Thank you all for your comments, stories and ideas. I'll try to get around to individually responding but as is so often the case, I'm writing during a run of 12 hour shifts. Please know that I appreciate you all and that I greatly respect the wisdom and insights you bring to our community here. Sweet dreams! Off to bed I go.
I had never heard of boarding. I do know that my physician husband often was unable to find placements for patients needing psychiatric care. The sheriff's department often refused to transport patients to appropriate facilities for treatment. Physicians shouldn't have to hit brick walls in trying to provide treatment for patients. But as our healthcare system becomes more and more driven by soul-less data, the opportunity to address basic problems like these fails us all.
As usual, Ed has hit the mark, articulating better than most of us can, the daily problems associated with ED life. It is, indeed, the social net in our society, badly fraying, and desperately in need of repairs; it’s unlikely to happen without concerted effort on the part of all stakeholders. I had often described my job as an ED physician as sweeping up after the elephants in the circus parade of life.
Timely article Ed. Last night my nurse got punched in the face by a methed out schizophrenic patient. Naturally psych would not take the patient without the precious drug screen so the nurse got assaulted trying to collect urine. I will forward this on to my team.
Great article. This past Friday on night shift it was 4:30a when registration called back saying she heard shooting in front of ER. We were short staffed as usual and so I went out with my 2 nurses to waiting room and saw a girl dragging her unresponsive boyfriend through the entrance as he exsanguinated from his femoral artery. The wr was a blood bath. We were pulling him on to stretcher when 8 guys came in wr and started beating the shit out of both the patient and the girlfriend. Our single unarmed security guard stood in awe and we quickly retreated behind the back door to the ED waiting for police. As we looked through the door window these thugs recently kicked and beat both of them. They mmm our registration secretary was hiding under desk and the wr patients were huddled in corner scared to death. The thugs then went to their car and dragged in their friend who was shot in head and laid him on floor and took off as they heard police sirens. That was a long 15 minutes for cops to arrive. The ER is an unsafe place. Thanks for bringing this to light. This part of the story does not make the news. All 3 local news stations show the bar where the shooting occurred and said the victims ‘were taken to the hospital’. The real story was the violence in our ED waiting room.
This is horrible! No wonder we all have PTSD. What if this event was recorded and sent to the media? Would that be a HIPPA violation if faces blurred out? Maybe this is what it would take to get some attention.. What if you were killed? You wouldn’t have even been mentioned!
Our healthcare system is broken in so many ways.Unfortunately folks like you are located on the tip of the spear. It won’t be fixed in our practice lifetime.
May be time to accept the reality and train nurses/MD’s/ PA’s/NP’s in combative medicine. The problem is not likely to improve and giving providers the tools to work within the system may lead to better patient outcome and staff retention.
State hospital closures were the worst thing ever to happen. A friend who has been a psych nurse her entire career saw patients in her assessment center in our town whom she had cared for at the state hospital 2-1-2 hours away; they started showing up within months as they became homeless. Families can’t or won’t take care of these folks.
And meth. Horrible drug. If it doesn’t kill you outright it dries your brain cells and turns you into a psychotic maniac. And as you mention, these folks are resistant to most of the medications used to try to “chemically restrain “ people.
Spot on with that stupid policy on physical restraints. Just stupid stupid stupid.
You touched a nerve with this one. And then folks can’t understand why nurses are striking---well duh. The folks making the rules aren’t the ones getting beat up and killed.
Safest ED I ever worked at was Bellevue in nyc back in the day. As a municipal hospital, our security WERE on duty police, they were trained, empowered and did deal with violent patients on daily basis. It’s astonishing hospitals b\don’t have armed security guards and metal detectors in all cases, but as you point out nothing is going to change until one of these ‘patients’ break into the c suite and goes postal. Time retire my friend and let All those new highly trained and experienced NPs to provide all of that cost effective care in the ED.
We rarely improve health, don’t care, and have no competent system to report. So what healthcare system? We now have a 600 pound pt living in our ED because of being newly homeless and NO shelter will take such a “grand” individual. Now he’s “suicidal” so no psych faculty will take such a “generous” soul. He now resides in the ED next to another “larger than life” homeless patient who is so mean and demanding that no shelter or ECF in the state will accept this loving individual . When “released from the ED” the pt has a PNES and is returned back daily via EMS for our loving care. Suggestions?
Please don't feel obliged to respond personally. I staffed some rural ERs back in the last century, very occasionally met someone who was out of control due to psychosis. Now it's hard to imagine willingly working in a place with such workplace hazards, particularly if they are continuing to become more and more frequent. As caregivers, we have such a strong sense of obligation to do no harm, to run towards danger instead of away from it, to exhibit unconditional positive regard for others, that we lose sight of "reasonable". A veterinary dentist won't provide care for a tiger that isn't asleep on a ventilator. I don't think it's unreasonable to keep a dart gun full of a rapid acting tranquilizer for individuals who present themselves and are too violent to safely approach within arm's length. For the hostile and verbally abusive, a quick trip on the gurney out the ER door into the parking lot isn't unreasonable. It just isn't obligatory to place ones self in the direct line of fire for the privilege of trying to offer care in an emergent basis. There is no reason to tolerate abusive behavior on the part of anyone. The response should be appropriate to the behavior. Restraint, whether chemical, physical, by separation(out the door), by a great big net or instant airbag straitjacket should be the REASONABLE response to an abusive, uncontrolled or violent person. You can't help someone who is actively trying to hurt you in one way or another.
The vulnerability of EMS and ER personnel to violence formed the foundation for a novel I wrote. It was a finalist for the Minnesota book award in fiction yet every aspect could occur at any time…
Emergency and other healthcare personnel are not adequately protected. In any other industry, it would not be tolerated. Things must change. Thanks for the article and increasing attention. Be safe all.
Thank you all for your comments, stories and ideas. I'll try to get around to individually responding but as is so often the case, I'm writing during a run of 12 hour shifts. Please know that I appreciate you all and that I greatly respect the wisdom and insights you bring to our community here. Sweet dreams! Off to bed I go.
I had never heard of boarding. I do know that my physician husband often was unable to find placements for patients needing psychiatric care. The sheriff's department often refused to transport patients to appropriate facilities for treatment. Physicians shouldn't have to hit brick walls in trying to provide treatment for patients. But as our healthcare system becomes more and more driven by soul-less data, the opportunity to address basic problems like these fails us all.
As usual, Ed has hit the mark, articulating better than most of us can, the daily problems associated with ED life. It is, indeed, the social net in our society, badly fraying, and desperately in need of repairs; it’s unlikely to happen without concerted effort on the part of all stakeholders. I had often described my job as an ED physician as sweeping up after the elephants in the circus parade of life.
Timely article Ed. Last night my nurse got punched in the face by a methed out schizophrenic patient. Naturally psych would not take the patient without the precious drug screen so the nurse got assaulted trying to collect urine. I will forward this on to my team.
Great article. This past Friday on night shift it was 4:30a when registration called back saying she heard shooting in front of ER. We were short staffed as usual and so I went out with my 2 nurses to waiting room and saw a girl dragging her unresponsive boyfriend through the entrance as he exsanguinated from his femoral artery. The wr was a blood bath. We were pulling him on to stretcher when 8 guys came in wr and started beating the shit out of both the patient and the girlfriend. Our single unarmed security guard stood in awe and we quickly retreated behind the back door to the ED waiting for police. As we looked through the door window these thugs recently kicked and beat both of them. They mmm our registration secretary was hiding under desk and the wr patients were huddled in corner scared to death. The thugs then went to their car and dragged in their friend who was shot in head and laid him on floor and took off as they heard police sirens. That was a long 15 minutes for cops to arrive. The ER is an unsafe place. Thanks for bringing this to light. This part of the story does not make the news. All 3 local news stations show the bar where the shooting occurred and said the victims ‘were taken to the hospital’. The real story was the violence in our ED waiting room.
This is horrible! No wonder we all have PTSD. What if this event was recorded and sent to the media? Would that be a HIPPA violation if faces blurred out? Maybe this is what it would take to get some attention.. What if you were killed? You wouldn’t have even been mentioned!
Our healthcare system is broken in so many ways.Unfortunately folks like you are located on the tip of the spear. It won’t be fixed in our practice lifetime.
May be time to accept the reality and train nurses/MD’s/ PA’s/NP’s in combative medicine. The problem is not likely to improve and giving providers the tools to work within the system may lead to better patient outcome and staff retention.
State hospital closures were the worst thing ever to happen. A friend who has been a psych nurse her entire career saw patients in her assessment center in our town whom she had cared for at the state hospital 2-1-2 hours away; they started showing up within months as they became homeless. Families can’t or won’t take care of these folks.
And meth. Horrible drug. If it doesn’t kill you outright it dries your brain cells and turns you into a psychotic maniac. And as you mention, these folks are resistant to most of the medications used to try to “chemically restrain “ people.
Spot on with that stupid policy on physical restraints. Just stupid stupid stupid.
You touched a nerve with this one. And then folks can’t understand why nurses are striking---well duh. The folks making the rules aren’t the ones getting beat up and killed.
Safest ED I ever worked at was Bellevue in nyc back in the day. As a municipal hospital, our security WERE on duty police, they were trained, empowered and did deal with violent patients on daily basis. It’s astonishing hospitals b\don’t have armed security guards and metal detectors in all cases, but as you point out nothing is going to change until one of these ‘patients’ break into the c suite and goes postal. Time retire my friend and let All those new highly trained and experienced NPs to provide all of that cost effective care in the ED.
We rarely improve health, don’t care, and have no competent system to report. So what healthcare system? We now have a 600 pound pt living in our ED because of being newly homeless and NO shelter will take such a “grand” individual. Now he’s “suicidal” so no psych faculty will take such a “generous” soul. He now resides in the ED next to another “larger than life” homeless patient who is so mean and demanding that no shelter or ECF in the state will accept this loving individual . When “released from the ED” the pt has a PNES and is returned back daily via EMS for our loving care. Suggestions?
Regional bariatric hospitals. Back to State mental hospitals.
Bus ticket? Nursing home placement? Psych consult? Ozempic? J/K
Outstanding synopsis Cousin Eddie! I couldn’t take “it” anymore after 30 yrs. Best to you!
Please don't feel obliged to respond personally. I staffed some rural ERs back in the last century, very occasionally met someone who was out of control due to psychosis. Now it's hard to imagine willingly working in a place with such workplace hazards, particularly if they are continuing to become more and more frequent. As caregivers, we have such a strong sense of obligation to do no harm, to run towards danger instead of away from it, to exhibit unconditional positive regard for others, that we lose sight of "reasonable". A veterinary dentist won't provide care for a tiger that isn't asleep on a ventilator. I don't think it's unreasonable to keep a dart gun full of a rapid acting tranquilizer for individuals who present themselves and are too violent to safely approach within arm's length. For the hostile and verbally abusive, a quick trip on the gurney out the ER door into the parking lot isn't unreasonable. It just isn't obligatory to place ones self in the direct line of fire for the privilege of trying to offer care in an emergent basis. There is no reason to tolerate abusive behavior on the part of anyone. The response should be appropriate to the behavior. Restraint, whether chemical, physical, by separation(out the door), by a great big net or instant airbag straitjacket should be the REASONABLE response to an abusive, uncontrolled or violent person. You can't help someone who is actively trying to hurt you in one way or another.
Everything you’ve written is true.
The vulnerability of EMS and ER personnel to violence formed the foundation for a novel I wrote. It was a finalist for the Minnesota book award in fiction yet every aspect could occur at any time…
Emergency and other healthcare personnel are not adequately protected. In any other industry, it would not be tolerated. Things must change. Thanks for the article and increasing attention. Be safe all.
https://www.amazon.com/Insurrection-Drake-Cody-Suspense-Thriller-Book-ebook/dp/B096G95V7M/ref=mp_s_a_1_2?qid=1692931791&refinements=p_27%3ATom+Combs&s=books&sr=1-2
It's the morally bankrupt, Social Darwinist "Healthcare" executives, stupid!