IAHSS 40th ANNUAL GENERAL MEETING

“The Emergency Department – What Keeps Us Awake at Night”
INTERNATIONAL ASSOCIATION OF
HEALTHCARE SECURITY AND SAFETY
www.iahss.org
AGENDA
 Overview of what keeps us awake at night
 Crisis and Mental Health Areas
 Victims of Violence
 The Police Relationship
 Weapons
 Workplace Violence
 The Triaging Process
St. Joseph’s Health Centre
EMERGENCY MENTAL HEALTH
What are the challenges that Emergency
Mental Health poses to Security?
RESOURCES
 Staffing levels
 Response expectations
 Skill sets of staff
 Cost for patient watches/clinical observations
 Physical layout and limitations
SECURITY’S TYPICAL MONTH
TRAINING
 Is the provided training adequate?
 Lack of collaborative training
 Various types of restraint applications (stretchers and restraints)
 Reporting
CAPACITY
 Overcrowding
 People being brought in from outside of our catchment area
 Delays in patients being transferred to inpatient units
 Patient dynamics
SUGGESTED STRATEGIES
Resources
 Statistical analysis of incidents/responses to ED to support required
resources
 Clear roles and responsibilities
 Regularly scheduled meetings with Security, ED and Crisis
 Security involvement in redevelopment of ED
SUGGESTED STRATEGIES
Training
 Engage suppliers for restraint training on all types of restraints as well as
their application on stretchers and beds.
 Joint training for staff from three key areas.
1.
Security
2.
Emergency Department
3.
Mental Health
 Collaborative response to incidents
SUGGESTED STRATEGIES
Capacity
 Document incidents of overcrowding and share with key decision
makers
 Communicate with clinical teams regularly to update status of patients
 Raise the flag of concern for patients who are escalating after long stays
St. Michael’s Hospital
VICTIMS OF VIOLENCE AND THE MEDIA
 Reporting of the location of victims of violence by the media
 Is this information really necessary for public consumption and does it
place our patients and healthcare workers at risk
 Staff concerns over personal safety when dealing with victims of
violence and their families
THE POLICE RELATIONSHIP
 Police and staff relationships during the treatment of a victim of
violence.
 Privacy concerns and the handling of evidence.
WEAPONS
 Weapons are frequently found on patients registering in the ED
 Toronto Police have confirmed that knives are routinely carried by the
homeless as a method of self protection
 Emergency departments in Ontario are not equipped or staffed to have
belongings checked before entering
 No consistency in searching mental health patients
SUGGESTED STRATEGIES
Victims of Violence and the Media
 Have Hospital PR departments work together to approach media
The Police Relationship
 Establish working groups with law enforcement agencies and where possible adopt letters
of understanding
 Ensure there are clear guidelines for dealing with law enforcement
Weapons
 Training for all ED staff in regards to identifying suspects

Protocols for searching patients
University Health Network
WORKPLACE VIOLENCE
 When violence erupts in a healthcare facility, the
consequences are many and unpredictable. Injury or death
of building occupants, lawsuits, property damage, and
diminished patient, staff, and community trust in the facility
are a few possible consequences.
 It is impossible to eliminate workplace violence in
healthcare settings; however, there are ways to reduce the
potential for violent occurrences and minimize the impact
of any violent situation that may arise
APPROACH
Mitigation/Prevention
Preparedness
Visible security presence
Violence awareness
Design
Risk Assessment
Written plans
Education / Training
Exercises
Recovery
Response
Treatment of injuries
De-briefing
Reporting
EAP
5555 / Panic alarm
Activation of Plan
Notification protocols
Police
DESIGN
RECOVERY
POLICY/PROCEDURE
RESPONSE
EDUCATION/TRAINING
INCIDENT
RISK CONSIDERATIONS
 Areas with higher frequency of violence or aggression
 Isolated areas
 Areas with lower staffing levels
 Areas with wandering patients
 Areas that provide sensitive services
 Emergency/Pediatrics/newborn areas
 Retail operations
 Areas storing narcotics, valuable assets etc.
 Areas in the hospital that mirror community violence threats
 Contraband items
KEY COMPONENTS
WHEN TO CALL THE POLICE
 Whenever there is a real or perceived threat that lives are in danger.
 When the initial staff or the Code White team determines the situation
is beyond their abilities.
 Whenever a weapon or firearm is involved.
 When the aggressive behavior occurs outside the limits of pursuit
established by the organization (e.g. off the hospital grounds).
 When the aggressor is not a client and threatens staff and client safety
and other means of intervention are not available.
 When any staff member requests it.
KEY COMPONENTS
SPECIFY RECOVERY STEPS
 Support for staff
 Debrief the incident
 Gap analysis
 Documentation
EDUCATION AND TRAINING
 Legal and ethical issues
 Code White Team composition
 Code White Team member roles and responsibilities
 Code White Team intervention procedures
 Personal safety techniques
EDUCATION AND TRAINING
 Prevention and management techniques for aggression
 Crisis communication techniques
 Use of restraints and transport techniques
 Authority for use of force
 Mental Health Act
MINISTRY OF LABOUR
HI, I’M TODD…
NOT ONLY AM I A
SENIOR MANAGER OF
SECURITY,
I’M ALSO A MINISTRY OF
LABOUR SURVIVOR
MINISTRY OF LABOUR
 Everyone should be able to work without fear of
violence in a safe and healthy workplace
 Violence in the workplace is not tolerated in
Ontario
 Everyone in a workplace has a role to play in
ensuring it is a place that is safe, healthy and
violence-free
Ministry of Labour Website
TRIGGERS
 Occurrence of incidents of workplace violence
 Worker complaints
 Safe at Work Ontario: Inspection Blitzes
RISK ASSESSMENTS
Employers must conduct risk assessments and communicate
results to Joint Health and Safety Committee.
Must be based on both:
1) circumstances specific to subject workplace, and
2) circumstances common to similar workplaces
 Written copies must be provided to workers
 Periodic re-assessment required
INFORMATION AND TRAINING
Employer must supply workers with information/instruction
on:
1) Policy and program
2) Persons with history of violent behavior if:
 Worker is likely to encounter person
 Risk of workplace violence likely to expose worker
to physical injury
SUGGESTED STRATEGIES
 Relational Security
 Procedural Security
 Physical Security
TRIAGE PROCESS
 Lack of understanding of process
 Delays result in agitation
SUGGESTED STRATEGIES
 Constant contact with staff
 Separate waiting rooms
How Can We Help Protect Our ED
Portable Panic Buttons
Fixed Panic Buttons
Triage Process
Access control
Environmental conditions
Lighting
Multidisciplinary team training
REFERENCES
 GUIDELINES: CODE WHITE RESPONSE-A Component of Prevention
and Management of Aggressive Behavior in Healthcare – WorkSafe BC ,
Health Association of BC, Occupational Health and Safety Agency for
Healthcare in BC
 IAHSS – Healthcare Security Industry Guidelines
 UHN Health and Safety Supervisory training
QUESTIONS?
Noreen Jivraj, CHPA
Manager, Emergency Planning and Security Services
St. Joseph’s Health Centre
Paul Greenwood, CHPA
Manager, Security, Safety and Emergency Planning
St. Michael’s Hospital
Todd Milne, CHPA
Senior Manager, Security Operations
University Health Network