Tag Archives: hospitals

De-escalating Violence

New Orleans   Getting more experience in hospital emergency and waiting rooms is on no one’s top ten list, but, trust me, you do the time and this comes with the territory.  If you can call it luck, it’s not you personally, though the anger and aggravation when it is family is every bit as bad. People are unhappy, scared, nervous and more.  Voices are raised.  Fists are slammed on counters.  Guards are around.  Sometime police are in and out.  Sirens are blaring outside.  Receptionists know little and say less.  Medical personnel are over worked and understaffed.  Come to think of it, the possibility, if not the prospect, of violence breaking out is ever present.  Reading a piece in The New York Times by Douglas Starr on the ways that medical personnel have learned to de-escalate volatile situations and what police can learn from them and vice versa suddenly resonated with me as an, “Oh, yeah!” moment, because it seemed so obvious and so right.

Let’s admit though from the very beginning that there are big differences from the streets to hospital sheets.  The biggest is that not everyone on one side is armed and possibly everyone on both sides are fully strapped.  That fear and uncertainty undoubtedly moves many a trigger finger.

Nonetheless, if medical staff who unarmed and are not allowed to “attack, shoot or otherwise harm patients” can learn techniques to defuse tense situations, so can police.  Compared to other professions they “report nonfatal violence-related injuries at many times the rate of other occupations including law enforcement” even though police have higher rates of fatalities which is another way of saying that they find themselves in tense and potentially violent situations but have been trained and have created a culture to contain violence.

Ironically, Starr’s examples come from tips they gained from police themselves as well as veterans hospitals that deal with the military in often traumatic situations.  Part of it is reading “body language” and creating a “reactionary space” that allows the health worker to respond, but a lot of it starts with taking a step back to realistically assess the situation in a “tactical pause” without firing first, so to speak, as many policemen seem prone to do.  The rules matter, but so does the person’s humanity. Makes sense.

Other common sense tips were helpful.  Never say “calm down” or “its policy” or refer to something as their “problem,” but to look for a collective solution.  Never point a finger was another great tip.  One that would help all doorknockers on home visits in dealing with a situation that turns uncomfortable or frightening by teaching a person to say, “Let me get right back to you because I need to go get a Form 9.”  There was no Form 9.  Substitute a flyer or survey or petition or anything that changes the space.

The piece notes that seventeen states passed laws mandating de-escalation training for police and some city police shops have acted on their own, some in response to the Ferguson shootings.  Change could be hard, he notes, with 18,000 police departments and no centralized policy making body for police, but Starr ends with the revolutionary notion that police, like doctors, should adopt a policy of doing “no harm.”

What a relief it would be for the rest of us if our dealings with police could be based on an assumption that they meant us no harm, so that we could unlearn the reality now which is an expectation of the opposite.

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Can Hospitals Afford NOT to Be Ready for Disaster?

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Baton Rouge   The headline caught my eye. Sheri Fink, author of what has to be the definitive case study of a hospital in crisis post-Katrina, the award-winning Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, had written an op-ed piece in the Times entitled, “Can Hospitals Afford to Be Ready for Disaster.” You can probably already see my head scratching. I had written a book about Katrina myself, The Battle for the Ninth Ward: ACORN, Rebuilding New Orleans, and the Lessons for Disaster. The one lesson I felt confident of was that we finally had a national, and certainly a community, consensus that we had to be ready for disaster, so for me the question was really, “Can Hospitals Afford NOT to be Ready for Disaster?”

The issue was an important one that is now lost in the bureaucratic maze. The Bush Administration started the wheels turning in 2007 post-Katrina and the Obama Administration proposed a draft for public comment in 2013. The language is stuck now in legal review at the Office of Management and Budget (OMB) on an extension of a 90-day legal review. The whole rule though is on a 3-year timetable, so if not finalized, we’re left with nothing.

You might say, “…but that can’t happen here.” We’ve had Katrina, Sandy Hook, Ebola, and now Zika all highlighting the need for disaster preparedness and, worse, proving over and over again how few health care facilities are ready and able. Please remember the Katrina situation involved nursing homes so unprepared for evacuation that many elderly were trapped and drowned. Memorial Hospital, the old Baptist facility, was in such a crisis mode as Fink has documented that “two desperate doctors later said that they hastened the death of patients who had waited days in the heat for rescue.” Reading the book, there was little doubt that many of these patients would have had years left to live had there been a different set of responses.

The rule would change much of those worries. It would affect 68,000 providers across the whole range of the health care industry and not just hospitals and nursing homes but kidney dialysis centers, mental health facilities, home health and the whole shebang.

So, this is a no-brainer, right? Well, it should be but you’ve already probably guessed that it would be if we had a public health system, but with a private dominated healthcare system if administrators can avoid spending the money, then emergency preparedness is at the bottom of the list. Fink even noted that there are 250 California hospitals that have still not been “retrofitted, replaced, or removed from service” 45 years after the Sylmar earthquake killed dozens at California hospitals. A professor in Maryland noted that an administrator was probably calculating that if they had to spend a couple of hundred thousand and they never had a disaster, then they lost revenue. This is topsy-turvy of course. You spend to prepare, while hoping you never have to meet a disaster. The same prof though noted that if the facility spent the money and faced a disaster and were ready, they would make a killing, but “how do you do a budget analysis on that?” Wow! The warped priorities here just takes your breath away, and where is Senator Charles Grassley from Iowa when we need him reminding so many of these facilities that they are tax exempt so why is “making a killing” a priority anyway!

We need this rule and probably a lot more. Time to Boy Scout up and get in touch with your Senators and Congressmen to reach out to the OMB and the Department of Health and Human Services and remind them that “Be Prepared” is not just a slogan, but a lifesaver!

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