83]

I'm also a relief charge nurse in a Level 1 trauma center. Our facility does go on "lockdown" during those types of instances. If the waiting room becomes too chaotic, security will clear the waiting room of everyone except for patients. During that time, we aren't allowed in or out of the ER, and any patients that are discharged are escorted out by security or else we just wait to discharge them. We also do not allow visitors back during lockdown procedures.

[traumaRUs, MSN, APRN]

In the level one trauma center where I worked, police worked with our security to secure the area and it was tightly controlled.

[TraumaSTAT]

Dixecehicken and vroe83 - Is there anyway you could e-mail me a copy of your "lockdown" policy?