Emergency department workers inherently vulnerable to violence

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The case seemed standard fare for a major urban hospital emergency department.

On April 9, Pittsburgh police responded to a report of an assault on North Side and, after arriving at the scene, found 19-year-old Andre Dunlap with lacerations on his nose and forehead.

Mr. Dunlap was taken to Allegheny General Hospital’s emergency room for treatment where, acting on gut instinct, a Zone One police officer investigating the assault decided to check Mr. Dunlap’s name against the FBI’s National Crime Information Center database.

Turns out, the young man being treated in the AGH emergency room was wanted in Alabama for capital murder. He had been charged with two others for allegedly killing a 22-year-old man during a drug robbery last December in Birmingham.

Mr. Dunlap was taken into custody without incident but the episode — which barely caused a ripple locally — illustrates the unpredictable and sometimes serious danger that emergency room staff members and patients can face.

As a 24/7 operation that takes all comers, an emergency department is inherently vulnerable to violence, said Emergency Nurses Association President Deena Brecher, an ER nurse at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.

“Emergency departments reflect the community they serve. Where violence is more common on the street, it’s more likely in the ER,” she said.

Many times, that violence is an extension of what just happened on the street.

In 2010, the U.S. Bureau of Labor Statistics reported 11,370 assaults on healthcare and social assistance workers nationally, a 13 percent increase over the previous year. The following year, the Pennsylvania Patient Safety Authority reported 384 acts of violence or verbal abuse, most of them threats, from 2006 through 2010.

Ms. Brecher said the nurses association, based in Des Plaines, Ill., once surveyed 13,000 members about whether they had experienced physical or verbal violence such as threats in the previous seven days.

More than half answered “yes.”

That does not surprise Bruce MacLeod, head of West Penn Hospital’s emergency department and current president of the Pennsylvania Medical Society.

“I think we’ve become immune to that, that at any moment someone could come into the emergency department with a weapon. Police might be the only other profession where there is that imminent danger all the time.”

It usually takes a major tragedy in a hospital to make national news, such as the 2012 shooting at Western Psychiatric Institute and Clinic that left two dead, including the shooter, and five injured. But there are also many other threats in an ER that never come to light, said Ms. Brecher.

“Saying ‘I got a knife pulled on me yesterday’ does not make the news,” she said.

While there will always be risks to working in an ER, Ms. Brecher said those risks should not be dismissed. Assaulting an emergency health worker in Pennsylvania is considered a felony. Still, she said, “We’ve created this culture of acceptance of violence in the emergency room.”

Hospital executives and even judges have been known to tell an ER nurse that assaults are an expected job risk, she said, so nurses may be reluctant to report an attack unless there is a clear no-tolerance policy.

“The problem with that is that it [violence] is not OK and it’s not part of your job. If it was a police officer, you would never allow that,” she said.

Last month, a memo circulated at UPMC Mercy hospital laying out new security measures for the emergency department, which include searching the belongings of patients brought in by gurney. AGH has a similar policy and both hospitals already use metal detectors for ER patients and visitors.

That seems to be the trend nationally, said Dr. MacLeod, although he said he personally has never felt afraid while treating ER patients.

“Over time, you get better at identifying people who might be a risk to you,” he said. “And I’ve always found that if you treat them with professionalism and courtesy, you do OK.”

But it’s the triage nurse who typically will first come into contact with a patient, and Ms. Brecher said she’s learned from experience some strategies for staying safe.

“I don’t wear a stethoscope around my neck and I don’t wear dangling earrings,” she said.

She makes sure any identification badge she’s wearing will easily detach if it’s pulled.

Perhaps most importantly, she added, “Never put your patient between you and the door to the way out.”

Steve Twedt: stwedt@post-gazette.com or 412-263-1963.

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