Wednesday, February 10, 2010

Gerald O'Malley, DO: Violence in the ER

My job as an emergency physician is analogous to my brother’s job as a NYC police officer in that it is often defined by hours of monotony punctuated by moments of sheer terror.

We deal with the consequences of brutality every day and sudden, explosive violence is never far away. My ER is located in one of the worst neighborhoods in Philadelphia and we have very large but unarmed security guards that provide protection to hospital employees, patients, and visitors. They don’t get enough recognition.

Despite our best efforts, a determined assailant can threaten the entire ER.
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Recently, a man caved in his wife’s skull with a claw hammer because she smoked up all his crack while he was out. She suffered multiple skull fractures and brain injury, and while we were working with the trauma team to stabilize her, the assailant posed as the patient’s brother and tried to get through security into the treatment area of the ER in order to do…something. Fortunately, a Philadelphia police officer recognized him and arrested him before he made it into the trauma room.

Another guy broke his girlfriend’s neck, her jaw, her nose, and three of her ribs and while she was in the CT scanner, he checked into triage under a fake name with a complaint of an injured thumb. He sneaked out of the FastTrack, where he had been triaged and was moving through the ER going room to room and peeking through curtains looking for our trauma patient in order to do…what? One our techs noticed him, approached and challenged him, and after a few minutes of excuses, he bolted through the ambulance doors into the Philadelphia night.

We have discussed the hard economic realities of installing, maintaining, and manning metal detectors in the ER, but we all agree that a realistic cost-benefit-threat analysis concludes that it makes no sense. As a faculty, we thought that metal detectors would send the wrong message to the community we serve – that we don’t trust them or we feel threatened by them. Interestingly, a pair of surveys from 1997 (one of them conducted right here in the City of Brotherly Homicide) suggest that patients in an urban ER waiting room actually feel safer with metal detectors and do not feel that their privacy is being invaded.

I was robbed at gunpoint in high school while working the night shift at an ice cream shop. I’ve never had a gun pulled on me in the ER. Yet.

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