4.3.1 Violence in the emergency room. , Sylviane Stotzer, (Nurse, Emergency Service, University Hospitals of Geneva HUG)

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Violence Against Healthcare

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University of Geneva

Violence Against Healthcare

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At the global level, there are many countries marked by violence affecting health care. The 'Health care in danger' project aims to establish practical measures and recommendations that can be implemented on the ground by policy-makers, humanitarian organizations and health professionals. In view of the multiplicity of actors and latitudes concerned, it is essential to be able to make available the tools needed to make informed decisions, guide behaviour in high-risk areas and provide everyone the means to create and optimize the dialogue between humanitarian professionals and health on the one hand and relevant authorities or other armed actors. This course covers various topics such as ethics, rights and responsibilities of the staff of health and pre-hospital personnel, issues related to international law and humanitarian law, international human rights, caregivers and patient safety as well as the role of communities to address and reduce violence against health care.

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Module 4: Hospital managers: ensuring the preparedness and security of health-care facilities in armed conflict and other emergencies

This module speaks of how health services are valuable at any time, but particularly during emergencies resulting from any hazard (radio nuclear, disease, chemical, food safety, social/political, natural); during emergencies, hospitals may face the additional burden of overcrowding, infrastructure damage, loss of staff, and increased violence against health care facilities and workers becoming victims of the emergencies themselves; therefore hospitals must be strengthened to stay safe and resilient even when faced with these difficult challenges.

4.3.1 Violence in the emergency room. , Sylviane Stotzer, (Nurse, Emergency Service, University Hospitals of Geneva HUG)5:17

Rencontrer les enseignants

Angela Gussing
Regional Director for the Americas
International Committee of the Red Cross
Beat Stoll
Dr
PD, Coordinator of the Master of Science in Global Health, University of Geneva
Esperanza Martinez
Dr, Head of Health
International Committee of the Red Cross
Alexander Breitegger
Legal Adviser
International Committee of the Red Cross
Frederik Siem
Senior Adviser for Health Care in Danger
Norwegian Red Cross (NorCross)
Bruce Eshaya-Chauvin
Dr, Medical Advisor Health Care in Danger Project
International Committee of the Red Cross
Jamie Williamson
Head of Unit, Relations with Arms Carriers
International Committee of the Red Cross
Luigi Fratini
Head of Prevention Cell Unit, Law & Policy department
International Committee of the Red Cross

Hi! My name is Sylviane Stötzer, I have been working

as a nurse at the Cantonal Hospital of Geneva (CHG) for 18 years,

and I teach to my colleagues as part of the Emergency Service Care Trainings

It is two years on-the-job formation

on violence and aggressiveness principally at

the Emergency Service reception, but also at the patient sorting

since that’s where we encounter the most violence and aggressiveness.

We are extremely lucky at the CHG to focus training on prevention

rather than on repression, and I wanted to tell you a few words

about the fact that the health care personnel in Emergency Services

is confronted on a daily basis to violence.

It is not because we’re not in a war-torn country,

that we do not face this violence.

Its extremely complicated, extremely complex,

because we’re not ready and trained.

Nurses, assistant nurses, medical doctors

all study for helping others, relieve people, accompany them,

but certainly not for being confronted with

daily violence which is present in an Emergency Service.

It is extremely complicated because we are not ready for this.

We are very lucky here, many things

have been put into place for years.

Amongst other and principally, the introduction

of a security guard during night time.

For about two years, we have had a security guard during the night,

which considerably contributed to reduce

verbal agressivity cases. We are quite lucky

normally not to face cases of physical aggressiveness,

it may happen, but verbal violences are daily in the Emergency Service,

and everyone agrees that this form of aggressiveness,

is as traumatizing and noxious for the personnel

than a physical aggressiveness, most of all,

when it happens on a daily basis as experienced here.

Principally at the reception desk.

The security guards are heavily present at the Emergency Services.

You should know that for the Emergency Service only,

more than 1600 security interventions are recorded per year,

only for the Emergency Service and the protection of people.

So when we consider that we are in danger, that we are threatened,

we call the security guards, and this happens about 1600 times a year,

which is a significant number, it’s a good job they are here!

It may also occur, and it is a new phenomenon which

was not the case 10 years from now,

that we have to call the Police, external to the hospital,

when the internal security forces are overwhelmed.

The typical example is when street fights occur

during the night between two rival groups,

that start attacking and naturally hurting each other,

they then both arrive injured at the Emergency Services,

and typically keep on fighting each other in the waiting room,

which was absolutely not the case 10 years ago,

and becomes very problematic here.

Back then we thought that violence and aggressiveness stopped

once the doors of the hospital passed,

and this is not any longer the case.

The Emergency Service is not a safe shelter anymore, and this is not any longer the case.

The Emergency Service is not a safe shelter anymore,

and it is complicated every day to manage this violence.

Now you have to know that most of the time,

the aggressiveness is an answer to non-met needs,

Such as: I’m hurt and you don’t provide painkillers

or I’m waiting and you don’t tell me the reason why

And this is fundamental.

Even if it has to be 30, 40, 50 times a day,

the health care personnel must inform the patient,

why there is a waiting queue, why it is… – bottom line,

the reason for someone being here should not be downplayed.

A patient who has been waiting here for five-six hours

about a 15-year old back-pain,

for him, it is important, it is an emergency.

However, it is a relative emergency, not a vital one.

So when he has been waiting for 5 hours and another patient

passes in front of him to go and see a doctor,

the former has a high chance to get angry, violent,

or even to take action since he does not understand:

I’ve been waiting for five hours

he just came in and comes first?

And that’s very difficult to manage, because it happens every day

and one has to explain to these people that we are

precisely in an emergency service, and an emergency service

is about emergencies.

And a 15-year old back-pain, even though the reason for the patient

to be here should not be minimized,

will not have priority over a road-accidented person

or a heart attack.

It is tough on a daily basis since we are not confronted with this,

not used to manage this violence, the relatives, the family,

who are all potentially aggressive people

because there is fear.

One does not go to the Emergency Service on a daily basis

and this creates fear and latent aggressiveness

which is very complicated to handle.

It is highly complex because we are not trained accordingly,

and that those are the actual experience-based skills of Emergency Services.

One does not learn to manage this violence,

but by working at the sorting of patient

by doing months and months of patient sorting, after years

we finally get, not to manage this violence,

but at least to live with it,

and act with as much humanity as possible in the reception of people,

which is, I want to recall it, the first step of a treatment,

Thanks

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