Disons que nous sommes encore à des année lunière de la situation telle que décrite ci-bas mais, on n'est pas à l'abris de menaces, aggressions et autre forme d'intimidation.
En 9 année de pratique, j'Ai tout de même été menacé de mort au moins 3 ou 4 fois, recu quelques baffes par des patients saouls, une fois menacé avec un couteau par un patient psychotique, bref, un peu plus à risque que le poste de préposé à la billetterie au Village du Père Noël... Depuis cette année, nous avons convaincu l'Administration de l'hôpital d'avoir un garde de sécurité 24 Hr/ 24 H dans l asalle d'attente. Grace à cela, nous avons noté une grande baisse au niveau de l'intimidation et des menaces auprès du personnel au triage. Il dirige les gens, reagit promptement dès que le ton monte et fait des tournées régulièrement dans l'urgence pour limiter le nommbre de visiteurs auprès des patients. MG CSSS ST-Jérôme -----Message d'origine----- De : Pediatric Emergency Medicine Discussion List [mailto:[EMAIL PROTECTED] De la part de Lavonas, Eric Envoyé : 14 avril 2006 12:41 À : [EMAIL PROTECTED] Objet : ED safety/security Maureen & Andrew, Alas, I'm afraid that you are both correct. Administrators seem to be very much afraid of a lawsuit from a patient or family member for alleged injury or violation of personal space. They seem congenitally unafraid of a suicidal patient eloping and completing suicide, of assault on a nurse, of a violent patient injuring another patient or a visitor, or of homicide in the workplace. Here's some information you might use to try to change their minds, along with references when I have them close at hand: (1) OSHA tracks homicides in the workplace. In a 1996 report, they counted 26 physicians, 18 nurses, 27 pharmacists, and 35 other HCW's murdered while on the job from 1980-1990. I imagine there's more recent data out there if you dig a bit. (2) A survey of 127 teaching hospital ED's found: 32% at least one verbal threat per day 43% at least one physical attack per month 18% at least one threat with a weapon /month 80% at least one injury to staff member /5 years 7% at least one violent death in ED past 5 years (3) A survey of 44 Pediatric ED's found: Average 5 verbal threats per week 75% at least one physical attack per year 25% at least one injury to staff per year (4) More than 25% of GSW victims have weapons on them in the ED (Wassberger Arch EM 1989; Ordog Acad EM 1996) (5) 4-5% of ED patients, families, and visitors carry a lethal weapon into the ED (6) Some recent shootings in ED's: Dec 19, 2003, Dover Ohio: http://www.timesreporter.com/left.php?external=repsearch_detail.php&ID=1 4860 June 11, 2004, Sweetwater, TN October 7, 2003, Mufreesboro, TN (shooter was a hospital employee with no history of mental illness or violence) Jan 15, 2001: Van Nuys, CA Feb 28, 1999: Meuthen, Mass April 8, 2003: Mass General Hospital (shooting occurred in the EP lab, not the ED) Sadly, this is very much a partial list of recent tragedies. I've worked in ED's that range from very large to very small, urban to rural, teaching and community, pediatric-only and mixed. My strongly held opinions on the topic include: (1) Every ED should have positive access control: Nobody comes in or out without either an employee ID badge, a patient ID bracelet, or a visitor pass; patients may only depart with discharge papers or the verbal OK of a doctor or nurse. Unfortunately, almost no ED's actually implement this. (2) There are plenty of reasons to undress every patient with altered mental status, altered behavior, a psychiatric complaint, or intoxication, or who is a victim of assault. For those who cannot be undressed, electronic frisking is a non-invasive second choice. This improves safety for staff, safety for the patient, and diagnostic accuracy. This should be a habit. (3) Every hospital should have at least one trained security person on campus at all times (more in busy and/or urban ED's). This person should have some non-lethal means to incapacitate a violent patient when the situation is such that staff cannot do so safely. The decision between OC foam, tasers, and batons is complex and beyond the scope of this list. Waiting for police to show up can be tragic. (4) We should maintain an expectation of appropriate behavior on the part of all visitors, and those patients who have the medical/psychiatric capacity to control their behavior. When behavior is inappropriate, unsafe, or disruptive, visitors should be warned, and then removed if the behavior continues. With an abundance of caution, due regard for EMTALA, etc, there are circumstances in which it is OK to refuse non-emergent care to a patient who chooses to be disruptive. In rare cases, escort off the grounds and/or involvement of law enforcement is completely appropriate. (5) Providing a safe workplace is not just a good idea -- it's an OSHA mandate and a moral obligation. (6) Educating the hospital administration is important. Have your facts straight. Keep at it. Use example lessons. Keep plugging. The admins have a lot of priorities to balance, and most are doing their level best. The squeaky wheel gets the grease, so be persistent. Have a great holiday, all (I'm off to work!). Eric Lavonas, MD Charlotte, NC For more information, send mail to [EMAIL PROTECTED] with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html --- URG-L Pour quitter URG-L, envoyez un message a la liste ([email protected]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
