WHY MOST EDs DO NOT HAVE ARMED GUARDS AND METAL DETECTORS
While visiting in New England recently I tried to find out how many local EDs had armed guards and metal detectors. I would say less than one quarter. The one thing these hospitals that have metal detectors and armed guards have in common is that they have already had a violent incident, almost always a shooting incident, in their treatment area or waiting room.
If one or more of your ED physicians or nurses have been gunned down in the ED, or several patients in your waiting room, metal detectors and armed guards are suddenly a no-brainer. Besides the cost of metal detectors and armed guards, one of the chief reasons that hospitals fight these two things is because they project the idea that the hospital, and specifically the ED, is a dangerous place. Well, the facts can only be suppressed for so long. Hospitals and EDs are statistically the most dangerous workplaces in this country. Mull that over for a minute.
I know that you thought those guys catching king crabs in Alaska had the most dangerous job, but it isn’t so. As I pointed out in a previous post, over 60 per cent of all assaults in the workplace occur in a healthcare setting. The overwhelming majority of victims are women with nurse’s aides having the highest number of assaults and RNs next. The ED is the most common site of an assault. So stop looking down your nose at postal workers.
I visited Washington recently and noted that almost every building was protected by metal detectors and armed guards. They must know something. If metal detectors and armed guards were ineffective at making an area secure, then why are they in every airport in the country? They obviously work. If the ED is truly the most dangerous workplace in America, why doesn’t every ED already have these proven safety features?
The size of the ED or town does not matter. Had you ever heard of Columbine before some deranged person decided to start shooting at this school? My point is that the factors which make EDs so dangerous are everywhere and increasing. These factors are in every community, and the ED is the final common pathway for everyone with violent behavioral problems. EMTALA is not going away. The professional ED patient has been emboldened in his violence toward hospital employees because he knows it is very unlikely that he will be prosecuted.
In Virginia, funding for mental health has undergone drastic cuts, with more cuts planned for the years ahead. This means more paranoid schizophrenics wandering the streets and ending up waiting for days in the ED for a psych bed to appear in a hospital somewhere in the state. My personal experience is that most of these potentially violent psych patients leave before a bed is found. Don’t expect policemen to stop calling a 911 ambulance to bring in every inebriated person on the street. Don’t expect hospitals to stop boarding admitted patients all night in the ED. Now that drug seakers know that ED physicians will be punished for not making them happy, don’t expect to see less of them. Press Ganey rules. Happy patients outrank security.
I have already outlined the advantages of having a certified, armed, uniformed guard on duty. You would need at least one such guard to legally confiscate a weapon. Unarmed security guards are of no value if the only person in your ED with a 9 mm pistol is a paranoid schizophrenic.
This brings me to ACEP and ENA. The groups that would seem to gain the most by having armed protection on site do not even list metal detectors or armed guards as one of their priorities in their position papers on violence. Of course, neither administrators nor physicians want to scare patients away by installing devices and personnel that suggest that the ED is a dangerous place. Those hospitals that have suffered tragic shootings don’t have this objection anymore. Personally, I believe that patients and staff would feel much safer with metal detectors and armed guards. I know I would.
The physicians who wrote the 2012 ACEP position paper on violence do not have the advantage that I have. My 38 years in the pit are over. These physicians are still employed by somebody who can be punished for taking a position that will cost hospitals millions of dollars. One of the most ridiculous objections I have seen to having armed guards is fear that someone will take the officer’s gun away from him. In all of the tragic shootings that I have read about in hospitals, fast-food restaurants, and schools, not a single one of these began by someone taking a gun away from an officer. Wake up to the fact that guns are easy to come by and it is a given that they are already in your ED. Criminals don’t need to take guns from officers. They likely have more deadly weapons than the police.
The reason that ACEP and ENA do not have a clear recommendation for metal detectors and armed guards cannot be due to a lack of demonstrated need for security. The number of violent incidents in the ED is accelerating in tandem with the number of alcohol and drug visitors and the number of psych patients. This information is readily available to anyone who has a computer and can spell Google.
Virginia is fortunate in one respect. Some states have no laws whatsoever protecting healthcare workers. What Virginia has going for it is a law regarding armed, certified, uniformed security guards. In Virginia, and in some other states, these guards have all of the powers of a policeman in the area they are hired to protect. They can hand out a summons on the spot if a patient slapped a nurse. They can arrest people. They have the same “limited immunity” to touch people that policemen have.
Every indicator we have says that violence will get worse in our EDs. Is it a question of how much blood is required in the floor for us to come together and make this a priority? Virginia Tech didn’t think they needed armed guards. Columbine didn’t think they needed armed guards. Each time I hear of another shootout it is clearer to me that this is a national problem.
Think about it this way. There may be as many as five or six semiautomatic pistols in the pockets of people in your emergency department, but none in the hands of anyone on your side. It only takes one pistol with a 13-15 round clip in the hand of one paranoid schizophrenic to murder your entire staff, simply because he is tired of waiting. Currently, most hospitals are buzzing this fellow right through the key pad entry into the treatment area without searching him or making him walk through a metal detector.
Anyone who has worked in a metropolitan area has probably experienced just how fragile our system of emergency departments are. An entire city with five or six hospitals can be brought to its knees by as few as 50 trauma patients. We are woefully unprepared for the disaster that dumps hundreds or even thousands at our doorstep. One of the first things that will happen in a mass casualty disaster–hurricane, power grid loss for any reason, flood, biological or nuclear accident or terrorist attack—is a run on the ED.
Under these circumstances, any person who owns a gun is likely to have it in his pocket. Wouldn’t you have your gun to protect your family if there was no power and anarchy ruled the streets? If we do not have metal detectors and armed guards already in place, who is going to protect the healthcare workers under these kinds of circumstances? How many employees would leave the relative safety of their own homes to go to an unsecured area full of desperate people? A hospital can call in extra security, but it can’t install metal detectors or hire certified armed guards in an hour.
I believe that hospitals throughout the country that do not install metal detectors and hire 24/7 armed, uniform guards are in a precarious legal situation, much worse than Virginia Tech. If Virginia Tech can successfully be sued for inadequate security measures, how can a hospital, a place that concentrates violent people, possibly avoid being prosecuted for not providing adequate security when the inevitable tragedy occurs? The risks are clear and accelerating. The consequences of lack of action are clear. Has someone made the financial decision that it would be cheaper to pay the claims to the families of dead patients, employees, and visitors than take appropriate security measures?
I believe that the American College of Emergency Physicians may also be liable for their inaction. Who else should better understand the risks? At the very least they should change their position statement to reflect reality. They should be out front leading the fight for adequate security in every ED.
I feel that the Emergency Nurses Association must stand up for itself and be clear about what it wants. There are people who want to help you. But if you can’t make up your mind whether you want metal detectors and armed, certified security guards protecting you 24/7, you should expect that your situation will not improve. The vague recommendations of ACEP and ENA about violence in the ED have been ineffective. ED violence is getting further and further out of control. The factors that drive ED violence are accelerating. ACEP and ENA have played right into the hands of the hospital corporations, who don’t want to spend the money anyway.
For once, can’t we act before another senseless death occurs in our emergency departments?
Charles C. Anderson M.D. FACP, FACEP
