To the Editor: Safety in psychiatric emergency departments is of paramount importance. Two studies reported that between 4 and 8 percent of patients searched in a psychiatric emergency setting had a weapon (1,2). Security measures used in emergency departments include on-site security, routine use of hand-held metal detectors, closed-circuit surveillance, secure rooms, panic buttons, and a paging code (3).
Our medical center conducted a review of safety policies and procedures after a former patient entered the lobby of our emergency psychiatric facility with a loaded firearm. The patient unfortunately committed suicide, but no one else was physically injured.
During the review, attention focused on procedures for notifying staff of a dangerous situation. Our facility uses a security code—Code Green—in a verbal public-address page to alert mental health and security personnel of a potentially violent situation and to direct the staff to respond to that location. The code is the same whether or not a weapon is involved. A telephone survey we conducted of 12 hospitals in the Pacific Northwest found that only four have a designated code for a behavioral emergency involving a weapon.
The use of a security paging code in a situation where a patient has a loaded firearm could be potentially disastrous if it summoned more potential victims to that location. We are in the process of adopting a separate paging code that would not only make staff aware of the dangerous circumstances but also warn them to avoid the area, keep others away, and allow security officers and police to respond.
Given the need to anticipate potential acts of violence, we hope other mental health facilities will consider using a similar system.
Dr. Eshelman and Dr. Resnick are associated with the Crisis Triage Center of the Providence Portland Medical Center in Portland, Oregon.