A Shooter in the ER

During my residency in a large inner city, I was tending to a patient who had been shot in the neck. A few minutes after the patient arrived, the perp came to finish the job and started shooting at his intended victim in the ER. The shooter was immediately subdued by security and we continued with our efforts to save the patient's life. Fortunately, no one was injured.

Emergency physicians responding to an August poll are reporting more frequent incidents of violence in emergency departments in recent years, a trend they say is helping drive professionals from the field and directly harming their ability to care for patients.

Fifty-five percent of emergency physicians say they have been assaulted in the ED while 79% say they have witnessed another assault, according to an August survey of more than 2,700 respondents commissioned by the American College of Emergency Physicians (ACEP).

In a 2022 American College of Emergency Physicians survey of E.R. doctors, 55 percent said they had been physically assaulted, almost all by patients, with a third of those resulting in injuries. Eighty-five percent had been seriously threatened by patients. The risks can be even higher for E.R. nurses, with over 70 percent reporting they had sustained physical assaults at work. I don’t know anyone who works in the E.R. who hasn’t suffered some form of violence there.

Hospital shootings are increasing, as evidenced by a recent episode at the El Paso VA . With more than 150 shootings at hospitals across the United States from 2000 to 2011--30 percent of those in emergency departments--the threat to patients and staff safety is real. The Department of Health and Human Services has issued guidelines on how to deal with a shooter in the hospital or hospital grounds, including awareness of suspicious or hostile behavior, bullet proof screens at intake areas, metal detectors and all the rest.

A new survey revealed that 64% of clinicians feel physically unsafe at work. The perceived risk of violence was especially high among women, clinicians under age 40, emergency department physicians and employees who work with patients struggling with addiction or other mental health conditions.

Patients are getting frustrated and angry and that can result in physical violence against medical staff. It requires an active plan to prevent and manage it. But, there are issues:

1. How far should a hospital go to protect the staff and bystanders using security technologies like facial recognition software?

2. Should health professionals be allowed to carry concealed weapons in a hospital?

3. Who bears the responsibility when a hospital employee is shot or injured?

4. Should "shooter on the premises" training be required, like fire drills, tornado drills and a stolen baby drill?

5. What about the responsibility of medical students and other trainees?

6. What should a health professional do it they have received a threat to them or their family?

7. What is the responsibility of the State Board of Medical Examiners if the person making threats is a doctor?

Workplace violence does not spare medical workers, nor is it confined to a given location or type of environment. I've known at least two colleagues who were killed in their private offices by disgruntled patients.

There are many parts to the dark underbelly of medicine that are hidden from most applicants to medical school.

The fact is that being a doctor is potentially hazardous to your health. Surgeons face an epidemic of disabling musculoskeletal disorders. But, that's not all. They also must face:

1. Blood borne diseases

2. Physical assault

3. Sexual harassment

4. Bullying

5. Sleep deprivation

6. Anxiety, depressions and substance abuse

7. A toxic educational culture

8. Personal and professional attacks as part of internecine turf battles

9. Retaliation for whistle blowing

10. Burnout

BOTTOM LINE: Hospitals are one of the most dangerous places to work. Here are some suggested solutions.

Hospital shootings are a real threat. Be careful out there.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs