Training, buddy system can reduce ED violence
Angry, violent individuals need specialized attention, and improperly handling a crisis can mean years of litigation, warns Robert Siciliano, CEO of NurseSecurity.com and a personal security expert in Boston. Fail to act properly and you could face liability from either the injured staff member or the assailant who was injured by your intervention. Or both.
Siciliano offers this overview of the strategies that can reduce violence in the emergency department (ED) and ensure a proper response to incidents:
- Create a safety culture for the ED. Establish guidelines that include adaptable safety and security procedures customized to the limits of the facility. Create zero-tolerance policies for violence and threats for patients, staff, and visitors. Create reporting procedures and a filing system to evaluate and quantify progress.
- Work together. It is essential that management demonstrate organizational duties to ensure the safety and health of their employees. Managers should offer support and "be there" when employees are in crisis.
- Educate employees about their responsibilities. Staff are responsible for learning their assigned duties and complying with security program guidelines. They also must be involved in ongoing procedures, committees, inspections, reporting, and dissemination of information.
- Know your risk factors. Employees must know what elements increase the risk. Patients' families and friends bring in handguns, knives, and other weapons. An ED's 24-hour unrestricted access, long waits, disgruntled family or gang members, and patients under the influence of drugs and alcohol all escalate the risk. Nurses are sometimes isolated in remote areas and are not trained to respond to physical threats.
- Ensure premises security. Options include security guards, metal detectors, pass keys, alarm systems, panic buttons, cell phones, proper lighting, and centralized radios. A central office to respond to distress calls is essential. Security cameras and curved mirrors assist in remote areas.
- Coordinate with local law enforcement. Although law enforcement usually responds after a crisis, it is important to create communications with local authorities and make them fully aware of the facility layout. Properly trained security guards usually can defuse violent situations whether by nonviolent means or with force.
- Use nonviolent intervention. Have systems in place to treat clients who are aggressive or acting out. Certified employee assistance professionals or social service staff should be on duty 24 hours a day to help calm angry patients.
- Use a buddy system. There is strength in numbers. To reduce potential threats, pairing staff can offset the chances of being overpowered. Elevators, stairwells, parking garages, home visits, and isolated areas are all potential threats.
- Minimize jewelry and cash. Not only is jewelry a potential target for thieves, it also can be a strangulation hazard during an attack. Carry only essential identification and cash. Beware of improvised weaponry in the form of surgical tools, keys, pens, or other items that could be used as a weapon.
- Offer self-defense training. Employees can be trained in assault response, avoiding assaults, personal safety, and self-defense.
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