Security In The Emergency Department

This past Tuesday a patient carrying a gun at Cypress Hospital in Harris County, Texas opened fire in the emergency department. According to news reports, he was “impatient, walked up to the reception area and fired several shots”. The same report also states the patient the patient was “upset after he was asked to remove his clothes before an X-ray”. (News Report) The account goes on to describe two off duty deputies, who were working in the building, arriving at the scene and confronting the patient just outside the ED. The patient was shot but not killed in the encounter.

Unfortunately, this scenario is all too familiar. Emergency departments across the nation are breeding grounds for frustration and emotional outbursts. In addition to the pain and illness that lead someone to the emergency department, there can be significant wait times to be seen and then longer waits for testing completion and treatment. Into this comes the addition of death, grieving family and friends, drug and alcohol intoxication, and acute unstable psychiatric illness. All of these form a perfect tinder box for a swell of emotional outbursts that are often directed at department staff and sometimes other patients.

Although there have been numerous shootings at emergency departments across the country, even more frequent are the acts that do not involve weapons but personal attacks on nurses and staff. Despite that, many hospital feel the expense of staffing an off duty uniformed, armed officer in the waiting room of an ED is too high. Some have even voiced concern that it changes the atmosphere in the waiting room and might be a negative influence on patient satisfaction. However, such opinions are unsupported by evidence. Uniformed officers are not present to simply protect staff. They are there for the common safety of everyone. Additionally officers are well regarded in most communities and there is no reason to believe their presence in the ED would be received otherwise. Tragic events such as the one at Cypress Hospital, are swiftly handled with minimal injury or loss of life by the immediate presence of armed law enforcement. Unarmed security is not able to control situations of this type and the cost of uniformed officers is negligible when compared to the cost of a life, or worse, multiple lives.

Regulatory agencies have touched on the issues by publicising statistics and opinions. The joint commission has published some of their own recommendations (starting page 95 … TJC Link). However, all stop short of the final critical step, uniformed law enforcement presence. The American College of Emergency Medicine’s position (Link) stops short of recommending armed hospital security, citing the projected cost of training and regulating such personnel for all the hospitals in New York. However, most hospitals that have armed security have chosen to employ off duty uniformed law enforcement officers. That decision comes with a much smaller cost since training, equipment and regulation is completed by the law enforcement agency.

The ED is the most common area for violence against a healthcare worker. (ENA, Medscape links) Additionally, hospitals are now being included in terrorism warnings by the office of Health and Human Services due to concern over ISIS supported “lone gunman” attacks. (HHS) How many more acts of violence against our healthcare workers need to occur before we acknowledge the solution? How many before hospitals nationwide and our regulatory bodies hear the cries of workers on the front line? Don’t wait until it occurs at your hospital. Perform your security assessment and make sure you complete the process by staffing officers in your ED.

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