Emergency doctors across New Zealand say that the efficacy of extra security provided to emergency departments over summer was ‘a mixed bag’, dependent on the quality of training and support provided to security staff.
Following the Australasian College for Emergency Medicine (ACEM’s) warning that violence was increasing in emergency departments (EDs) and its urgent call for trained 24/7 security staff, Health Minister Dr Shane Reti provided additional security to some EDs over the busy Christmas and New Year period.
ACEM Aotearoa New Zealand Chair Dr Kate Allan said, “Aotearoa’s emergency clinicians are grateful that Dr Reti promptly listened to our concerns on increasing violence in the ED and provided a boost to urgently needed security. We are pleased to report that feedback on the initiative from colleagues on the ground is mostly positive – but there has been a mixed bag of experiences.”
“ED staff said that security staff who had been appropriately trained and integrated in their communities were ‘amazing’, ‘proactive’, and useful. These security guards were familiar with the communities they were working in, and the unique ED environment. They appropriately supported patients experiencing mental health distress and whānau during long waits and helped deescalate situations. Other colleagues reported that the presence of extra security reduced instances of verbal abuse, and ‘kept a lid’ on things after violent incidents.”
However, other ED doctors across the country informed ACEM that some security staff did not seem to be appropriately trained, integrated, or supported. Therefore, they were unable to communicate effectively with patients, visitors and whānau or respond effectively to safety issues. Other doctors reported that their EDs did not receive any security, leaving ED staff feeling ‘unsafe and unsupported’.
Dr Allan said, “This range of feedback indicates that having appropriately trained and supported 24/7 integrated security in the ED works. Going forward, we need to make sure every ED in New Zealand has 24/7 carefully selected security staff who are supported and empowered in the ED environment, culturally aware, can build healthy relationships with staff, patients, carers and whānau, and are skilled in de-escalation techniques. These people will be key members of the ED team and will free up doctors and nurses to focus on delivering crucial healthcare and help make emergency departments safer – for everyone.”
ACEM encourages Dr Reti to also continue to focus on addressing the systemic issues that contribute to long waits for care, staff burnout and aggression and violence in the ED. Solutions for these systemic issues should include the delivery and appropriate staffing of all mental health facilities pledged in the 2019 mental health budget package, at least 150 appropriately staffed high-level aged residential care beds (ARC), and solutions to provide and retain a sustainable emergency care workforce.
ACEM has reached out to Te Whatu Ora Health/New Zealand (HNZ) for more information on the planned aggression prevention programme and looks forward to continuing to work with Dr Reti and HNZ to make emergency departments safer – for everyone.