Doctors, Nurses Learn How to Treat Violent Situations

The class could easily be titled “What They Didn’t Teach You at Med School.”

Dr. Nagasamudra Ashok danced in a strange choreography of chokeholds, arm twists and escape moves for most of Thursday afternoon--all for the sake of improving emergency room safety.

Ashok, part of a group of 40 doctors and nurses, took slowly to a self-defense course that seemed to rub the Hippocratic oath the wrong way. They were learning how to protect themselves and others in violent situations in hospitals.

Unfortunately, the new course held at Anaheim General Hospital is one of many being conducted around the state for medical workers who increasingly find themselves the victims of violent attacks, say health care professionals.

“With the popularity of television’s ‘E.R.,’ people see hospitals in an idealized way,” said John C. Millen, a spokesman for Farmers Insurance Group, which sponsored the class. “It’s absolutely real for these people who live day to day with the threat of violence.”

The top-rated television show depicts the intense drama that unfolds in a large city emergency room.

Ashok, 42, and a 15-year emergency room veteran, has seen his share of kicks, slaps and punches.

“This class forces us to think in terms of managing a violent situation, which occur all too often. It helps prepare us for confrontations,” he said.

The course is aimed at satisfying a 1994 state law that requires hospitals to assess security and train nurses and other emergency room employees to identify problem patients and defuse situations.

The law was approved by the state Legislature in the wake of a 1993 shooting in which a 40-year-old Skid Row resident gunned down three doctors at Los Angeles County-USC Medical Center. The law also mandates hospitals to have security plans for dealing with armed intruders and protecting patients and staff by July of this year.

Nearly every participant had their own story about violence erupting in their emergency room--where the life-and-death atmosphere sends tensions soaring.

Don Chapman, who handles security at Anaheim General Hospital, recalled an attack about two years ago when an apparently passed-out youth suddenly cut a doctor and a nurse with a knife while laying flat on a gurney. Chapman 42, said the teen-age patient cut the workers with a four-inch blade when workers tried to take off his boot.

It was later found that the boot hid a stash of illegal drugs, said Chapman, who helped restrain the youth.

“We get quite a few druggies in here,” said Chapman, who has been at the Anaheim hospital for about three years.

Hospitals just seem to attract a violent and desperate people, say health care experts.

“They are the only place open 24 hours, seven days a week that has money, drugs and drug paraphernalia,” said class instructor Allan D. Morphett, a risk-management specialist with Farmers. “It can make them a magnet for serious trouble.”

Fortunately, extreme episodes are fairly unusual, even for an emergency room, say health experts. But they cite hospital surveys which show about 60% of staff, visitors or patients report violent acts over the course of a year.

Medical staffers are more accustomed to healing the wounded than injuring the healthy, even if they appear threatening. By training and disposition, medical workers are at a distinct disadvantage if a physical confrontation erupts.

“We have a professional responsibility to do no harm,” said instructor Jean Ruby Robinson, a registered nurse at UC Davis. “We teach techniques that don’t cause pain.”

Medical ethics prohibit highly effective defensive moves such as pinching, eye-gouging and groin kicks.

Instructors who praised medical workers for emergency heroics to save a patient, however, strongly advised against it in a violent situation. If someone gets violent, said instructors, it’s no time to be brave--run away.

“We are trying to give you ways to out of dangerous situations,” said Morphett. “Simply get out of there.”