WHY METAL DETECTORS AND ARMED SECURITY SHOULD BE IN EVERY ED
In 2009 Patricia B. Allen, MBA, RN wrote a superb article on KevinMD.com/blog entitled Violence in the emergency department and how to promote ER safety. It is perhaps the best summary that I have seen. She correctly identifies the risk factors for ED violence and even hits one of my favorite bones of contention—the cluelessness of many hospital administrators regarding the risks that ED employees have and their absence of dialogue with ED employees on the subject of ED violence.
I would like to point out what appears to me to be an important lapse in logic in Ms. Allen’s otherwise excellent summary. On her first page she makes this statement: “A large number of hospitals and their administrators believe that ‘violence can’t happen here.’ But violence can happen-no matter the size or location of the hospital. Being unprepared and downplaying the risk places hospitals in an extremely vulnerable position.”
I couldn’t agree more. As she points out herself, those factors that drive violence are concentrated in every ED. EMTALA, boarding of admitted patients, closure of psychiatric facilities, and cuts in mental health programs affect every hospital.
Ms. Allen goes on to recommend a 3-step beginning, all of which makes perfect sense until she asks the rhetorical question,” Does your facility warrant the consideration of metal detectors and around-the-clock security?” She recommends talking to local police about gangs, crime rates, and the hospital’s geographical location, and ends with a most profound conclusion: “The only failsafe way to eliminate the presence of contraband in the ED is via electronic screening for weapons.” I agree wholeheartedly with the last sentence.
So where is the breakdown in logic? It is illogical to say that violence can happen anywhere, no matter what the size of the hospital or its location, and then say that the local police can predict the likelihood of violence from the presence of gangs and the frequency of crimes in the hospital’s geographical location. First of all neither the presence of gangs nor crime statistics have been cited as predictors or drivers of ED violence. How many of you ever heard the word “Columbine” before some deranged person decided to shoot students in a classroom there? My point is that all EDs are at risk because they all are affected by the same drivers of violence. I believe that all employees deserve to have the same measure of safety in the workplace. Ms. Allen correctly identifies the only failsafe way to eliminate weapons from the ED.
When Ms. Allen asks the question, “Does your facility warrant consideration of metal detector and around the clock security?” she is making the assumption that someone or some committee can predict the unpredictable–when and where violence will occur. She has already admitted that violence is unpredictable and that it is not just a problem for large inner city hospitals. Hospital administrators, boards and corporate executives are no more able to predict the unpredictable than anyone else. This breakdown in logic allows every hospital to do whatever they feel like doing. And that is what is happening.
Would you want your wife, or daughter, or sister, or mother to work in the most violent workplace in America with the assurance from the local hospital that, in their opinion, it is less likely that she will be killed there than in some other ED?
There can be no wiggle room for unqualified people to make impossible reassurances to the public and the staff that the local ED is a safe workplace. We must insist that they all be equally safe with regard to weapons control.
There is another reason why making all EDs weapons safe is the most sensible course. Homeland Security knows more about metal detectors and armed security than just about anybody, wouldn’t you say? So far, they have concentrated on securing airports and government buildings. When we have the next national disaster, either natural or terrorist-inspired, EDs in the disaster area will likely be over-run with patients. Unfortunately, in the past, when the lights have gone out in America, for any reason, looting and anarchy have started immediately. The number of people carrying guns has skyrocketed. Many of these people are carrying guns for protection of themselves or their families. Wouldn’t it be reasonable for all EDs to prepare for the kinds of common weather disasters that nobody can predict? Guns must be stopped in every ED at the doors of the hospital or the waiting room. Period.
How can we expect the very people who would have to approve the expenditure of millions of dollars on metal detectors and armed security guards to be able to make an unbiased determination that these measures were necessary, especially given the fact that no one can predict when and where violence will occur?
