Hospital Hazard: In Some Communities, Emergency Rooms Seem under Siege. Health-Care Officials Fear Chaos Would Follow a Terrorist Strike. (Medicine)
Gribbin, August, Insight on the News
Hospitals can be scary places for patients, but for doctors, nurses and others who work there they can be downright dangerous. "Every emotion is expressed in the emergency room every day," says Thomas Arnold, a professor of medicine and acting chairman of the Emergency Medicine Department at Louisiana State University's Health Sciences Center. Care rarely comes fast enough for visitors, Arnold explains. "Sometimes they object violently when other, more urgent patients are treated before their relatives. Then, too, people sometimes turn on doctors when, unfortunately, we must inform them their relative has died."
Consider what happened to Paul Matera, emergency-room physician at Providence Hospital in Washington. "It was about 2 a.m.," Matera recalls. "I was working on a trauma patient with numerous, serious chest and abdomen stab wounds. He was 19 or 20 years old, and very large, weighing about 250 pounds. I had been talking to him, telling him what I was doing while trying to stabilize him and keep him alive. Suddenly he sat up and spun me around. He hit me in the back of the neck with his fist, rupturing a number of discs."
Despite the pain, Matera continued to treat his patient. Subsequently, he has had three surgeries to repair the damage to his back, the latest performed this summer finally easing the persistent pain. Two years ago, the American Medical Association awarded him its rare Medal of Valor for "courage under extraordinary circumstances in nonwartime situations."
Matera's story and similar tales are being repeated these days partly as a result of Sept. 11: Hospital administrators and health-care officials are examining whether medical facilities are equipped to cope with the consequences of terrorist acts. In the process, they have found that many lack the ability to protect their workers even in normal times -- much less in moments of chaos.
"Despite the increase in concerns about bioterrorist threats, respondents cited patient violence as the No. 1 threat to emergency-department personnel," reports a survey that asked emergency-room managers and other representatives from 50 hospitals about worker safety. The finding coincides with larger studies by the 154,229-member American Nurses Association (ANA). In its national, online survey of 4,826 nurses conducted in November, less than 20 percent said they felt safe in their "current working environment." Seventeen percent reported being assaulted physically in the last year, and more than half were threatened or abused verbally.
"More assaults occur in the health-care and social-services industries than in any other," states the largely ignored, voluntary Guidelines for Preventing Workplace Violence for Health Care Workers prepared by the Occupational Safety and Health Administration. The document points out that the incidence of violence is increasing, noting that between 1980 and 1990, 106 occupational violence-related deaths occurred among health-care workers including physicians, pharmacists, nurses and nurse's aides.
"The nursing staff at a psychiatric hospital sustained 16 assaults per 100 employees per year," according to the report. "This rate compares with 8.3 injuries of all types per 100 full-time workers in all industries and 14.2 per 100 full-time workers in the construction industry."
Officials of the ANA and the American College of Emergency Room Physicians, among others, say that about 80 percent of cursing, pushing, slapping, punching and throwing events go unreported. Some of the victims keep quiet because they consider such behavior normal job hazards. Others contend hospitals and hospital-management groups ignore their complaints and at times retaliate by firing them or transferring them to less desirable jobs. …