The West Hall

This is the locked down area that I work so you guys have a better visualization of it.

It's taken from the side with the 2 regular hospital beds. The ones shown are where the 2 plain white rooms are. Which are hidden around the corner. And then there's two more doors behind the person taking the photo that also lock down. So it can be two separate areas.

The photo is from the hospital website, but I took off any identifying marks. Of course unless you already know where I work. :) But I'm doing my best to comply to HIPPA policy and so far I don't think I've broken any.

Combative Subjects

I remember the first combative person I had to attend to was a patient up on the 3rd floor of the hospital. At the time this was called a Code 28 (Combative Person), it's now called a Code Grey in compliance with the national standard (Though we don't use all of them. e.g. we would never announce over head someone has a bomb or gun over head).

It was about 2230-2300 when the code went off via intercom. I was in the back West Hall there were two other guards already back there and they both looked at me, since I was a newbie I got to go. My heart was racing with excitement, anticipation, and a little bit of fear. A lot of times the excitement of running to disarm/de-escalate someone clouds your judgment of real emanate danger which could become very bad.

I used my cross country running skills to sprint from the back of the ER out to the main lobby; there were a lot of people there. An audience in my mind. It seemed so cool to me at the time. Codes are going off over head no one knows what it means and then to see me busting through the ER doors with the look of "going-to-kick-some-ass" on my face. I was yelling at people to get out of my way, "Step to the left! No your other left!" and me dodging around people with me shouting in to my radio "This is 29 responding to code!" I swing open the door to the stairwell. Running up two flights of stairs I open up the door at the top of the stairwell to be met by surprised looks of nurses and a bit of confusion. I was on the wrong floor on the wrong side of the hospital.

I'd only been working at the hospital for less than a week and wasn't too sure as to the wings of the hospital yet. One wing goes to the 4th floor; the other wing is only 2 floors. So I run back down the stair well sprinting to the other side of the hospital, then up 3 more flights of stairs. At this point I wanted to pass out from so much excitement and having to run up so many stairs. Finally making it to the floor there are about 10 people in the room with the patient. I jump in to help with the nurse holding the patient's legs down on the bed while everyone is shouting trying to get the guy under control. Putting breathing masks on him and making sure he doesn't go in to cardiac arrest. The patient had undergone surgery and woke up in a state of confusion and became aggressive. He wasn't conscience at the time of his aggressive state. Swinging and cursing as we're holding him down trying to get him to breathe properly. He had ripped out his IV and it had to be placed back in. By this time he was starting to understand what he was doing and calmed down a bit.

He was very upset to find that he urinated all over himself. And then laughed about it. And what was weird about situations like these, is sometimes it seems like it was over in an instant. But in fact we'd been with him for almost an hour by this time trying to keep him under control. It goes both ways I guess. Sometimes a short-while can seem like an eternity, and this time a longer amount of time went by like it was 30 seconds.

A lot of times, just the mere presence of being with a patient can calm them down. Usually the work of a silver-tongue can help coax a patient in to being more cooperative. And most of the time it's just because they're extremely confused usually caused by new medications they are taking and nothing too serious.
On the other hand though, we do get some that don't want to be at the hospital but need to be, and they can be a bit more dangerous.

About a week ago or so we had police officers bring a patient in that was found on someone's porch with a bunch of pill bottles in their pockets with all the labels ripped off. When the police found him he woke up and told the officers to put a bullet between his head and then passed out again. He was brought in, what we thought was unconscious. We tried a few techniques used to wake people up. Usually the strumming of your knuckles on someone's collarbone will wake them up or slapping their face a little bit. But he wasn't waking up. So we stripped him of his clothes and put a gown on. We went with one last trick as to trying to wake him up, a lot of patients pretend to be unconscious if they think they might be in trouble with the police. Or pretend to be going in to labor. So the Doctor ordered a folly catheter (a tube that goes up the urethra and then in to a bag, it pretty much pees for the patient). And surely enough the guy woke up.

I was monitoring the camera at the time and two other guards and 3 nurses and a police officer were in the room. And the patient was cooperative at first but when the Doctor started to ask questions he started to shout profanity at the Doctor (who is a really sweet person) and then he raised his fist to her. That's when we jumped in with the restraints and restrained him to the bed. He was going to be here for awhile. Combative + Suicidal = long time before you get to go. About 2 hours later we get sent back in with the nurses to help put a folly catheter in. He's calling myself and the rest of the staff mean names such as [expletive deleted] and [expletive deleted]. They made me sad. Anyway, as it's going in I look at the guy's face and he looks at me like he's going to spit. I put my hand down to cover his mouth and he turned his head at the last second and hawked a big one in my manager's face. My manager didn't like that too much. Luckily my manager is able to keep his cool, I know most people aren't. A face mask went over the patient's face because he is now a spitter. He was left in restraints the rest of the shift I worked and I'm not sure what happened to him thereafter, but I'm glad I was gone when he was released. And I hope he was able to get some help.

The following night we get a patient that was brought in by police. It took 6 officers to restrain her. She was a pretty big woman. The reason why she was brought in was because she had bitten her father. The patient and both the parents' believed that she was possessed by the devil. She was kicking, screaming, biting, clawing, and spitting. The injected some Ativan in to her legs and she calmed down for the most part. She arrived around 0000. And about 0200 she was brought down from 4-point restraints to 2-point restraints. Around 0400 she had been pretty calm in the 2-point restraints and the nurse asked her, "Do you think if we take you out of the 2-point restraints you will remain calm?” Silence from the patient. Maybe she was too sleepy to talk? The nurse asked again. "Do you think you'll remain calm for us if we take you out of the restraints?” "Depends." the patient replied. "Depends on what?" said the nurse. "Depends on if God wants me to remain calm." replied the patient. So she was going to stay in the restraints a bit longer.

At about 0700 the DMPH (Designated Mental Health Professional) arrived to evaluate the patient and determined that she will be going to a locked down mental health psychiatric ward. About 15 minutes after the DMHP left, I noticed the patient took her heart pulse monitor off of her finger. I usually don't care if a patient does this; it's not really a big concern if I'm watching them directly. I can see that they are still alive and that they look somewhat normal. But I'm watching on camera and I see her put her arm behind her head and then back across her chest. I go in to the patient room (luckily she was only about 10 feet from where I monitor the cameras) and I see that she had tied the cable around her neck. I stick my hands in between her neck and the cable and tell her to stop. She looked at me and pulled it tighter. I struggled to get it off her head (she was pretty strong even for someone only using one arm while the other arm was restrained). She let go of the cable and grabbed the flashlight off of my belt (which is in a Velcro case. which I no longer wear because of this incident), and held her hand back like she was going to throw the flashlight at my face. I grabbed her wrist and started to shake the flashlight out of her hand but she wasn't letting go, so I had to slam her hand on the gurney and continue to shake her hand until it finally dropped out of her hand. This was when I radioed a Code Grey for help to be paged overhead. The patient then grabbed on to my wrist and as I pulled away she dug her nails in to my arm and drew blood. It wasn't too deep, but enough for blood to drip down.

Another guard wasn't too far away when I called for help and the Code Grey was paged overhead so other nursing staff came running in to assist putting the other restraints on the patient. As we are taking the other monitoring cables and catheter off of her she is singing gospel music at the top of her lungs and then she screams as loud as she can
"I AM GOING DOWN WITH THE DEMONS TO LAY TO REST", this was pretty scary. And I felt bad for her hoping she wasn't really possessed by demons but just crazy.

She was going to be transferred to the psyche ward within a half hour and needed to be given more Ativan for the transfer over for the safety of the Ambulance drivers and that of the patient's. While the nurses were trying to inject the medicine in to her legs she started kicking and me and my manager had to hold her legs down. She was very strong and kicked while the needle was in and luckily the nurse pulled out in time so the needle wasn't in, but it had stabbed her leg and bled a bit.

We figured it was safer to give the Ambulance guys our set of restraints to restrain the patient to their gurney during the transfer rather than their little foam straps usually used to keep patients still who have a neck injury or something. (They weren't going to hold this woman.) And of course she left at 0815, right at the end of my shift. It seems that's how it always is. A patient comes in at the start of your shift until the end of the shift and you're stuck in the West Hall the entire time. It gets boring when you have to watch all your patients sleep for 8 hours, but it's also nice.

Other than those two incidents. I haven't had anyone else try and swing at me intentionally. Most of the time the combative ones don't really know that they're being combative due to intoxication or extreme confusion caused by whatever situation they are in. I think my next post will be on a lighter note and some funny situations and conversations I've dealt with.

Mental Health Evaluation

Probably the majority of patients that I watch in the west hall (or in any other room I guess) are those that are in need of a Mental Health Enquiry/Evaluation or MHE. This covers a very large spectrum of reasons, but for the most part it's an altered state of mind from the norm. This could be from suicidal thoughts, extreme confusion, dillusions, hallucinations, etc. These patients probably make up about 90%of the ones that we watch because a MHE can be in combination with anything else.

Depression is one of the largest factors as to why people have suicidal thoughts / attempts and it's usually over something, in my opinion, trivial. Relationships are a big one. When someone breaks up with another, depending on how their mental make up is in the first place, also in my opinion, will be taken to such an extreme they will feel that their life is no longer of worth and will want to take it. There are some stories people have told me that are very tradgic as to why they are where they are now such as abuse from a significant other. It's very disturbing that someone who supposedly loves you will take advantage of you mentally, physically, financially. It's not love though. But it happens unfortunately and people will do what they think would "end the pain". Most commonly in the form of an Overdose on an illegal or legal substance or through self-mutilation.

When a patient is brought in for an overdose, depending on the amount of substance ingested and how long ago will determine the treatment for the overdose. Most commonly the patient will have to down, according to Wikipedia "1 gram/kg of body weight ( for adolescents or adults, give 50–100 g )" of Activated Charcoal. I haven't asked a nurse exactly how much is in a standard bottle of Activated Charcoal but it's a lot. The purpose of it is to absorb all the chemicals from the ingested substance rather than something like Ipecac which makes you vomit. Eventually the Activated Charcoal will leave your body in the form of explosive diarreah and vomit but not until after some time. Then after the patient is medically stable a social worker will be assigned to talk to the patient about what had happened that led up to the situation that they are in now. From there the social worker will determine if they are okay to go home after they are medically cleared and will give them some information on how to seek help from therapists or go through some kind of out patient program. Or if the social worker believes that the patient may need to seek something more serious, they will call a County Designated Mental Health Professional also known as CDHMP or we usually just say DMHP.

Unfortunately there's only like 1 or 2 that work shifts, or so it seems, so the wait a patient may endure before seeing a DMHP can be anywhere from 1-4+ hours. Once the DMHP comes and makes a mental evaluation of the patient, similar to Social work, they will either let them go home and give them information on therapists or other outpatient-like help or they have the power by law to legally detain someone against their will to be placed in a Mental Institution. Sometimes at a low-security facility for like 3-7 days or even longer at a locked-down facility. This can be tricky because the DMPH can detain someone for up to 72 hours excluding holidays and weekends. This means that if you are detained on Friday at 0000. You can be there all day friday, saturday, sunday and technically only have been detained for 24 hours. Usually doesn't happen, but it happens.

One time that this had happened, had happend to a patient that had Alzheimer's disase. Some background as to why he was brought to the hospital. His daughter had called the police on him because he was getting violent with her and swung his cane at his wife. He had no recolection of ever swinging at his wife and that he would never do such a thing. The thought of such had made him start to cry. He had believed that he was in California when we asked him where he was. The information that he gave us as to where he lived was correct, but he had come to Washington the day before and did not remember ever leaving California. This guy was a pretty nice old guy for the most part. Unfortuantely he kept asking us why he was here at the hospital every 8 minutes or so. And when we would tell him that we had just told him why he was here and would get upset at us and call us liars for never have telling him why he was here. We would tell him the same story every time, and everytime he would yell at us for being liars. He began to become aggressive towards the staff and other guards so we had to move him from the regular hospital room of the west hall to one of the plain white rooms, just so he had less objects to throw at us.

So far he had been in the room for about 4 hours, we gave him a recliner chair similar to the ones that are in the Birthing Unit. They're pretty comfy. But according to him he had been in that room for about 3 days without food or water and not able to make any contact with anyone in the outside world. This was not true because we'll ask a patient if they need any food, water, restroom, warm enough, every 15-20 minutes or so depending on how they may actually be. The DMHP had eventually came and had detained him. Unfortuantely for him it was on a Friday and the daughter and wife were not returning any of the calls. So this guy was going to be stuck with us for awhile. He ended up staying with us for about 3-4 days overall. But his story ended up being about two weeks. I felt bad for him. But there's virtually nothing that can be done about his mental state. It's a very sad disease.

And on a scary note, he had a Valid Driver's license.

Some other patients I've dealt with with mental disorders are commonly diagnosed with scizophrenia / paranoia and the patient is going through a psychotic episode or they have stopped taking their medications. A common perscribed drug I've seen is Quetiapine, commonly known as Seroquel. Some serious side effects happens when people either take too much of the medication, take the medication with alcohol, or stop taking it all together as listed by drugs.com: mood or behavior changes, anxiety, panic attacks, trouble sleeping, feeling impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or self-mutilation.


Pretty serious stuff. A patient I was watching after had taken too much seroquel with a mixture of alcohol had knocked his thoughts all out of whack. He was put in to 4 point restraints for his own safefy because he didn't know who he was, where he was, how old he was, what year it was, etc. He would pass out for a few minutes, then wake up talking about a Construction site he's working at and needs to tear down a wall. Then would pass out again. Then would wake up again asking to see his mom, and that she was just down the hall in the living room watching tv. Then he would pass out again. And then he would wake up and I would ask him if he knew what was going on and he would look at me and say "Yeah, I know what's going on. I understand everything you're saying. There are no problems here at all." and then would pass out again and continue to talk in his sleep. I don't think he was suicidal, but just took too much medication and mixed it with alcohol.

Another patient who also took the medication was brought in to the ER for Suicidal Ideations and self-mutilation on his forearm. His ex-girlfriend had broken up with him a year ago or so on unruly terms. And she had called him that evening saying that she would call him every year on his birthday and call him names and such until he would finally just kill himself. Well he said he took a bunch of his medication and doesn't remember carving "HELP ME" in his forearm. He was in the ER with his roommate and he swore that he did not do it, but someone else inside his head had done so. Talking to him he seemed alright. But he wasn't alright. They ended up making 9 or 10 stitches in his arm on the deep insesions and used the medical super glue on the rest of his cuts and wrapped it up.

Again, another victim of abuse. Words are very powerful and people don't understand that sometimes. Or maybe they do. Either way, they are terrible human beings to where they dilberatly want to harm someone else and should be jailed.

I'll probably write more stories about Mental Health patients later. Some are kinda funny, most are sad. But eh, that's life. My next post will probably be about Combative Patients I've dealt with.

Introduction

My name is Derek but over the radio I'm known as 29. I work the grave shift for a security company at a level 1 trauma center hospital since July 09. Starting out I thought I was going to need to become a big mean person, but so far it's almost the opposite. The Majority of my time spent at the main hospital campus (there are 3 campus' that our company works at), is spent in a back locked down hallway of the Emergency Room known as the "West Hall".

The West Hall consists of 4 hospital rooms with magnetically lockable doors, cameras, and microphones. Two of which are regular looking hospital rooms: Counters, equipment, televisions, etc. The other two are plain white rooms with a gurney in it which are strapped down to the floor. There is a locked cabinet on the wall that we can open if we do need to put medical equipment in the room for such an emergency. This hallway is locked down on both ends of the hall. There is a giant magnet that holds the door shut and you'll break your foot before you break the door open.

The primary function of my job is to ensure safety for the patients, visitors, and staff, but we as security guards do so much more. We're not just gorillas that over abuse powers just because we have a badge. We are also Registered Nursing Assistants and help out a lot. What it is that I do in the West Hall is what we call "Close Observation". There's a significant amount of people that come in for Suicidal Ideation, Suicidal Attempts, Combative, Intoxicated (either on illegal or legal substances), and those who need a Mental Health Evaluation which ranges from manic depression to dementia, schizophrenia, mental delays etc. We have special codes we use to determine a patient's status as to their stay but for security reasons I'll just say them in their General Form.

A lot of these people come in on the worst day of their lives and the last thing they need is someone to boss them around. We do our best as security guards and as people to comfort our patients and make sure they are feeling safe while they are in our care. We make sure if they are warm enough and give them warm blankets (we have these blanket warmers that are like little ovens that warm the blankets up to like 120 degrees F), we make sure that they have enough food and water (depending on if the nurse OKs it. You never know what they are there for initially and food and water could only make things worse for them medically.), and I'll also talk with the patients about things. Either the situation that brought them there or just general conversations. This is probably one of the best tools we have for keeping patients calm in my opinion. A lot of people that come in for Suicidal Ideation or Suicidal Attempts just need someone to listen to them and care about what's going on in their life. There are a lot of sad people in my town (just in my town alone, I can only imagine the rest of the world.), and they just need someone to talk to and care for them. It's really that simple. So being kind to someone in public will literally be the best thing to happen them all day, week, month, year or even longer. It's never too early to be kind because it could sometimes be too late. I'll talk later about my involvement with patients and situations I've dealt with.

Some other things we do as a part of safety for patients are restraints, this can be the best part of the night or the worst part of the night depending on how it goes. This is when a patient becomes combative to others or at risk of self harm. Depending on how cooperative or uncooperative this can take 2-6+ people to get someone safely restrained. Our goal is not to use restraints as a punishment and to get them out of restraints as soon as possible. But this will all depend on the behavior and actions of the patient. We do remove each restraint every two hours and exercise their limb so it does not grow tiresome, and then it'll either be placed back in restraint or not. Depending again on the patient.

Another task we have to do is help bag bodies / move bodies to the morgue. At first this sounds terrible, but it's usually not so bad. About 95% of the time the bodies are already bagged when we get there to pick them up. Sometimes though they are short staffed and need help. So that's one service we provide. Another time that we may have to bag them is if the body bags rip open. It's pretty terrible when it does. By the time we go to pick the body up, it's usually already been there for at least an hour or so. Enough time for the body to start it's decomposing. Usually in the form of bowel movement. So when a bag rips open at this time the first thing you see is a body floating around in itself. *shudders*. The grotesqueness of it all isn't as bad as the smell though. But that's death, just so much as it is a part of life. I have some interesting stories to tell later about bagging bodies I'll tell later.

Another cool thing we get to do is help out with the Helicopter Airlifts. When a patient suffers from a major injury usually dealing with a head or neck injury they will needed to be airlifted to a level 3 trauma center. And my job for this is to help unload equipment from the helicopter and escort the airlift team down to the ER from the roof to the ER via elevator that we switch off for public use, which would normally go from the parking garage to the ER lobby, and we also help escort the airlift team from the ER with the patient up to the Helipad and load them back on. It's very cool to be able to help out with something like this, and the helicopters they use are very fast. The hospital they transfer to is about an hour and a half by car with little to no traffic, with the helicopter it takes them 5-7 minutes!
That's pretty much the generalization of the job we perform at the main campus. We also make rounds of the hospital to make sure everything is staying calm. We'll run odd jobs for nurses such as delivering things to different departments.

I am also specially trained to work the PBX switchboard (which is the hospital Operator for all 3 campuses), not all the guards are able to do this, so it's kinda cool that they have me do it. During the grave shift I play operator 3 times a night to give the regular operator a lunch break and regular breaks. It's not as busy as the day so it's not so bad. A lot of the calls are the nurses asking for the hospitalist to be paged to their floor or to page the nursing supervisor. Not many people call between 12am and 5am to talk to visitors.

Another campus I work at time to time is the Birthing Unit in a different city. It's part of the same hospital just a bit smaller. Only about 40 patient rooms as to opposed to the 200+ rooms at the main campus. And the ER is about half the size, where a lot of patients would be transfered to the main campus and we do about 95% less patient watches. Our main purpose at the birthing unit is to protect the patients and the babies. We do this by using RFID transmitter bracelets that we place on the infants ankles, and if this is forcefully removed alarms go off throughout the floor telling us which baby it came off and what room they are in and we'll go running to make sure no one is trying to steal a baby! We also have readers along the walls so if an infant gets near a door the alarms go off as well. And the wing where the patients stay are locked down. There is no going in or out unless you pick up a phone and ring the front desk to be let out. And every visitor that goes in signs in with a picture ID shown to gain entrance, and we buzz them in to the wing. It's a very secure locked down area. Annnnnnnd I get to take pictures of cute babies for most of the night ^_^ .. *cough* for documentation and security purposes of course, so we know babies won't get switched up. This shift I consider my vacation and relaxing shift because I don't really worry so much about patients wanting to kill me or stalk my family and kill them in their sleep. Which I will also talk about in a later post. But for now I think this is a good introduction as to what I do as a Security Guard in a Hospital.