DOVER-FOXCROFT, Maine — Maine hospitals say it’s tough enough to concentrate on the health needs of patients who walk through the emergency room doors without doctors and nurses having to worry about their own safety or the safety of other patients.
But that worry is real for emergency room staff members, who are dealing with an uptick of patients with mental health and substance abuse problems.
“We are continually hearing concerns from hospitals about challenges within their emergency departments regarding security concerns,” Mary Mayhew, vice president of the Maine Hospital Association, said Tuesday.
A study in the Journal of Nursing Administration in 2009 showed that an “amazing number of nurses have been victims of physical violence or verbal abuse,” Bill Briggs, past president of the national Emergency Nurses Association, said Tuesday.
“We found it was pervasive throughout the country,” Briggs said. But it was less prevalent in pediatric hospitals and hospitals that had implemented violence prevention programs. Another study is under way. The previous study did not have a breakdown of incidents by state.
“It’s a concerning problem, and it’s a problem in every emergency department in the state,” Dr. David McDermott, medical director of emergency services at Mayo Regional Hospital in Dover-Foxcroft, said recently. “With the prevalence of mental health issues in the community, when those patients destabilize, they’re often brought here to the emergency department.”
Staff members at Mayo have been both threatened and assaulted by patients in the ER, McDermott stated. “It’s not a daily occurrence, but sometimes the line between folks being in control and folks not being in control of their own emotions is a thin line,” he said.
To help improve safety, Mayo Regional Hospital was the first hospital in Maine to install a new wireless communication system called Vocera. The system provides caregivers with a badge that allows hands-free communication anywhere in the hospital and quick access to local law enforcement.
It was used recently when law enforcement officials brought a suicidal patient to the hospital. While being treated, the patient became distraught and unruly, so the Vocera system was used to summon the police, according to McDermott.
“We do feel that it has improved the communications between different members of the [emergency room] team, and it has enhanced patient safety by improving communications,” McDermott said. He also noted that it has decreased the noise level in the hospital by reducing overhead paging.
Other hospitals also put a priority on security. Steve Russell, head of security at Eastern Maine Medical Center in Bangor, said there have been incidents in the past where patients or family members have become agitated at EMMC. Even little things can set off some people, he said. For example, patients may just want to talk to a family member or look out a window but they haven’t communicated that desire to the emergency provider; rather, they get angry.
Russell said his unarmed security force and the emergency room staff have been trained in the same techniques to de-escalate angry patients. Without being patronizing, the staff works to calm patients down and get to the core of their anger. Sometimes that’s not possible, so the Bangor Police Department is called to assist, he said.
Last August, the Bangor City Council voted to accept funding from EMMC to purchase a Taser that city police officers can use to subdue unruly patients inside the emergency room. A Bangor police official said Tuesday that the Taser is kept in a locked cabinet at the hospital.
Dr. Erik Steele, chief medical officer of the Eastern Maine Healthcare Systems, who also works in several rural emergency departments at night, said assaults on hospital personnel are a growing problem. Information shows that the number of assaults on health care personnel and especially ER personnel has gone up steadily in the past 15 to 20 years in the U.S., he said.
An emergency department is a place anyone can come to 24 hours a day for whatever reason, Steele said. “When you’re angry, frustrated and don’t know where else to turn to, drunk, depressed, whatever it is, an ED tends to be where you go,” he said.
Very few emergency departments in Maine can handle a person who walks in the door and is looking to harm staff, according to Steele. “We all live with that fear.” While the staff has been trained in de-escalating potentially violent situations, he said emergency department staff members are specifically trained to help people, not to take people down.
BDN writer Eric Russell contributed to this report.