The Journal of Emergency Medicine, Vol. 49, No. 3, pp. 355–358, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2015.04.020
Violence: Recognition, Management and Prevention
WEAPONS RETRIEVED AFTER THE IMPLEMENTATION OF EMERGENCY DEPARTMENT METAL DETECTION S. Terez Malka, MD,* Robin Chisholm, PHD,† Marla Doehring, MD,‡ and Carey Chisholm, MD‡ *Department of Emergency Medicine, Department of Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, †Department of Medical Informatics, Indiana University School of Medicine, Indianapolis, Indiana, and ‡Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana Reprint Address: S. Terez Malka, MD, Department of Emergency Medicine, Department of Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28203
, Abstract—Background: Several high-profile violent incidents have occurred within emergency departments (EDs). There are no recent studies reporting the effectiveness of ED metal detection. Objective: Our aim was to assess the effect of metal detection on ED weapons retrieval. Methods: In September 2011, a metal detector was installed at the entrance of an urban, high-volume teaching hospital ED. The security company recorded retrieved firearms, knives, chemical sprays, and other weapons. We performed qualitative analysis of weapons retrieval data for a 26month period. Results: A total of 5877 weapons were retrieved, an average of 218 per month: 268 firearms, 4842 knives, 512 chemical sprays, and 275 other weapons, such as brass knuckles, stun guns, and box cutters. The number of retrieved guns decreased from 2012 to 2013 (from 182 to 47), despite an increase in metal detection hours from 8 h per day to 16 h per day. The number of retrieved knives, chemical sprays, and other weapons increased. Recovered knives increased from 2062 in 2012 to 2222 in 2013, chemical sprays increased from 170 to 305, and other weapons increased from 51 to 201. Conclusions: A large number of weapons were retrieved after the initiation of metal detection in the ED entrance. Increasing hours of metal detection increased the number of retrieved knives, chemical sprays, and other weapons. Retrieved firearms decreased after increasing metal detection hours.
Metal detection in the ED entrance is effective in reducing entrance of weapons into the ED. Metal detectors may offer additional benefit in reducing attempts to enter with firearms. Ó 2015 Elsevier Inc. , Keywords—operations; violence; weapons; patient safety; employee safety; administration
INTRODUCTION There have been several high-profile acts of violence involving deadly weapons in United States (US) emergency departments (EDs) within the past decade (1–5). A 2012 Crime and Security Trends Survey reported a 37% increase in violent crime within health care organizations from 2010 to 2012 (5). The International Association for Healthcare Security reported in 2010 that the greatest number of physical assaults against health care providers occurred in EDs (1). A 2011 survey of ED physicians confirmed the high prevalence of assault, reporting that 78% had experienced at least one act of violence within the workplace (6). Metal detectors are commonplace in public venues, such as stadiums, airports, museums, government facilities, and even schools. Some hospitals have been reluctant to implement use of metal detectors. In an era of budget restrictions, the cost benefit of metal detection is
Poster Presentation, Society of Academic Emergency Medicine Annual Meeting, Dallas, TX May 16, 2014.
RECEIVED: 27 February 2015; ACCEPTED: 16 April 2015 355
356
S. T. Malka et al.
not clear and may represent a significant expense. In addition, hospital administrators may fear that implementing metal detection represents negative profiling of patients and may be off-putting to visitors (7). In fact, in 2013, Los Angeles County opted to remove metal detectors from several of their hospitals in order to make the hospitals more ‘‘appealing to patients’’ (8). Data, however, suggest that the public is amenable to the presence of metal detectors. Several studies have explored attitudes toward metal detectors and found that patients, families, and hospital staff have generally positive perceptions of the use of metal detection in the ED, citing increased feelings of safety and security as positive effects (7–10). Despite this, less than half of surveyed physicians in 2011 reported working at an ED with metal detectors (6). It is also difficult to prove the efficacy of metal detection in retrieving dangerous weapons and preventing violent assault. To date, there are only two published studies exploring the efficacy of metal detectors for retrieving weapons in the ED, and none within the past decade (10,11). Our goal is to assess the effect of metal detection on preventing weapon entry into an urban ED.
and other potentially dangerous metal objects (such as box cutters and crowbars). Metal detection was initially available 8 h per day in 2011 and 2012 and increased to 16 h per day in 2013. We analyzed weapons retrieval data and trends for a 26-month period and compared weapon retrieval between 2012 and 2013. RESULTS A total of 5877 weapons were retrieved during this 26-month period, for an average of 218 per month. This includes 268 firearms (4.6%), 4842 knives (82%), 512 chemical sprays (8.7%), and 275 other potential weapons, such as brass knuckles, stun guns, and box cutters (4.7%) (Table 1). The number of retrieved guns decreased from 2012 to 2013 (from 182 to 47; p < 0.001). Conversely, the number of retrieved knives, chemical sprays, and other potential weapons increased. Retrieved knives increased from 2062 to 2222 (p = 0.002), chemical sprays increased from 170 to 305 (p < 0.001), and other potential weapons increased from 51 to 201 (p < 0.001) (Figures 1 and 2). DISCUSSION
METHODS We performed a retrospective review of security records for a 26-month period from September 2011 to December 2013. In September 2011, a metal detector and ‘‘no weapons’’ signage were installed in the entrance of an urban private community teaching hospital ED (110,000 visits/year) located in the Midwest. This ED is a Level 1 trauma center serving adult and pediatric patients. All ambulatory patients are screened on entrance to the ED registration area via an arch-style walk-through metal detector staffed by security personnel. Patients arriving by ambulance or helicopter are excluded from metal detection. Hospital employees wearing hospital attire or displaying a hospital badge are also excluded from screening. The security company recorded all retrieved metallic weapons including firearms, knives, chemical sprays,
A significant number of weapons were retrieved after the installation of metal detectors and security personnel in the ED entrance. This suggests that a significant number of concealed weapons were present in the ED before the installation of metal detectors. This number underestimates the total number of potential weapons entering the ED as ambulance patients were not screened and metal detection was not available 24 h per day during the observed time period. Additionally, security reported anecdotally that it was not unusual to see people begin to enter the building and then turn around after seeing the metal detection system. Some of these people may have harbored weapons that otherwise would have accompanied them into the ED. Hospital maintenance personnel also reported finding discarded weapons in the landscaping outside of the ED after the initiation of metal detection.
Table 1. Weapons Retrieved per Study Period 2011 2012
Firearms Knives Chemical spray Other SD = standard deviation.
Significant D
2013
Min
Max
Mean (SD)
Min
Max
Mean (SD)
p Value
7 113 3 0
22 208 24 16
13.8 (4.4) 163.8 (27.1) 12.9 (5.2) 4.6 (4.0)
0 146 12 7
8 244 45 32
4.3 (2.8) 202.0 (30.6) 27.7 (8.2) 18.2 (8.2)
< 0.001 0.002 < 0.001 < 0.001
ED Metal Detection
357
on violent events within the ED was not studied. The data do suggest that metal detection in the ED entrance can play a role, along with other security measures, in reducing the entrance of potentially deadly weapons to the ED. It is possible that the presence of metal detection and security personnel may have an additional benefit of discouraging patients and visitors from attempting to enter with firearms. It is unclear if this impacts overall hospital campus safety, as weapons can simply be stored or hidden outside the entrance, or transferred between potential visitors. Figure 1. Weapon retrieval by month. ED = emergency department.
While overall weapon retrieval increased when metal detection hours doubled in 2013, the number of retrieved guns decreased. This is possibly due to increased visibility of the metal detectors and signs and growing awareness of the presence of security. The increase in other weapons retrieved is concordant with increased metal detection hours and suggests a logical direct correlation between metal detection hours and weapons retrieval. Operation of metal detection services incurs additional expense for hospitals that might be already struggling with budget shortages. These expenses should be weighed against the potential bad publicity accompanying a weapons-related event in their ED, as well as the legal expenses accompanying the injury or death of an ED employee not protected by such a system. Limitations Limitations to this study include the presence of other potential entrances to the ED, the limited metal detection hours, and the fact that ambulance patients are excluded from screening. In addition, the impact of metal detection
Figure 2. Firearm and knife retrieval 2012 to 2013 (knives are divided by 10 for the chart).
CONCLUSIONS The implementation of ED entrance metal detection resulted in recovery of a large number of weapons and potential weapons despite limited hours of operation. Retrieval of firearms decreased with increased hours of metal detection and overall weapon retrieval increased with increased metal detection hours. REFERENCES 1. Griffin J. Healthcare facilities see rising crime rates. Security Info Watch website. 2013. Available at: http://www.securityinfowatch. com/article/10863653/%20%20http:/bjs.ojp.usdoj.gov/content/ pub/press/cv11pr.cfm. Accessed June 7, 2014. 2. Associated Press. Man with gun shot by police at Utah hospital emergency room. Huffington Post website. 2014. Available at: http://www.huffingtonpost.com/2014/05/16/utah-hospitalshooting_n_5338268.html. Accessed June 7, 2014. 3. Bryan C. Cops: man fatally shoots himself inside lobby of hospital emergency room in Woodbury. CBS Philadelphia website. 2014. Available at: http://philadelphia.cbslocal.com/2014/03/20/crewsresponding-to-shooting-incident-at-south-jersey-hospital/. Accessed June 7, 2014. 4. Park M. Bitten, shot, spat on: violence in hospitals common for staff. CNN website. 2010. Available at: http://www.cnn.com/ 2010/HEALTH/09/16/hospital.violence.hopkins/. Accessed June 7, 2014. 5. Blades M. The workplace violence epidemic. Security Info Watch website. 2012. Available at: http://www.securityinfowatch.com/ article/10653412/the-workplace-violence-epidemic. Accessed June 7, 2014. 6. Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 2011;40:565–79. 7. Meyer T, Wrenn K, Wright SW, Glaser J, Slovis CM. Attitudes toward the use of a metal detector in an urban emergency department. Ann Emerg Med 1997;29:621–4. 8. Gorman A. L.A. County removing metal detectors from some hospital facilities. Los Angeles Times website. 2013. Available at: http://articles.latimes.com/2013/feb/03/local/la-me-metaldetectors-20130203. Accessed June 7, 2014. 9. Mattox EA, Wright SW, Bracikowski AC. Metal detectors in the pediatric emergency department: patron attitudes and national prevalence. Pediatr Emerg Care 2000;16:163–5. 10. Simon HK, Khan NS, Delgado CA. Weapons detection at two urban hospitals. Pediatr Emerg Care 2003;19:248–51. 11. Rankins RC, Hendy GW. Effect of a security system on violent incidents and hidden weapons in an emergency department. Ann Emerg Med 1999;33:676–9.
358
S. T. Malka et al.
ARTICLE SUMMARY 1. Why is this topic important? There have been several high-profile events of violence toward emergency department (ED) employees and patients involving weapons. Metal detection in ED entrances may ameliorate the risk of violent attacks involving deadly weapons. 2. What does this study attempt to show? This study attempts to demonstrate the numbers of patients and visitors entering the ED with potentially deadly weapons. We also wanted to explore the effectiveness of metal detection in preventing the entrance of weapons into the ED. 3. What are the key findings? We found that a large number of patients and visitors were attempting to enter the ED carrying deadly weapons, including knives and guns. ED metal detection was successful in retrieving thousands of potentially deadly weapons and preventing their entrance to the ED. 4. How is patient care impacted? The ED should be a safe haven for both patients and staff members. Metal detectors can play a role in ensuring the safety of patients and care providers by preventing the entrance of deadly weapons to the ED.
http://dx.doi.org/10.1016/j.jemermed.2015.04.020
Violence: Recognition, Management and Prevention
WEAPONS RETRIEVED AFTER THE IMPLEMENTATION OF EMERGENCY DEPARTMENT METAL DETECTION S. Terez Malka, MD,* Robin Chisholm, PHD,† Marla Doehring, MD,‡ and Carey Chisholm, MD‡ *Department of Emergency Medicine, Department of Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, †Department of Medical Informatics, Indiana University School of Medicine, Indianapolis, Indiana, and ‡Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana Reprint Address: S. Terez Malka, MD, Department of Emergency Medicine, Department of Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28203
, Abstract—Background: Several high-profile violent incidents have occurred within emergency departments (EDs). There are no recent studies reporting the effectiveness of ED metal detection. Objective: Our aim was to assess the effect of metal detection on ED weapons retrieval. Methods: In September 2011, a metal detector was installed at the entrance of an urban, high-volume teaching hospital ED. The security company recorded retrieved firearms, knives, chemical sprays, and other weapons. We performed qualitative analysis of weapons retrieval data for a 26month period. Results: A total of 5877 weapons were retrieved, an average of 218 per month: 268 firearms, 4842 knives, 512 chemical sprays, and 275 other weapons, such as brass knuckles, stun guns, and box cutters. The number of retrieved guns decreased from 2012 to 2013 (from 182 to 47), despite an increase in metal detection hours from 8 h per day to 16 h per day. The number of retrieved knives, chemical sprays, and other weapons increased. Recovered knives increased from 2062 in 2012 to 2222 in 2013, chemical sprays increased from 170 to 305, and other weapons increased from 51 to 201. Conclusions: A large number of weapons were retrieved after the initiation of metal detection in the ED entrance. Increasing hours of metal detection increased the number of retrieved knives, chemical sprays, and other weapons. Retrieved firearms decreased after increasing metal detection hours.
Metal detection in the ED entrance is effective in reducing entrance of weapons into the ED. Metal detectors may offer additional benefit in reducing attempts to enter with firearms. Ó 2015 Elsevier Inc. , Keywords—operations; violence; weapons; patient safety; employee safety; administration
INTRODUCTION There have been several high-profile acts of violence involving deadly weapons in United States (US) emergency departments (EDs) within the past decade (1–5). A 2012 Crime and Security Trends Survey reported a 37% increase in violent crime within health care organizations from 2010 to 2012 (5). The International Association for Healthcare Security reported in 2010 that the greatest number of physical assaults against health care providers occurred in EDs (1). A 2011 survey of ED physicians confirmed the high prevalence of assault, reporting that 78% had experienced at least one act of violence within the workplace (6). Metal detectors are commonplace in public venues, such as stadiums, airports, museums, government facilities, and even schools. Some hospitals have been reluctant to implement use of metal detectors. In an era of budget restrictions, the cost benefit of metal detection is
Poster Presentation, Society of Academic Emergency Medicine Annual Meeting, Dallas, TX May 16, 2014.
RECEIVED: 27 February 2015; ACCEPTED: 16 April 2015 355
356
S. T. Malka et al.
not clear and may represent a significant expense. In addition, hospital administrators may fear that implementing metal detection represents negative profiling of patients and may be off-putting to visitors (7). In fact, in 2013, Los Angeles County opted to remove metal detectors from several of their hospitals in order to make the hospitals more ‘‘appealing to patients’’ (8). Data, however, suggest that the public is amenable to the presence of metal detectors. Several studies have explored attitudes toward metal detectors and found that patients, families, and hospital staff have generally positive perceptions of the use of metal detection in the ED, citing increased feelings of safety and security as positive effects (7–10). Despite this, less than half of surveyed physicians in 2011 reported working at an ED with metal detectors (6). It is also difficult to prove the efficacy of metal detection in retrieving dangerous weapons and preventing violent assault. To date, there are only two published studies exploring the efficacy of metal detectors for retrieving weapons in the ED, and none within the past decade (10,11). Our goal is to assess the effect of metal detection on preventing weapon entry into an urban ED.
and other potentially dangerous metal objects (such as box cutters and crowbars). Metal detection was initially available 8 h per day in 2011 and 2012 and increased to 16 h per day in 2013. We analyzed weapons retrieval data and trends for a 26-month period and compared weapon retrieval between 2012 and 2013. RESULTS A total of 5877 weapons were retrieved during this 26-month period, for an average of 218 per month. This includes 268 firearms (4.6%), 4842 knives (82%), 512 chemical sprays (8.7%), and 275 other potential weapons, such as brass knuckles, stun guns, and box cutters (4.7%) (Table 1). The number of retrieved guns decreased from 2012 to 2013 (from 182 to 47; p < 0.001). Conversely, the number of retrieved knives, chemical sprays, and other potential weapons increased. Retrieved knives increased from 2062 to 2222 (p = 0.002), chemical sprays increased from 170 to 305 (p < 0.001), and other potential weapons increased from 51 to 201 (p < 0.001) (Figures 1 and 2). DISCUSSION
METHODS We performed a retrospective review of security records for a 26-month period from September 2011 to December 2013. In September 2011, a metal detector and ‘‘no weapons’’ signage were installed in the entrance of an urban private community teaching hospital ED (110,000 visits/year) located in the Midwest. This ED is a Level 1 trauma center serving adult and pediatric patients. All ambulatory patients are screened on entrance to the ED registration area via an arch-style walk-through metal detector staffed by security personnel. Patients arriving by ambulance or helicopter are excluded from metal detection. Hospital employees wearing hospital attire or displaying a hospital badge are also excluded from screening. The security company recorded all retrieved metallic weapons including firearms, knives, chemical sprays,
A significant number of weapons were retrieved after the installation of metal detectors and security personnel in the ED entrance. This suggests that a significant number of concealed weapons were present in the ED before the installation of metal detectors. This number underestimates the total number of potential weapons entering the ED as ambulance patients were not screened and metal detection was not available 24 h per day during the observed time period. Additionally, security reported anecdotally that it was not unusual to see people begin to enter the building and then turn around after seeing the metal detection system. Some of these people may have harbored weapons that otherwise would have accompanied them into the ED. Hospital maintenance personnel also reported finding discarded weapons in the landscaping outside of the ED after the initiation of metal detection.
Table 1. Weapons Retrieved per Study Period 2011 2012
Firearms Knives Chemical spray Other SD = standard deviation.
Significant D
2013
Min
Max
Mean (SD)
Min
Max
Mean (SD)
p Value
7 113 3 0
22 208 24 16
13.8 (4.4) 163.8 (27.1) 12.9 (5.2) 4.6 (4.0)
0 146 12 7
8 244 45 32
4.3 (2.8) 202.0 (30.6) 27.7 (8.2) 18.2 (8.2)
< 0.001 0.002 < 0.001 < 0.001
ED Metal Detection
357
on violent events within the ED was not studied. The data do suggest that metal detection in the ED entrance can play a role, along with other security measures, in reducing the entrance of potentially deadly weapons to the ED. It is possible that the presence of metal detection and security personnel may have an additional benefit of discouraging patients and visitors from attempting to enter with firearms. It is unclear if this impacts overall hospital campus safety, as weapons can simply be stored or hidden outside the entrance, or transferred between potential visitors. Figure 1. Weapon retrieval by month. ED = emergency department.
While overall weapon retrieval increased when metal detection hours doubled in 2013, the number of retrieved guns decreased. This is possibly due to increased visibility of the metal detectors and signs and growing awareness of the presence of security. The increase in other weapons retrieved is concordant with increased metal detection hours and suggests a logical direct correlation between metal detection hours and weapons retrieval. Operation of metal detection services incurs additional expense for hospitals that might be already struggling with budget shortages. These expenses should be weighed against the potential bad publicity accompanying a weapons-related event in their ED, as well as the legal expenses accompanying the injury or death of an ED employee not protected by such a system. Limitations Limitations to this study include the presence of other potential entrances to the ED, the limited metal detection hours, and the fact that ambulance patients are excluded from screening. In addition, the impact of metal detection
Figure 2. Firearm and knife retrieval 2012 to 2013 (knives are divided by 10 for the chart).
CONCLUSIONS The implementation of ED entrance metal detection resulted in recovery of a large number of weapons and potential weapons despite limited hours of operation. Retrieval of firearms decreased with increased hours of metal detection and overall weapon retrieval increased with increased metal detection hours. REFERENCES 1. Griffin J. Healthcare facilities see rising crime rates. Security Info Watch website. 2013. Available at: http://www.securityinfowatch. com/article/10863653/%20%20http:/bjs.ojp.usdoj.gov/content/ pub/press/cv11pr.cfm. Accessed June 7, 2014. 2. Associated Press. Man with gun shot by police at Utah hospital emergency room. Huffington Post website. 2014. Available at: http://www.huffingtonpost.com/2014/05/16/utah-hospitalshooting_n_5338268.html. Accessed June 7, 2014. 3. Bryan C. Cops: man fatally shoots himself inside lobby of hospital emergency room in Woodbury. CBS Philadelphia website. 2014. Available at: http://philadelphia.cbslocal.com/2014/03/20/crewsresponding-to-shooting-incident-at-south-jersey-hospital/. Accessed June 7, 2014. 4. Park M. Bitten, shot, spat on: violence in hospitals common for staff. CNN website. 2010. Available at: http://www.cnn.com/ 2010/HEALTH/09/16/hospital.violence.hopkins/. Accessed June 7, 2014. 5. Blades M. The workplace violence epidemic. Security Info Watch website. 2012. Available at: http://www.securityinfowatch.com/ article/10653412/the-workplace-violence-epidemic. Accessed June 7, 2014. 6. Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 2011;40:565–79. 7. Meyer T, Wrenn K, Wright SW, Glaser J, Slovis CM. Attitudes toward the use of a metal detector in an urban emergency department. Ann Emerg Med 1997;29:621–4. 8. Gorman A. L.A. County removing metal detectors from some hospital facilities. Los Angeles Times website. 2013. Available at: http://articles.latimes.com/2013/feb/03/local/la-me-metaldetectors-20130203. Accessed June 7, 2014. 9. Mattox EA, Wright SW, Bracikowski AC. Metal detectors in the pediatric emergency department: patron attitudes and national prevalence. Pediatr Emerg Care 2000;16:163–5. 10. Simon HK, Khan NS, Delgado CA. Weapons detection at two urban hospitals. Pediatr Emerg Care 2003;19:248–51. 11. Rankins RC, Hendy GW. Effect of a security system on violent incidents and hidden weapons in an emergency department. Ann Emerg Med 1999;33:676–9.
358
S. T. Malka et al.
ARTICLE SUMMARY 1. Why is this topic important? There have been several high-profile events of violence toward emergency department (ED) employees and patients involving weapons. Metal detection in ED entrances may ameliorate the risk of violent attacks involving deadly weapons. 2. What does this study attempt to show? This study attempts to demonstrate the numbers of patients and visitors entering the ED with potentially deadly weapons. We also wanted to explore the effectiveness of metal detection in preventing the entrance of weapons into the ED. 3. What are the key findings? We found that a large number of patients and visitors were attempting to enter the ED carrying deadly weapons, including knives and guns. ED metal detection was successful in retrieving thousands of potentially deadly weapons and preventing their entrance to the ED. 4. How is patient care impacted? The ED should be a safe haven for both patients and staff members. Metal detectors can play a role in ensuring the safety of patients and care providers by preventing the entrance of deadly weapons to the ED.
