Viewpoint (2018)

violence: violenceI am now retired from a career in emergency medicine that spanned almost five decades, but back then I had the opportunity to lecture to family practice residents on a variety of topics, including preparing for emergencies in their offices. My advice was to prepare them to handle the basics, and stock necessary medications, IV equipment, intubation or at least bag and mask apparatus, and the basics needed to deal with violent trauma. I pointed out that these situations would probably arise infrequently and that perhaps the most important thing was to have a clear plan for expeditious transfer to a facility prepared to deal with these emergencies daily. I advised those family practitioners that if these situations did arise frequently, they ought to consider moving their office to a different location. We can't move the emergency department, and if we try, the trauma will follow us. That is our job. We are now and have been for many years prepared to deal with the kind of threat and violence that seems to be increasingly frequent in our country. No other specialty in medicine faces the situation that exists every day in the emergency department. When I went to work in the ED, I expected to see victims of car crashes and gunshot and knife wounds—and aggressive, violent patients. That was my turf. The aggression was often the result of psychiatric problems or of drug or alcohol intoxication, but that didn't make it any less dangerous. It was part of my turf. My department was prepared to deal with it and did so expeditiously, as do so many other EDs across the country. It is a situation we all hope to eliminate, but for now we are dealing with it. One of the problems I see in this country is that we seem unable to learn from others' solutions. Other industrialized nations have addressed health care, immigration, and gun violence, but we seem unable or unwilling to learn from their experiences and adopt their solutions. Other countries have dealt successfully with the epidemic of gun violence this country now faces, but so have we in one place: our emergency departments. We as a nation could learn from this successful approach. My department did not arm the doctors or nurses any more than they expected me to do my own CT scans or code for services delivered. That was not my job. My department, as with most EDs I know, had armed professionals to deal with the violent patients (or occasional violent family members). That was their job, and they did it well. They did it, I hasten to emphasize, better than I could. If the parallel is being missed, I will state it as plainly as I can: Arming teachers is no more a solution than arming doctors and nurses. Professionally trained and equipped personnel have been successful in a far more dangerous environment. We should all learn from this experience. As for the larger problem, I do not think we should ask our first responders—police, firefighters, or EMTs—to face military weapons while fulfilling the responsibilities of their jobs, even if that policy requires an adjustment in our national attitude toward the availability of military weapons and the consequent surrendering of some of our personal freedom to possess such weapons. Citizens in other countries are willing to make that sacrifice. I hope the citizens of this great nation will one day be willing to do the same. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].