WAKE UP, EMERGENCY NURSES
Last year I began a campaign to promote metal detectors, bullet-proof glass, and armed security guards in every emergency department. I took on this mission because I had personally been in an ED or trauma center eight times in my 38-year career when shots were fired. My greatest frustration has been that there is no consensus among emergency nurses that these measures are needed, despite the fact that healthcare workers have the highest risk of assault of any workplace in America. There are many organizations like JCAHO, CMS, and OSHA that could have mandated these security features years ago. Congress could have mandated these measures years ago. I beg all emergency nurses to read the account of the recent tragedy in Newtown, Conn. and consider one undeniable fact.
The federal government has abdicated its role in the management of mentally ill persons. The persons who would do such unspeakable things as just happened in Newtown are being concentrated in emergency departments throughout our country. They wait for hours to find a psychiatric bed. The potential for such a tragedy in an emergency department far exceeds the risk of an elementary school.
There is no gun control law that will eliminate your high risk. Each of the two pistols carried by the mentally ill person who killed all those children can spit out lethal bullets just as fast as a semi-automatic AR-15, which was apparently used for most of the killings. Thus, a ban on assault weapons and high capacity ammunition clips will do nothing to protect you. A single clip in a Glock .45 (also carried by the shooter) holds 13 rounds, each capable of killing a human being with one shot. There are millions of semi-automatic pistols in circulation, about three for every man, woman, and child in America. Because of the second amendment, it is unlikely that any law can take these out of circulation. It makes no difference whether you love guns or hate guns. The fact is that people whose workplace concentrates angry, frustrated, suicidal, and homicidal persons is at the highest risk for a mass shooting.
No congressional committee, or government agency, or hospital administration, or hospital organization is going to mandate the spending of significant amounts of money to install equipment and bullet-proof glass or hire armed security guards when the nurses can’t agree that these are necessary. It is not enough to have symposia on violence in healthcare and come away without endorsing these particular deterrents, which are known to be effective. Are you waiting for a disaster in your own department before you act? That is the pattern I found. By telephone survey and visiting trauma centers, I found that almost all of the 5 per cent of our nation’s emergency departments that use such security features were prompted by a tragedy in their own department.
This breaks my heart. Do each of you have to see one or more of your colleagues lying in a pool of blood in the floor of your own department before you give up your wishful thinking and feelings of invincibility? Are you still worried about your department not looking friendly? I want to help you. I’m willing to go to a congressional committee and fight for your safety. I have the additional advantage of being shot at myself in the ED, multiple times, not for anything I did or said, but because I was standing in the wrong place at the wrong time. As a retired emergency physician who lives near Washington I know that I could help you. I know some of the legislators. I seek no money for my efforts. There is one critical ingredient missing. With all of the budget cuts that will be required in the near future, nobody is going to mandate these security features for emergency nurses who can’t agree on a single resolution in support of them.
Do you really think that making your hospital a “gun-free zone” is going to do anything besides make you even more of a target? In case you haven’t noticed, almost all mass shootings occur in “gun-free zones”. Shooters don’t like to go where someone might shoot back. It is a show of force that prevents violence. A show of weakness and disarmament invites violence. The idea that patients will be frightened by having security measures in the emergency department is counter to my own experience. I believe that most people feel safer in the emergency department waiting room when there is a security officer present.
I have the greatest respect for the nursing profession. My wife is a nurse. Sadly, I feel that I can do no more until emergency nurses stand up for themselves and their patients, as well as the children and the parents who will be left behind when a shooter walks through their ambulance entrance behind a stretcher pushed by paramedics. Let me know when you make the connection between totally unpredictable violent mental health patients, guns, and emergency department employees. Please do not put yourself through the agony of one day realizing that you could have prevented a tragedy if only you had supported security measures in your emergency department.
Charles C. Anderson, MD, FACP, FACEP
