LAWYERS HAVE MADE US AFRAID TO DEFEND OURSELVES OR OUR COLLEAGUES
Many of the legal issues that healthcare workers have regarding defending themselves would be ameliorated by having a certified, armed, security officer in the department. This officer has essentially the same ability to interrupt fights, write summons, and perform arrests as a regular police officer. An unarmed security guard is usually afraid to touch a patient and cannot arrest anyone. In my experience, these guards have been useless when a violent person needed to be taken to the ground and hand-cuffed. They don’t even carry handcuffs.
There will always be times when a patient will lash out from his stretcher and injure an employee. Whenever this kind of attack can be ended by backing out of the room, that is the best course. Sure, you’re disappointed that the patient broke your nose, but vengeance cannot be the reason we use our fists and hands. The certified, armed security guard can issue the patient a summons or even arrest him. If at any time a confrontation can be diffused without touching a patient, I would certainly recommend that approach.
I have heard several lectures about how it is usually possible to diffuse violent situations without use of force. Usually doesn’t do anything for the minority who need aggressive action immediately to stay alive. If there is no one in mortal danger, by all means try to calm the patient and get him under control without a physical confrontation. Often a new face will calm an enraged patient. If there is no one in eminent danger, I recommend waiting on the rest of the support team. Hopefully you have one. It would be better if you had the armed, uniformed security guard as well.
One of the most frightening situations that do not involve weapons is the patient who is out of bed and is attacking a member of the staff. In my view, when a patient steps out of bed and attacks someone, any attempt that you make to keep him from hurting others should not result in a charge against you, no matter which of your own extremities are required to end the assault.
Our hospitals refuse to state clearly that everyone has the right to defend themselves. Self defense is a cornerstone of our legal system. Part of your job cannot be a punching bag. There is a big difference between using your fists to “get your licks in” and using your fists only to defend and immobilize. When help arrives in the form of enough people to restrain this individual, then the employee should disengage to have his own injuries evaluated.
It would be nice if assaults were easy to predict and always responded to the same simple methods to regain control. This is not reality. Action Teams and Code Atlas teams are very important, but the employee may be dead when the team gets there if the employee cannot defend himself and those around him will not help him due to fear of being charged with a crime or fired by their employer. Violence in the ED is usually sudden and unpredictable. Often, the response must be instantaneous, or the results may be disastrous.
Let me give you an example that occurred to me. An HIV positive patient was having her blood drawn by a nurse from a triple-lumen central line that I had inserted. I had used lidocaine and the procedure went smoothly. The nurse drew two ten milliliter samples of blood and was in the process of transferring the blood to lab tubes. The patient grabbed one of the syringes from the Mayo stand and the needle cap fell off. With her left hand the patient put her arm around the nurse’s neck. She held the needle to the nurse’s neck. My best recollection is that she wanted Dilaudid.
I did not want to leave the room and besides, I did not have access to the PIXUS machine anyway. I did not think that I could reach across the patient’s body to her hand. I felt that I was just as likely to cause her to plunge the needle into the nurse’s neck or into my hand if I tried. What would you do?
I hit her in the face with my fist, as hard as I could. I still had two pairs of size eight and a half gloves on. I felt her facial bones collapse. That was not my intention, but I did not want her half awake. The syringe fell to the floor and the nurse was unharmed. I feel that my actions were justified. Neither of us documented the incident. We knew what the Monday morning quarterbacks would say. I felt certain I would be fired. As it turned out, after her head CT scan, the patient couldn’t recall how she was injured. My point is, anyone should be able to take reasonable steps to defend himself or his colleagues from mortal danger, including using his fists, if that is the only weapon available.
Of course, the very person who will not hire a certified, armed guard to protect you will be the first one to recommend that you be fired for striking a patient. Concierges, metal detectors, and armed, certified security guards in the ED are no-brainers—perfect for the tools the average administrator has. Legislators will have to grapple with other ideas that I LIKE:
(1) A healthcare employee cannot be fired or reprimanded for reporting an assault by a patient.
(2) A healthcare worker cannot be charged with a crime for using reasonable force to protect himself from harm by an out-of-control patient. In all cases where possible the employee will disengage from the patient and back out of the room.
(3) If a healthcare employee cannot disengage from a violent patient, and he feels that his life is in danger, he can use any reasonable force to separate himself from the patient without being charged with a crime.
(4) Any healthcare worker may come to the aid of another healthcare worker who is being assaulted by a patient. The good Samaritan healthcare worker may use any reasonable force to rescue the assaulted employee, and may not be charged with any crime, even if he must hit the patient to rescue the assaulted colleague.
I welcome your comments on these ideas, which will no doubt be controversial, especially for someone who has never had to fight for his life in the floor of an ED or the back of an ambulance.
