Getting spit on by a patient is so common that it’s hardly worth mentioning. It’s the bites, punches, firearms and airborne objects that you really need to watch out for. That was the consensus among the ER doctors roaming the San Diego Convention Center Tuesday afternoon. Thousands of emergency room specialists are in town this week for the 50th annual meeting of the American College of Emergency Physicians, and many were happy to discuss the results of their organization’s newly released survey on emergency department violence. Nearly half of those surveyed said they have been physically assaulted on the job, and seven out of 10 have witnessed a colleague subjected to physical assault. In pretty much every case, a patient or a patient’s family member, friend or other relation caused the violence, which was almost never prosecuted. Only 3 percent of responding doctors said they pressed charges after a violent incident. The survey results did not particularly surprise Dr. Gary Vilke, professor of emergency medicine at UC San Diego Medical Center. “It was several years ago, but I did get bit in the arm by a patient and the same thing happened to one of our nurses,” Vilke said. “The spitting, that’s just a regular occurrence.” Dr. Andrew Summersgill, now working at a hospital in Hawaii, had no trouble doing him one better, recalling an incident treating a New York emergency room patient in the South Bronx who was on several different drugs, lashing out at staff and HIV positive. “I’m wearing full protective gear, and he breaks free,” Summersgill said. “He bites through my gear and into my arm. His face was covered with blood at the time, so I got an HIV exposure on top of a bite.” Evelyn Figueroa, a nurse practitioner from Las Vegas, recalled a man brought in by ambulance to a hospital where she previously worked in Florida. “He was screaming, ‘I want pain medication, I want pain medication,” Figueroa said. When doctors refused, the patient pulled out a gun. “He was so inebriated that the gun hit the side rail of his bed and fell between his pant legs,” Figueroa said. “I grabbed the gun, but almost everyone was going crazy. One of our nurses quit because of that.” With an estimated 7,000 emergency medicine physicians from all over the world congregating in San Diego, it was not difficult to find plenty of M.D.s with stories of violence on the job to share. But most seemed to see their chances of getting hurt while trying to heal as relatively old news. This stuff, they all said, has been part of the job forever. And that’s the point of doing the survey, said Dr. Vidor Friedman, ACEP’s president. Health care workers, hospitals and others involved in providing care are too quick to excuse violent bad behavior. Doing so, he said, has gradually created an expectation among the public that violence that would get a person arrested on the street will be tolerated in the emergency department. “I think if we have a culture of zero tolerance for violence in our emergency departments, that minimizes a lot of the violence,” Friedman said. The overarching goal, he added, is to find ways to stop patients from becoming violent in the first place. Hospitals are increasingly taking steps to “de-escalate” potentially violent circumstances. Dr. Terry Kowalenko, a Michigan-based emergency physician who has researched ER violence, said that requires helping staff know what warning signs are likely to pop up before a patient takes a swing at his or her caregiver. Having robust security available, and a quiet place for agitated patients to calm down, can all make a big difference in a hospital’s violence rate. “There is a big subset of people who become violent who didn’t come in violent, and often that’s a result of how they felt they were treated or not treated,” Kowalenko said. Local hospitals have been trying to take this knowledge to heart for years. Janie Kramer, chief operating officer of Sharp Memorial Hospital in San Diego, said the facility saw a sharp decrease in physical violence when it moved to 24-7 security and made a significant investment in security cameras. While verbal abuse is still too common, she said having a significant focus on security really has helped. “We do have security in rooms one-on-one with patients if they’re showing signs of violence, and we know that makes a big difference,” Kramer said. She said Sharp will pursue charges against patients when they become violent and their behavior is not a symptom of mental illness. But the ACEP survey showed that that’s rarely the case. Many of the 3,539 doctors who responded said their hospitals ask them not to press charges after a violent incident. That appears to be changing. It was not too difficult to find doctors on the convention center floor Tuesday who have pushed back in court. Dr. Luis Villegas, an emergency practitioner at Bellevue Hospital in New York, said he felt he could not let a particularly aggressive attack that involved a drug-addicted patient stand. “He picked up a monitor and threw it at my head,” Villegas said. “I managed to catch it, so thankfully I didn’t get hurt, but that’s when I went through the process of pressing charges. I mean, that’s assault. Thankfully, the New York City (district attorney) and the Bellevue Hospital police were fantastic about the process.” Violence in the emergency room "I've been punched and kicked and scratched and attempted to be bitten in the past. Usually, it has to do with mental health. A lot of people have mental health disorders which cause them to be overly aggressive which makes it hard to do our job," Dr. Shana Ross, Chicago "The patient was drunk at the time,he had some bruises, so clearly had fallen, or was beaten up and was in the trouble. We were trying to get him to calm down, we got him to comply to go on a bed and started putting in an IV, (I said) 'you are going to get a stick.' I stick him and I get a bop. Mentally ill patients, you know, they will fight, so you don't go to them one-on-one, you go to them with a team. You approach them all at one time so it looks like you are intimidating," Dr. Sara-Ann Hylton, Kingston Jamaica Source
