The highest risk areas for workplace violence are the emergency department, psychiatric wards, and waiting rooms. 70% of incidents go unreported, and women are over 8 times more likely to be victims. Hospitals should implement security measures like metal detectors, restrict access, and train staff in de-escalation techniques to help prevent and manage violent situations. An ounce of prevention is worth a pound of cure.
Introductory lecture on some epidemiological models in causal inference, including the sufficient component cause model and the potential outcomes model.
Austin Journal of Public Health and Epidemiology is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of Public Health and Epidemiology. The journal is dedicated to publication of innovative research and reviews subjected to applied, methodological and theoretical issues with emphasis on studies using multidisciplinary or integrative approaches.
Austin Journal of Public Health and Epidemiology aims to progress epidemiological awareness and Public health and also serves as a discussion on the epidemiology of infectious and non-infectious diseases and their control. The outcomes of epidemiologic studies are crucial arguments for action in the ground of public health policies and efforts are made to carry the journal to the decision makers' attention. The journal is also a foundation of material for those who are actively teaching epidemiology.
Austin Journal of Public Health and Epidemiology accepts innovative review articles, research articles, case reports and rapid communication on all the aspects of Public Health and Epidemiology.
The Pain as a Triggering Factor of Dental Anxietyijtsrd
The pain contains a special touch to each person. Of all our senses none captures our attention so well that pain. We can ignore the other senses, but it is very hard to ignore the pain. But with all the discomfort that it produces, we would be in danger if we did not feel the pain. Because of pain are training in the body, neurodegenerative and psychiatric global reactions. Psychologically, pain may be manifested by anxiety, fear, irritability, frustration, etc., each living the pain depending on individual variables perceptual, emotional, behavioral and cognitive. In Dental Medicine dealing with pain leads to avoidance of treatments needed, leading often to tooth loss, with serious consequences, both on the physical level through feeding difficulties and psychic level by reducing self esteem caused by an unsatisfactory aesthetic. An appropriate management of pain and anxiety can increase the therapeutic compliance and thus the quality of life through training and developing coping mechanisms effectiveness. Liliana Neagu | Dr. Gabriela Iorgulescu "The Pain as a Triggering Factor of Dental Anxiety" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38286.pdf Paper URL : https://www.ijtsrd.com/humanities-and-the-arts/psychology/38286/the-pain-as-a-triggering-factor-of-dental-anxiety/liliana-neagu
Dear Colleagues,
I would like to share this Topic (RISK MANAGEMENT) with you..
I have presented in one of the Khartoum congresses few years ago.
It may be of value for some of you mainly those taking their second part exam or those providing save women health services
Dear Colleagues,
I would like to this topic with you.
I have presented in one of the Khartoum conferences few years ago.
I felt it might be of value to some of you mainly those taking their second part exams or those providing safe women health services business.
This presentation is created by Ruby Sinha Mahapatra, 1st Year MHA student of Future School of Hospital Management. The presentation is aimed to create a basic health awareness amongst students aspiring to pursue hospital management. For more information go to www.futurehospitalmanagement.in or visit us at our Future School of Hospital Management, Sonarpur Campus.
Sample 3 bipolar on female adult populationNicole Valerio
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Ian's UnityHealth 2019 grand rounds suicide preventionIan Dawe
At the end of this presentation, you will :
1. Knowledgeably describe the problem of suicide in our
clients as an issue beyond just the traditional targets of our
medical interventions,
2. Understand concepts of quality and process improvement
as they relate to implementation of suicide prevention
strategies in hospital and community settings,
3. Become a champion of the Project Nøw approach to improve
care and outcomes for individuals at risk of suicide in
healthcare systems locally, provincially and nationally.
Introductory lecture on some epidemiological models in causal inference, including the sufficient component cause model and the potential outcomes model.
Austin Journal of Public Health and Epidemiology is an open access, peer reviewed, scholarly journal committed to publish articles in all areas of Public Health and Epidemiology. The journal is dedicated to publication of innovative research and reviews subjected to applied, methodological and theoretical issues with emphasis on studies using multidisciplinary or integrative approaches.
Austin Journal of Public Health and Epidemiology aims to progress epidemiological awareness and Public health and also serves as a discussion on the epidemiology of infectious and non-infectious diseases and their control. The outcomes of epidemiologic studies are crucial arguments for action in the ground of public health policies and efforts are made to carry the journal to the decision makers' attention. The journal is also a foundation of material for those who are actively teaching epidemiology.
Austin Journal of Public Health and Epidemiology accepts innovative review articles, research articles, case reports and rapid communication on all the aspects of Public Health and Epidemiology.
The Pain as a Triggering Factor of Dental Anxietyijtsrd
The pain contains a special touch to each person. Of all our senses none captures our attention so well that pain. We can ignore the other senses, but it is very hard to ignore the pain. But with all the discomfort that it produces, we would be in danger if we did not feel the pain. Because of pain are training in the body, neurodegenerative and psychiatric global reactions. Psychologically, pain may be manifested by anxiety, fear, irritability, frustration, etc., each living the pain depending on individual variables perceptual, emotional, behavioral and cognitive. In Dental Medicine dealing with pain leads to avoidance of treatments needed, leading often to tooth loss, with serious consequences, both on the physical level through feeding difficulties and psychic level by reducing self esteem caused by an unsatisfactory aesthetic. An appropriate management of pain and anxiety can increase the therapeutic compliance and thus the quality of life through training and developing coping mechanisms effectiveness. Liliana Neagu | Dr. Gabriela Iorgulescu "The Pain as a Triggering Factor of Dental Anxiety" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38286.pdf Paper URL : https://www.ijtsrd.com/humanities-and-the-arts/psychology/38286/the-pain-as-a-triggering-factor-of-dental-anxiety/liliana-neagu
Dear Colleagues,
I would like to share this Topic (RISK MANAGEMENT) with you..
I have presented in one of the Khartoum congresses few years ago.
It may be of value for some of you mainly those taking their second part exam or those providing save women health services
Dear Colleagues,
I would like to this topic with you.
I have presented in one of the Khartoum conferences few years ago.
I felt it might be of value to some of you mainly those taking their second part exams or those providing safe women health services business.
This presentation is created by Ruby Sinha Mahapatra, 1st Year MHA student of Future School of Hospital Management. The presentation is aimed to create a basic health awareness amongst students aspiring to pursue hospital management. For more information go to www.futurehospitalmanagement.in or visit us at our Future School of Hospital Management, Sonarpur Campus.
Sample 3 bipolar on female adult populationNicole Valerio
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Ian's UnityHealth 2019 grand rounds suicide preventionIan Dawe
At the end of this presentation, you will :
1. Knowledgeably describe the problem of suicide in our
clients as an issue beyond just the traditional targets of our
medical interventions,
2. Understand concepts of quality and process improvement
as they relate to implementation of suicide prevention
strategies in hospital and community settings,
3. Become a champion of the Project Nøw approach to improve
care and outcomes for individuals at risk of suicide in
healthcare systems locally, provincially and nationally.
Workplace Violence has yet again come to the forefront of society as the recent tragedy in Manchester, CT illustrates. Accordingly, Kevin Connell has orgnanized a “Complimentary Webinar” for HR Managers, Business Owners and CEO’s of companies across North America. In the webinar it addressed the issue of Workplace Violence, the warning signs to look out for, how it happens, and why no company is immune to it, no matter, how large or small your organization. Most importantly we will address ways to prevent it from happening in the first place.
Background: The frequency and intensity of both natural and man-made disasters have increased substantially over the past few decades. Consequences include great suffering, massive mortality, enormous economic losses, environmental damage and lasting psychological disorders of the survivors. For this reason, community members and government agencies have high expectations regarding the quality of medical care provided during a disaster response. Disaster medicine covers all aspects of disaster response including: disaster management systems, triage, epidemiology and infectious diseases prevention and psychological management.
Objective: This study aims to asses familiarity of students of the University of Medicine/ Faculty of Technical Medical sciences with disaster medicine concepts, evaluate training needs and define the preferred teaching method. It is a cross-sectional study of 100 students selected at random. A self administered structured questionnaire was distributed to the students containing questions regarding triage categories, first aid steps, trauma treatment, biological and chemical weapons, procedures to follow in specific disasters and preferred learning method.
This slides explains the Management of aggression in patients with psychiatric illness. Aggression management is one of the important job responsibility of mental health nurse
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
Suicide by Patient in health care organization occupies 2nd position In all 12 sentinel events reported to Joint commission on accreditation of health care organization (JCI).
How Hospital administrator should handle this Problem.
Suicide in a hospital is known risk factor and recognized as sentinel event by JCI &NABH. Health care provider should know what to do in a post suicdide scenario.
Patient safety is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health.
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...Dr Ghaiath Hussein
This is a series of presentations I gave in the Eastern Mediterranean Public Health Network (EMPHNET)'s Public Health Ethics (PHE) that was held in Amman in June 2014.
This presentation outlines the ethical issues in public health emergencies and disasters.
Quality and safety in global surgery and healthcare conference presentationDr Edward Fitzgerald
Quality and safety in global surgery and healthcare conference presentation including Lifebox Foundation - presented at the International Student Surgical Network
PLANNING FOR EMERGENCY AND DISASTER MANAGEMENT.pptxPRADEEP ABOTHU
Emergency and disaster management is essential for healthcare preparedness, with nurses playing a crucial role. The World Health Organization (WHO) defines emergencies as immediate threats to human health, life, property, or the environment. Disasters, on the other hand, are sudden or prolonged events that cause significant disruption and exceed a community's ability to cope. They can be natural or human-made.
Disaster management involves mitigation, preparedness, response, and recovery. Mitigation aims to reduce the impact of disasters through risk assessment and vulnerability reduction. Preparedness includes developing plans, conducting training, and stockpiling supplies. Response involves immediate actions to save lives and meet basic needs, while recovery focuses on restoring affected areas and supporting the return to normalcy.
Key organizations and professionals in disaster management include the WHO, National Disaster Management Authority, local government and health departments, and various stakeholders. Disaster management plans are comprehensive strategies to respond to and recover from disasters, aiming to protect life, mitigate damage, coordinate resources, support community resilience, and enhance preparedness.
The disaster control room serves as the central command center, coordinating the response. It includes a rapid response team, designated beds for patients, necessary resources, and training and drills for preparedness. Elements of a disaster plan include education and training, resource assessment and mobilization, communication and coordination, and evacuation and sheltering protocols.
Activation of disaster management plans involves establishing a reception area, implementing a triage system, ensuring accurate documentation, managing public relations, and organizing crowd management and security arrangements.
Nurses have significant roles in disaster management. In healthcare facilities, they provide direct patient care, conduct triage, coordinate and communicate with other professionals, manage resources, and maintain documentation. In the community, nurses engage in preparedness education, conduct health assessments, collaborate with organizations, promote health and disease prevention, provide psychological support, advocate for the affected, and ensure continuity of care.
In conclusion, nurses are vital in emergency and disaster management, contributing to care, coordination, and support. Their expertise, compassion, and adaptability make them invaluable in mitigating the impact of disasters and promoting the well-being of individuals and communities.
Violence against doctors at their workplace is not a new phenomenon. However, in recent times, reports of doctors getting thrashed by patients and their relatives are making headlines around the world and are shared extensively on social media. Almost every doctor is worried about violence at his/her workplace, and very few doctors are trained to avoid or deal with such situations. This PPT aims to discuss the risk factors associated with violence against doctors and the possible steps at a personal, institutional, or policy level that are needed to mitigate such incidents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. General Consideration about Safety in
Emergency Department
Montinee Sangtian, MD
Emergency Physician
Rajavithi Hospital
3. Common safety and health topics:
Emergency Department (ED) Module
http://www.osha.gov
4. Workplace Violence Facts
70% of all workplace violence incidents do not get
reported.
2637 nonfatal assaults on hospital workers (1999)
(8.3 assaults per 10,000 workers)
• Government employees have a higher rate of
violence than private sector employees
• Women are over 8 times more likely to be
victims of Workplace Violence than men
National Institute for Occupational Safety and Health : Violence: Occupational Hazards in Hospitals
5. The highest frequency of violent attacks
emergency department
psychiatric ward
waiting rooms
geriatric units.
6. Violent in ED
A 1988, 127 U.S. teaching hospitals ( > 40,000 visits/yr)
• 32% reported at least one verbal threat daily
• 18% reported at least one threat with a weapon daily
• 25% reported restraining at least one patient daily
• 7% had experienced a violent death in the ED.
• 80% had a staff member injured by violence.
Lavoie FW, Carter GL, Danzl DF, Berg RL: Emergency department violence in United States teaching hospital.
Ann Emerg Med1988;17:1227
8. Are your ED at risk?
• emergency department > 50,000 per year
• and an average waiting time>2 hours
• were significantly associated with increased
incidence of violence.
9. Resident Life
1994 , 461 emergency medicine residents
62% were concerned about their personal
safety while working in the emergency
department
50% thought that security measures in their
hospitals were inadequate.
1999, survey of psychiatry residents
36% had been physically assaulted in
residency.
10.
11. Well, we work in the high risk area of violent.
How should we prepare for the situation…..???
12.
13. Ummm…………
However, only 40% of hospitals surveyed
provided formal nursing education on violent.
The survey found that 24- hour security was in
place at only 23% of emergency departments.
15. PREPARING THE EMERGENCY DEPARTMENT
TO PREVENT VIOLENCE
Only 21.4% control access to the emergency
department during high-risk hours
16. War or ED ?
Weapons carriage in ED : 4% to 8%
5.4 weapons a day using a metal detector.
26.7% of major trauma patients were armed with
lethal weapons.
Ordog GJ: Weapons carriage among major trauma victims in the emergency department.
Acad Emerg Med1995;2:109
17. Should assume :
all violent patients are armed (until proved)
especially those presenting with major trauma.
Ordog GJ: Weapons carriage among major trauma victims in the emergency department.
Acad Emerg Med1995;2:109
18. What is EP’s role in violent?
Emergency physician should…
control the patient and the situation
diagnose and treat reversible causes of violence
protect the patient and staff from harm
Scene Safety
Preservation of Evidence and Documentation
Reporting
Duty to warn Third Parties
21. Predictors of Violence Patients
Positive Predictor Not Reliable
Male Ethnicity
Prior history of Diagnosis
violence. Age
Drug or Alcohol abuse Marital status
Education
24. PREPARING THE EMERGENCY DEPARTMENT
TO PREVENT VIOLENCE
Security Personnel
Patient Searches (Early recognition)
Alarm Systems (Direct to local police)
Limited Access to the Emergency Department
Controlling flow into the emergency department
Use of a Designated Room
Prevention
25. Prevention
• To control the factors in the
Primary environment that encourage the
development of frustration and
Prevention aggression.
Secondary • involves response to pre-violent
agitation and aggression.
Prevention
Tertiary • To limitation of the actual act of
violence itself once it has occurred
Prevention
26. Prevention : Primary prevention
To control the factors in the environment that
encourage the development of frustration and
aggression.
Attempts to shorten waiting times .
Pleasant waiting room environment.
The presence of surveillance cameras and a visible
security force also act as deterrents (although their
implementation is a form of tertiary prevention).
27. Secondary prevention
involves response to pre-violent agitation and
aggression.
• Early recognition of high-risk patients
• Managing Aggression
• Communication
• Non-verbal communication
• Defusion strategies
• De-escalation techniques and skills
28. De-escalation Technique
1. Simple Listening
2. Active Listening
3. Acknowledgement
4. Allow Silence
5. Agreeing
6. Apologizing
7. Inviting Criticism
8. Develop a Plan
WHEN NOTHING WORKS : Explain what will happen next if
the angry person does not follow the instruction you offer.
29. • Give clear, brief, assertive instructions
• Explain your purpose or intention
• Negotiate options
• Avoid threats
• Move towards a “safer place” (i.e. avoid being trapped in a
corner)
• Ensure your non-verbal communication is non-threatening
• Allow greater body space than normal
• Appear calm, self controlled, and confident without being
dismissive or over-bearing
30. • De-escalation is a very difficult and humbling skill.
• You cannot be unsure of your own pride or self-esteem.
• You must be able to control your own anger.
• You must be able to see the bigger picture.
• You must be willing to practice what you’ve learned.
31. NEVER THREATEN
unless you are prepared to take the next step !
Once you have made a threat, or given an ultimatum,
you have ceased all Negotiations and put yourself in
a potential win-lose situation.
32. Tertiary prevention
To limitation of the actual act of violence itself once
it has occurred.
Physical and chemical restraints are used, and
security and police intervention are often needed.
Emergency department protocols.
Security measures.
33. Restrain and Seclusion
The Joint Commission on Accreditation of Health Care Organizations (JCAHO)
1. The implementation of restraint or seclusion is limited to
emergencies where imminent risk of harm exists to
patient or others.
2. Staff is trained and competent to apply restraint safely.
3. Staff is trained to minimize the use of restraint.
4. Patients in restraints are regularly evaluated and
monitored.
5. Orders for restraint use are provided by licensed
practitioners and are time limited.
6. Medical records document that the use of restraint or
seclusion is consistent with organizational policy.
34. American College of Emergency Physicians. Emergency physicians’ patient care
responsibilities outside of the emergency department [policy statement];
Approved September 1999. Ann Emerg Med 2000;35:209
35. The violent patient suffered as well !
13% of hospitals reporting injuring patients
while restraining them, including one
strangulation death.
Litigation was pending in 16% of surveyed
emergency departments because of restraint
of patients.
36. Prevention Strategies that Work
• Metal Detectors installed in a Detroit Hospital
prevented the entry of 33 handguns, 1,324 knives,
and 97 macetype sprays in 6 months
• A system of restricting movement of visitors in a
NYC hospital using identification badges and passes
limiting visitors reduced violent crime by
65% in 18 months
37. KEY CONCEPTS
Emergency department staff should be trained to
recognize the early signs of impending violent behavior
and to implement appropriate de escalating techniques.
Every emergency department should have a formal plan of
action to deal with violent patients.
Violent patients should be evaluated for possible medical
and psychiatric conditions
An ounce of prevention is worth a pound of cure.
38. References and Further Reading
• ACEP Policy Statement : 2009 Policy Compendium
• Joint commission on accreditation of healthcare organization
(JCAHO) Standard 2009
• Rosen’s emergency medicine, 6th ed, ch.189
• Emergency Psychiatry: Principles and Practice, By Rachel
Lipson Glick, Jon S Berlin, Avrim Fishkind
• Managing violent and aggression : a manual for nurses and
health care workers, Tom Mason, Mark Chandley
• Security in the Health Care Environment. By David H. Sells,
Jr.; published by Aspen Publishers, Inc.
• Guidelines for Preventing Workplace Violence for Health Care &
Social Service Work : www.ohca.gov
• www.crisisprevention.com
54. Deadly shootings at US army base
Major Nidal Malik Hasan,
Psychiatrist
A US Army major has opened fire on fellow soldiers at the Fort Hood
military base in Texas, killing 13 people and injuring 30, officials say.
http://news.bbc.co.uk/2/hi/americas/8345713.stm