October 8, 2006, 1:10 am

When A Patient Threatens To Shoot You

No funny photo goes with this particular post.

In a comment to one of my “The Answer Nurse” posts, I received this disturbing question:

Question:

What is the correct response when a patient states “Something has to be done about this headache or I will come back with a gun and start shooting.”?

Recent events have made me think that this question needed to be handled with gravitas and responded to in a serious manner.

The following is just my opinion on what should be done, based on the scenario posted in the question. If you are ever in this situation, follow whatever your hospital policy dictates or whatever you have to do to save lives.

This is not to be taken as advice – simply what I would do if it were me.

ABOVE ALL ELSE, TAKE THE PATIENT SERIOUSLY!

  • IMMEDIATELY notify your local police or sheriff’s department that an ACTUAL THREAT has been made. While awaiting a response:
  • Inform hospital administration/nursing supervisor at once. Tell the ER doctor immediately.
  • Utilize your hospital security to ascertain that your patient does not have a weapon in his posession at that time. Whether your hospital security carry weapons or walkie-talkies, you need to get them down there.
  • Let the verbal terrorist think he/she is about ready to get the biggest dose of any narcotic they want on the face of the earth and that your sole reason for living is to cater to their every whim so that they do not leave your sight
  • DO NOT
    • Place the patient in the waiting room
    • Place the patient in a multi-bed ward
  • Do
    • Stay calm
    • Room the patient immediately if possible. Discharge/move other patients.
    • If possible, register the patient as fast as possible at the bedside to get as much information as you can
    • If the police don’t show up Code 3 (and they should), actually medicate the patient if you can with as much as you can get the doctor to ethically order. In other words, “do something about their headache”.
    • Be alert to sudden changes in affect, signs of agitation or escalation:
      • pacing
      • cussing
      • more threats
  • You may be the only witness to that verbal threat
    • What the patient says to you can be charted in quotes, verbatim and becomes a legal part of the medical record.
    • Chart accordingly. The chances that what you write will be used in court are high. Especially in this day-and-age.

We have lost colleagues to ER shootings in the past.

For those of us who do not live in high-crime areas, we can be like “sitting ducks” in our work environment.

Get busy and get your department as safe as possible by:

  • limiting the access to your department by making entry to the patient area difficult
    • use a door code
    • use a badge-swiping system
  • Be especially aware of doors with access from the rest of the hosptial.

I don’t even want to think of this.

But better to think about it now before they are playing those “five funeral songs” you put in your last blog meme.

Again, this is just my opinion of what I would do if faced with this situation. Your milage may vary.

Make sure you have a policy/action plan in place.

And pray you never need it.

    11 Comments

    • Julie
      Julie

      October 8, 2006 at 6:05 am

      Excellent, Kim! One can’t take anything for granted any more (He’s just stressed, and venting…)
      Be mindful of any guests the patient may have in tow, as well.


    • scalpel
      scalpel

      October 8, 2006 at 8:19 am

      I totally agree.


    • Cathy
      Cathy

      October 8, 2006 at 10:10 am

      Kim, what a horrible thing for you and all other medical professionals to have to think of and make plans for. It seems wrong that those who give so much to make people well have to worry about a patient taking their life…Sad!


    • Mama Mia
      Mama Mia

      October 8, 2006 at 1:58 pm

      Perfect advice and exactly what I would do!! Thank you Kim.


    • Mel
      Mel

      October 8, 2006 at 4:07 pm

      Perfect advice, Kim. Not too long ago, we had a person (not a patient, we’d have tried to help him if he’d walked through the door) shoot himself just outside our ED doors. There were cops in the parking lot at the time. He wanted witnesses, apparently…


    • Julie
      Julie

      October 14, 2006 at 7:02 pm

      Great words we should always remember. It is to easy to become complacent in the workplace.


    • Pam
      Pam

      October 17, 2006 at 7:22 pm

      To the nurse facing this threat–take it very seriously. I too had a similar situation; unfortunately, I didn’t have a good experience. A few years ago, we actually had a man come up to the unit where he had been a patient and he shot and killed a nurse he thought had treated him poorly.

      I cannot say where I was working when this second incident happened, but it was a trauma center in a large midwestern city. We have gang violence, drug wars, and recently 3 14 year old boys kicked and stomped to death a man for a $10 bike he bought at Goodwill. So we deal with all types of violence on a daily basis.

      On this day, we were getting our asses spanked. We were running a trauma, a cardiac arrest, and a GI bleed with a SBP of 60 in addition to regular ER critical patients. A man presented to our door a victim of multiple gunshot wounds–none life-threatening. At the same time, we received a call from the county ambulance service dispatch warning us that they had been called to his residence for the GSW, but they did not transfer him because he became aggressive and agitated, and the EMS staff refused to transport because they feared for their safety. The police were on scene, and were very familiar with this guy. They refused to accompany the EMS crew in his house because in the past “when he saw the police on his property, he became even more threatening” so they didn’t want to make him mad. He is a well known drug dealer in the area, and they just didn’t want to do the paperwork.

      As you can imagine, our anxiety level was high. We started getting him undressed to assess his injuries. As we do that, our policy is to call out their belongings to a scribe who writes them on a clothing sheet on arrival to avoid problems later. When they picked up his coat to put it in a bag, (not looking in the pockets or anything) he became enraged and began to threaten the staff about not touching his coat, and threatening to “kick anyone’s ass who messed with his coat.” Of course, all kinds of red flags came up. It wasn’t the first time we found drugs, drug money, or weapons in a patient’s coat.

      The docs are like treat him, and leave the room. All 3 female RN’s left in the room feel very threatened. Security and the police are called immediately to ascertain if he has a weapon. Our security refuses to look for a weapon since the police refuse to come to the hospital because they “don’t want to piss him off more.” So, the police and our security tell us to deal with it and move on. He continues his diatribe about touching his coat, and he says he has memorized our faces, and if we touch the coat, he will come back to the hospital and kill us when we go to our cars at the end of our shifts.

      As I say, we have patients all over the place, and because of his threats, X-ray and CT refuse to do any images until we are certain he is unarmed. This brings the ER to a standstill because trauma pts come first, so no other patients can get their images done until this is resolved. We are told by our RN dept manager and the docs to deal with it. We are at a stalemate. The trauma surgery residents put him flat in the bed to do a bedside ultrasound. I see this as my opportunity. Since no one else is going to make sure we are safe, I have 2 other RN’s block his view of the door pretending to be watching the U/S. I slowly sneak the coat out of the room, and in view of another RN, I look through his pockets for weapons. I find none, but I found a large amount of crack and a large sum of money. I don’t touch these items and leave them right where I found them. I told the RN’s he didn’t have any weapons and I put the coat right back where I found it without the patient seeing what I did. One of the security guards came up to me a few minutes later and asked what I found when I went through his coat–I guess news travels fast. I said no weapons, which is what everyone was concerned about in the first place. They came to take him for his films so we could get things going again.

      About 30 minutes later, the police show up because our security called them and told them of his possession. He is not arrested, they don’t even speak to him because just seeing the police “makes him go off.” An officer walks over in plain view of the patient, takes his drugs from his coat and leaves. That’s it–nothing else.

      Everyone is amazed, but many staff come and thank me for taking a personal risk to ensure their safety. Imagine my surprise when an hour later, I am called into the ED RN and ED Medical staff office and the hospital attorney is there. I am told that I performed an illegal search on the patient, and the police want to file criminal charges against me. They are waiting to arrest me and the hospital attorney is here to advise me, but because I disobeyed orders by my manager to ignore the risk and treat the patient, she can’t help me and I need to get my own attorney.

      I explained, as I and my co-workers said at least 10 times, we didn’t care about anything except to ensure he had no weapons. We didn’t care about the drugs or the money, and when I put his coat back he had everything he came with. I mean, we didn’t want him selling drugs, but we don’t have badges and guns, so that wasn’t our call to make. They told me that was not a good excuse and I could be fired for insubordination as well.

      My RN co-workers and radiology staff were interviewed by the police, our managers, and the hospital attorney. All of them said the same thing I did, and that they were thankful I was willing to look out for their personal safety even if the police, our security, and administration didn’t think their right to safety was important.

      After many hours of hiring my own attorney at $500 an hour, talking with the county prosecutor, the police, and my manager, they decided they would not file charges against me, but they placed this incident in their computer system, and if I was involved in any other similar incident, or even got another complaint from a police officer, I was going to jail–no ifs ands or buts. I wasn’t fired, but I was suspended and have the incident in my file which can be used against me when the time comes for merit raises for years.

      Would I do it again? In a heartbeat, because no one watches out for us except us. People still talk about it, and people still thank me that they were able to go home to their families that day.


    • S. R.
      S. R.

      October 23, 2006 at 8:08 am

      Yes indeed, this is quite scary, not just in the ER but in a quiet unsecured ward in the middle of the night.


    • […] Emergiblog – When a patient threatens to shoot you […]


    • wayne
      wayne

      November 7, 2006 at 8:43 am

      As a hospital security officer at a facility that has over 1000 beds, I can tell you that this sort of thing happens on a daily basis. I applaud the answer given to the question and only add that one of the 1st things to be done would be to contact the security department. they will be able to help you and will most likely have a history for the particular patient if he has made threats in the past.


    • DoneWithIt
      DoneWithIt

      June 11, 2007 at 2:36 am

      After being an LPN for better than 10 years, I went back to school and I’ve never been more concerned for my personal safety as when I had to do my “Mother/Baby” rotation. Almost everyday we had a “Springer” episode in the making and in our part of the country, guns are an everyday part of life. I felt more secure when I worked in the state prison!


    About Me

    My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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