Caring for Those on the Front Lines of Medicine: What About Those Who Face Violence Daily?

Many medical responders and health-care providers are at the front lines of violence every day while receiving and treating patients. Hospitals play a critical role in responding to the events of community violence that occur in their geographic areas or, even worse, within the vicinity of the medical centers themselves. Disaster and emergency-response planning plays a critical role in ensuring staff are equipped with the steps and skills they need when an emergency strikes. However, these caregivers are very often not protected from or treated for the violence and trauma they face each day in their work.

St. Cloud Hospital lies in the city of St. Cloud, a city in the heart of Minnesota with a population of 65,000. Lessons from what that Level 2 trauma center experienced can serve other hospitals that may find themselves in similar situations.

Rachel Mockros, an emergency-preparedness coordinator for the hospital, says they’ve never been immune to critical events, withMinneapolis only 60 minutes away and a steady stream of trauma patients from much of rural Minnesota. Because of this, they train a considerable amount for disasters, including violent events.

One such traumatic happening occurred in October of 2015. A patient who had attempted suicide was brought in, unconscious. “He had a warrant for his arrest because he had committed some very violent acts against his wife,” Mockros says. “He was placed in the ICU, and because of security concerns, he had a county deputy guarding him.”

When the man regained consciousness just around dawn, he attacked the deputy on duty, grabbed his service weapon, and shot him during a struggle. A hospital security guard, at great risk to his own safety, rushed in and shot the man with a Taser, sending him into cardiac arrest. “Our staff was in lockdown, and suddenly we had two medical emergencies,” Mockros recalls.

But their training did not fail them. After the shots were heard, emergency buttons were pushed, summoning security. Every employee on duty, without exception, immediately followed the protocols they’d learned for dealing with an active shooter on the premises, and when the all-clear was given, personnel rushed in to provide emergency care to the wounded deputy and his assailant.

Though neither the assailant nor thedeputy survived, Mockros says, “We feel very fortunate we had been training for several years for these types of events, which I feel is a key to a proper response. Training frequently, taking it seriously, and taking the time to go through the steps you’d do in real life is invaluable.”

After the shooting, Mockros adds, “I was very humbled by the amount of gratitude the staff expressed about their training and preparedness. We’d taken a stand to say that this kind of training is important, that it is a part of our culture, and that we take it seriously. I feel at the end of the day, it has become a mindset for us.”

The staffers at St. Cloud Hospital were tested again in May 2016, when a patient in a secure mental-health observation room attacked a staff member. Though everything in the unit was accessible only to those with secure badges, the patient grabbed a badge reader from the wall, pulled wires out of it, and tried to strangle a staffer. The staffer came through the experience okay, but the event was so unpredictable in nature that it caught the team off-guard. “We learned from this, of course, and now all badge readers are safely secured to walls. Environmental safety is so important in mitigating these events,” shares Mockros.

Both events highlight the need for hospital staff to communicate from wherever they are. The hospital’s communication strategy includes loud personal alarms on every staff badge, as well as silent staff-alert buttons that can be pressed discreetly to call for help, so that a potentially dangerous situation can be de-escalated without alarming or further aggravating the patient, visitor, or intruder.

“For situations like shooters, we practice ‘run, hide, fight’ twice a year,” Mockros says. “We practice as though there’s an armed person intending to cause harm to people in the building. We help staff learn how to choose the best option for safety, wherever they are.”

The St. Cloud team members were tested yet again, months later, when eight shoppers were stabbed at a local mall. The assailant was shot and killed by an off-duty police officer who happened to be shopping in the mall at the time.

EMS workers performed triage at the scene and brought in the most critical patients first. “We were privileged to have a police officer in the emergency room at the time, and he was able to give us information as the event was occurring,” Mockros says. “This gave us a 20-minute warning, and we were able to clear out half of the emergency room in preparation.”

Again, they were aided by their advance training—in this case, for responding to mass casualties. “We shared with the patients in the lobby what was happening, and told them we had these critical patients coming in,” says Mockros. “Some of the patients stuck around, and several left. We opened treatment rooms very quickly. We managed it with the staff on duty, although we called staff from within other places in the facility.” All the victims survived.

Since those three events, the hospital’s staff has done a lot of thinking about what worked and didn’t work, Mockros shared. What continually arose was the importance not just of regularly training to respond safely and effectively to violent events or mass casualties, but of attending to staff humanely in the aftermath of such events. The deputy’s shooting and death in the hospital, for example, shook the sense of safety of many in the workplace, she said. “The biggest piece to deal with wasthe healing,” Mockros recalls. “No staff member was physically harmed, but emotionally, they were definitely impacted. How to provide them with the tools they need to heal is the challenge.”

For some staff, the needs were as simple as having security walk with them to their cars at the end of each shift. Others needed a healing touch, brought to them by massage therapists at work. Others responded to therapy animals. “We offered everything,” Mockros says. “Prayer services, counseling—you name it, we offered it. Everybody heals differently, and at a different pace.”

Perhaps one of the most audacious things the hospital did was to offer as much paid leave as anyone wanted. “We just gave it to them, and nobody abused it. Everyone

used it, we feel, for good reasons,” Mockros says, adding, “After all, we heal patients, so why not heal the staff?”