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. 2017 Apr;18(3):466-473.
doi: 10.5811/westjem.2016.10.30271. Epub 2017 Mar 3.

Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State

Jonathan S Weyand  1   2 , Emily Junck  3 , Christopher S Kang  4 , Jason D Heiner  3   5
Affiliations

Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State

Jonathan S Weyand et al. West J Emerg Med. 2017 Apr.

Abstract

Introduction: Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events.

Methods: A voluntary, blinded, 28-question Web-based survey developed by emergency physicians was electronically delivered to all 87 Washington State ED directors in January 2013. We evaluated responses by descriptive statistical analyses.

Results: Analyses occurred after 90% (78/87) of ED directors responded. Annual censuses of the EDs ranged from < 20,000 to 100,000 patients and represented the entire spectrum of practice environments, including critical access hospitals and a regional quaternary referral medical center. Thirty-four of 75 (45%) reported the current level of security was inadequate, based on the general consensus of their ED staff. Nearly two-thirds (63%) of EDs had 24-hour security personnel coverage, while 28% reported no assigned security personnel. Security personnel training was provided by 45% of hospitals or healthcare systems. Sixty-nine of 78 (88%) respondents witnessed or heard about violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient's family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35% believed the initial additional security response would not be adequate, with 26% reporting no additional security would be available within 15 minutes.

Conclusion: Our study reveals the variability of ED security staffing and a heterogeneity of capabilities throughout Washington State. These deficiencies and vulnerabilities highlight the need for other EDs and regional emergency preparedness planners to conduct their own readiness assessments.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.

Figures

Figure 1
Figure 1
Percent distributions of violent threats or acts witnessed by or reported to emergency department (ED) directors and reported to hospital administration.
Figure 2
Figure 2
Number of security personnel that could respond within 15 and 30 minutes of activation of the hospital emergency management plan.
See this image and copyright information in PMC

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