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 II

Continuing from Part I.

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.

CMS spokeswoman Ellen Griffiths was careful not to extend the Lehigh Valley case into a national mandate for all hospitals. CMS, and any state agencies that act on CMS’s behalf, usually respond to complaints rather than actively inspecting hospitals for compliance with rules. But she did observe, as did a Pennsylvania Health Department spokeswoman, that the CMS rules strongly discourage use of weapons with patients. The rules state:

“CMS does not consider the use of weapons in the application of restraint or seclusion as a safe, appropriate health care intervention. For the purposes of this regulation, the term “weapon” includes, but is not limited to, pepper spray, mace, nightsticks, tazers, cattle prods, stun guns, and pistols. Security staff may carry weapons as allowed by hospital policy, and State and Federal law. However, the use of weapons by security staff is considered a law enforcement action, not a health care intervention. CMS does not support the use of weapons by any hospital staff as a means of subduing a patient in order to place that patient in restraint or seclusion. If a weapon is used by security or law enforcement personnel on a person in a hospital (patient, staff, or visitor) to protect people or hospital property from harm, we would expect the situation to be handled as a criminal activity and the perpetrator be placed in the custody of local law enforcement.”1[1]

Therefore, having a bunch of people wrestle with the patient, raising the heart rate, blood pressure, respiratory rate, intracranial pressure, et cetera even higher than they would be with the use of a TASER, is less harmful to the patient because this more dangerous practice is not classified as using a weapon.

Griffiths said CMS would not discuss whether hospital security should carry stun guns or other weapons because that is a “law enforcement” issue that falls outside CMS jurisdiction.[1]

This is entirely about CMS telling hospitals how to handle violent patients.

Dealing with violent patients is a patient care issue, even when law enforcement are needed to assist with managing the patient.

For the Pennsylvania Health Department to abandon these patients to law enforcement is not fair to those who treat violent patients in Pennsylvania.

For the Pennsylvania Health Department to abandon these patients to law enforcement is not fair to violent patients in Pennsylvania.

This may come as news to CMS spokeswoman Ellen Griffiths but –

Not all violent patients are criminals.

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 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. Only tangentially related to this topic, but couldn’t find a post more appropriate to this thought. What about the idea of personal liability/medical malpractice insurance for the individual EMS provider, carried by said provider whether or not their employer already provides that for them. Thoughts? Could be an interesting conversation.

    • Can’t say, clowns will eat me,

      Only tangentially related to this topic, but couldn’t find a post more appropriate to this thought. What about the idea of personal liability/medical malpractice insurance for the individual EMS provider, carried by said provider whether or not their employer already provides that for them. Thoughts? Could be an interesting conversation.

      It is an excellent idea.

      the liability insurance allows us to protect ourselves from being thrown under the bus – not that that would ever happen in EMS. 😉

  2. Rouge,

    I used to work hospital security as a “side job”. I got paid at least as well as an ER tech and it was fun, at times.

    We carried OC (Pepper) Spray and handcuffs. Our policy was that if we had to use them, it became a police matter, with LEO’s responding to take a report and likely take custody of the prisoner.

    At times, handcuffs were used for immediate restraint of a patient that was a threat to staff, but only until leathers could be placed.

    I don’t think Tasing combative patients for the intent of getting them into restraints is OK – however, Tasing a patient that is a threat to staff, especially if they’ve already committed a battery to a staff member, Tase their ass and restrain them – and encourage staff to file criminal complaints.

    DT4EMS.org has some shocking facts about frequency of attacks by patients in healthcare. It happens far too often. I know I was last assaulted a week ago, by a drunk patient going to a trauma center as a rule-out head injury. I was punched in the shoulder as he fought to get off the backboard (yeah, ’cause backboards do any good anyway) We shrug it off, but should we?

    • Jon Blatman,

      Rouge,

      I used to work hospital security as a “side job”. I got paid at least as well as an ER tech and it was fun, at times.

      We carried OC (Pepper) Spray and handcuffs. Our policy was that if we had to use them, it became a police matter, with LEO’s responding to take a report and likely take custody of the prisoner.

      That should depend on an assessment of the patient/prisoner.

      One of my friends had an on-the-job head injury, working as a medic. while he was being treated, he became violent. Ordinarily, he is one of the quietest, most polite people I know. Sometimes illness/injury changes who we are or how we perceive the world. that does not automatically mean that the person is a criminal, or that the person has no responsibility for his actions.

      We need to consider cases individually. A violent diabetic is not going to improve by being locked in a cell. He is going to improve when his blood sugar problems are treated.

      At times, handcuffs were used for immediate restraint of a patient that was a threat to staff, but only until leathers could be placed.

      Yes.

      I don’t think Tasing combative patients for the intent of getting them into restraints is OK – however, Tasing a patient that is a threat to staff, especially if they’ve already committed a battery to a staff member, Tase their ass and restrain them – and encourage staff to file criminal complaints.

      It may be the most practical means to restrain the patient.

      Safest for staff, safest for other patients, and safest for the violent patient.

      DT4EMS.org has some shocking facts about frequency of attacks by patients in healthcare. It happens far too often. I know I was last assaulted a week ago, by a drunk patient going to a trauma center as a rule-out head injury. I was punched in the shoulder as he fought to get off the backboard (yeah, ’cause backboards do any good anyway) We shrug it off, but should we?

      We need to be able to protect ourselves. One of the ways is through aggressive standing orders for heavy sedation. Oddly enough, this may be something the administrators agree with me about. Maybe.

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