Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates – Part I

There is an interesting article in Annals of Emergency Medicine about contradictory rules from conflicting agencies that affect patient care.

One emergency department (ED) gets cited by a federal agency for using stun guns to subdue violent patients. Another is fined for failing to provide a safe workplace. It is a federal catch-22, leaving ED administrators caught between seemingly contradictory mandates from federal bureaucratic silos.[1]

Different agencies.

Different rules.

No communication.

Faulty logic.

If those of us taking care of patients were guilty of the same errors, we would expect to be fined, or shut down, although probably not for faulty logic.

Yet, when those who regulate us are guilty of these errors, we are expected to satisfy all of their demands and be grateful for the abuse attention.

Dr. Kane has the sense that violence in hospitals is getting worse. Statistics back up her perception. ED visits resulting in violence increased from 16,277 to 21,406 between 2005 and 2008, nearly a one-third increase, according to the federal Substance Abuse and Mental Health Services Administration. Visits to the ED for drug- and alcohol-related incidents increased during that time from 1.6 million to 2 million.[1]

Do the federal, or state, regulatory agencies feel the need to do something to protect those taking care of the patients or to help those taking care of the patients to protect their patients?

No. These regulatory agencies just create more responsibilities for others. These regulatory agencies do not have any responsibility for the damage they cause.

The mayhem is having an influence on hospital staff. More than half of ED nurses are victims of physical or verbal abuse at work in a given week, according to a survey by the Emergency Nurses Association released in September 2010.[1]

CMS’s actions in Pennsylvania raise a question: Should all hospitals that must comply with CMS regulations stop using stun guns? According to a survey in Campus Safety Magazine, 26% of hospital security officers carry “less-lethal” weapons such as neuromuscular incapacitating devices (stun guns made by Taser International), 7% carry handguns, and 13% carry both.[1]

CMS is the Centers for Medicare & Medicaid Services.

In Pennsylvania, the use of TASERs on patients is not considered to be acceptable, because these weapons act by neuromuscular incapacitation. On the other hand, doctors may use paralytics, which are medicines that cause neuromuscular incapacitation, and that neuromuscular incapacitation is considered a treatment, rather than a weapon.

Anything can be a weapon. All that matters is the way that it is used.

Pretty much the same can be said for treatments.

Botulism is extremely poisonous WMD (Weapon of Mass Destruction), but it can be used as a treatment. Ditto radiation.

Just because something is generally perceived as a weapon does not mean that its use is always harmful.

The TASER can be an effective means of protecting patients, but this is something that the regulators do not seem to be capable of understanding in their overly simplistic view of the way the world works.

I also wrote about the problems with violent patients in MedicCast – EMS and Health Care Workplace Violence on Federal Radar. Jamie Davie discussed this in the podcast EMS and Health Care Workplace Violence on Federal Radar.

To be continued in Part II and later in Part III.

Footnotes:

[1] Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates
by Jan Greene
Annals of Emergency Medicine
Volume 57, Issue 4 , Pages A20-A23, April 2011

Free Full Text from Annals of Emergency Medicine                 Free PDF from Annals of Emergency Medicine

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Comments

  1. The easiest, and in my opinion answer is to get rid of both federal agencies and let state or local officials make the determination of how best to deal with this issue.

    Then again, I’m a radical.

    • Too old To Work,

      The easiest, and in my opinion answer is to get rid of both federal agencies and let state or local officials make the determination of how best to deal with this issue.

      I don’t see the state as being any more reasonable, or less bureaucratic, than the federal regulators. This did come from Pennsylvania, although an interpretation of federal rules by Pennsylvania.

      Then again, I’m a radical.

      When thinking for ourselves is radical, we are in trouble.

      We have been in trouble for a long time.

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