Marc Grossman | Trevor Wolfe | Rich Giroux - Violence against HCPs (3/7/25)

All right, everybody, welcome to the Florida EMS webinar. It is Friday, March 7, and the timing on this one couldn't have been better because of the fact that we have a lot of great things happening in EMS and at the hospital level, but at the same time, there is like a deeper underbelly of things that are happening. And it just so happens that last week's episode of the Pit, which I'm sure many of you are watching, there was a case where at the very end of the episode, a patient punched the nurse in the face. Last night's episode followed that up. And what I found interesting was right when that case got brought up, all the other nurses said, oh yeah, I've been hit, I've been spit on. And so they're finally demonstrating to America that this is not an isolated incident. And.

Many of you know and heard of the case that happened at Palms West Hospital. But unfortunately, what you heard on the media was not accurate. Right. And so hold on a second. So I have today Dr. Rich Durow, who is emergency medicine physician, who actually took care of that nurse, and he agreed to come on the show today. So without any further. And we have, we have some other very great speakers coming up right after Rich, and he's at a meeting, but he took time out for this. So, Dr. Gero, thanks for joining us and please give us what you can regarding that case at Palm West. Tell us anything that you can with respect to that case. We'd really appreciate it.

I appreciate the invite, Peter. I appreciate being able to talk about this comp.

This, this.

This conversation, considering how polarizing it is.

Peter.

Thank you everybody for hopping on this call to discuss this issue that really plagues every avenue of healthcare. So unfortunately, the situation kind of started on the Monday before the event. We had 30 some odd year old patient present to the emergency department complaining of chest pain, as any emergency physician would. They started to work up that patient. This patient, during that visit, including getting a CT of his chest after some abnormal penalties were found in his blood, jumped off the CT table, kind of went down the hall in a very odd manner. They were able to get him back onto the CT scanner. CT scan was done, brought back to the room. The, you know, further discussion from the other, my other ER physician with his wife kind of noted some, you know, some changes in behavior. So it was opted to have one of our telepsychiatrists kind of evaluate this patient. During that evaluation, it was felt between the ER physician and the psychiatrist, it would probably be best to Baker act This patient. However, as everyone knows, with the extensive mental health crisis that we have going on in our country and very limited space for these patients to be cared for, we have a medical issue that needs to be addressed. So unfortunately, we cannot transfer this patient out to a Baker act facility until we medically clear these issues that were going on. So in turn, he was admitted to the hospital for these workup. At that time, the minute he was identified as a Baker act, there was a patient safety coordinator at the patient's bedside recording every 15 minutes from the minute he was down in the ER all the way up until this event of just his, you know, behaviors and stuff like that. Now fast forward 24 hours later to what we're all here to discuss.

And 15 minutes before that event, and they're in the record. You know, there was no issues going on. He wasn't doing anything inappropriate, but he had started complaining of chest pain again. At this time, the nurse in question went in to go check on this patient, to start redoing vital signs, et cetera. And this is where our event occurred. The unfortunate incident from the start of the event lasted less than 30 seconds. From completion of.

What occurred, it took another 60 seconds for the patient to not only get out of our hospital, but to also make it out to a major highway or major road system called Southern Boulevard. Just so you guys have an idea of the time frame. So in less than a minute and a half, the event occurred and this person was gone.

During that time period. My nursing staff in the. My leadership in the emergency department is part of our code BERT team, or behavioral response team. And they were at our nurse's bedside within a few seconds of this event occurring, and they started to render care. This event also included my administration, my CEO, who is a pretty exceptional man, and a former paramedic, flight medic, like a lot of you on this call. And he handed a bag valve mask to our cmo, who was a trained obgyn, and my nursing staff, and they went to work on the patient, and he pursued the suspect on foot. At this point, they in turn, you know, brought the patient down to me. I was in phone communication with my nursing director to kind of really get a better picture so I can get my room ready. You know, we didn't really have the luxury of having a nice encode, so I was ready for, like we normally would from an ems. So I used my nursing director as my end code to have my room prepped in whatever I needed. We intubated her within minutes of arrival, had did full trauma scan and had her out our doors on a helicopter in 40 minutes. So that's the, the way the events all portrayed now. It was in 14 years of doing emergency medicine, this was the first time I've had to experience this. And it was definitely something that I'll never forget. So the end of, end of talk for me is I'm so appreciative of this group that's on here and the pushes that we're going to be making for, for changes to protect not only our nurses, our physicians, but our medics and everybody in general that is entering in the hospital. So, Peter, I'll turn it back over to you to kind of see how we go from here, sir.

Dr. Drew, thank you so much for clearing up exactly what happened when I listened to the media and then I called you, who is 180 degree different story when you, when you recognize how great your CEO Jason Kimbrell, amazing guy did and your cmo, now I'm learning the CMO is involved and the fact that he had the will to go chase after the guy. What CEO does that while he's calling 91 1? You guys are under great care. So thank you for coming on the podcast today because it's very easy to have these media outlets just go click bait, right? And automatically they try to blame a human being who actually stepped up to the plate. And we all know his quality and the type of person that he is. So kudos to him, kudos to you and your entire team. And we really hope that this nurse makes a full recovery and I hear she's doing well. Okay, thank you, Peter. You got it. Thank you. All right, now we're going to move to let me get the spotlight on our next amazing guest. So for those of you who have been following the floor EMS webinar for some time, you know Trevor Wolf, I've known this man for many years. You can see that he's working today. He's a flight nurse. But much more than that, he has his own personal story. And not only did he.

Suffer from that story, but he actually made the next next steps to actually make a difference and make an impact. And that's really why I wanted to bring him on today. And he's got things that are happening as we speak that he's working on that I would like him to speak about. So out of the St. Louis area, Trevor Wolf, thank you so much. Take it away, my friend. Thank you.

It's always, always an honor to be here. I appreciate it. And Rich I'm so sorry you had to deal with that situation. We, a couple years ago had a nurse and a medic who were stabbed in the ED here medical, stabbed in the back. Nurse was stabbed in the head and the neck a couple times, holding her own pressure on her carotid as she bled out. Thankfully she survived. I work with her now and she's an asset, but obviously she can't ever work in the healthcare field again. And really she's losing her house soon because she can't work. But beyond that, I just want to kind of give that as a perspective for the downstream effects of these things that happen.

I got my start several years ago, I guess probably about eight years ago now after about after telling a new young nurse the words that I hate to hear as it's part of our job. He came to me with a concern that the more often he deals with patients like this, the more he's afraid he's going to hurt them. And we understood and he ended up getting out of the ED and going to the OR because of this specific thing. So it was the day after that that I told a nurse that she couldn't bring her patient out. She had an IV in, she's a known drug user, she wanted to go out to smoke. We couldn't guarantee what was going to happen. I was, you know, patients OD in the parking lot with our lines, right? So she didn't like that information and she came out and decked the nurse and laid her out. And that's when I called a guy that I knew who was a police officer who then became part of the Missouri legislature. And I said, dude, you need to make a law. He says, okay, let's deal with this, let's do this. And then, you know, I obviously slept through civics because I figured it would be at least a month before we had a good law in place. Right after I tell a legislator that he needs to make a law. Thankfully I got a bit of an education on that in the process. About four years later we actually had a couple laws in the meantime a year before actually the governor signed it in. Now we had a guy come in with a meth induced psychosis who laid me out. And I actually, I had a brain injury that took a good, good two years to get over. It took about two years to be able to put speech in good patterns. I had to get out of patient care. I just could not take the chaos that I usually thrived on that you really have to be able to thrive on and focus on to do this job, right? So Missouri, we passed. First of all, we got back to where health care workers are special victims again. Missouri gotten rid of all the special victims, because prior to that, everybody was a special victim. You know, somebody who carried blue scissors was a special victim for some reason. Missouri. So they got rid of all of them, and now it's basically police and healthcare workers. So simple assault gets elevated to a felony. But I don't necessarily like that being the end, because I'd rather prevent than just punish, because punishment only helps reduce crime by maybe 10% at the most. And most of the time when we're dealing with people, they're beyond that threshold of being able to talk to them and talk them down so they will not think about repercussions. They will just act. They get into their amygdala and start having that primal response. And you cannot deal with these people. You all know these people, and these are the people who put us in a horrible position of what to do with them safely, for us and for them. So we created two laws that kind of mirror each other. One's for healthcare facilities, one's for ems, just because they're in statutorily different areas. So you have to create a mirroring law. And it's interfering with them. So calling, harassing, threatening, making loud noises. I mean, it can be, you know, if you feel as though somebody is interfering with your ability to care for others, instead of calling the police and having them take them away under the guise of.

Oh.

Guys will be in there when they're not supposed to. Trespassing. Thank you. Sorry, guys. Trespassing, which the hospitals won't prosecute, and I understand why. So the cops really take them away in a bluff and nothing happens. We give them a. We take them, they get a very small misdemeanor, a class D misdemeanor. And what it is, is a way to take them, cite them so that it is documented. And because it is, does elevate with repeated offenses and indeed de escalate. And the point is to stop a felony from happening before it happens and stop an injury from happening before it happens. We don't need more felons, right? So if it does happen, I'm fine with it becoming a felony. I want that to happen. But in the moment, doesn't make any difference. The other thing we did is a lot of people are reluctant to make reports because, you know, a lot of nurses are young, single women, and they don't want to be stalked rightfully. So. So we made it in this state to where if you make a police report against somebody for, for violence, that you only have to give your name and the place you work up until when you are required to give your information in court. So that was. That's also helpful. We've dealt with a couple of different things. Right now we have a project going on with the new county prosecutor in St. Louis county that will include three other counties in the suburbs and exurbs around St. Louis. St. Louis isn't known for being the calmest place in the world. And the PA is typically where we see the barrier. For the longest time, police were always our friends and they still are, but so we could call them, they make a report, person be arrested, things that happen. But then they stopped even doing that and largely because they felt though the DA wasn't going to do anything. So we have a new day. She is. She is amazing. She was the prosecutor on Tammy's case, the one who got stabbed. And so before she was even in the PA position, she was. She's been part of the program for years. She created her own task force. Even when the current PA told her to disband it, she kept it going. And she gets with all the police chiefs in the area. We have one of our big three health care systems who are actually thankfully on board because that's extremely important. And he is the former police chief of the county. So it's very helpful. And we are discussing what the laws are because not every officer knows every single law all the time. We just had a case here in the hospital I'm based at to where the officer didn't know that nurses, specifically in the emergency department are special victims. So part of it is education to these officers and compliance. So we have to build that circle back of the officer wanting to take the report because the PA will do something about it. And the hospitals are another thing because we got it. We really have to get them to get their tail out of between their legs and admit there's a problem and work with the prosecutors. Jason Tsapora out of Wake Forest has done an excellent job at Wake Forest. His. I think it's. I think it's Atria Health, that group. He's done an excellent job. He's also had some very supportive executives. So hopefully when we start doing this, we'll start seeing some data. Now we see that in the healthcare system, in the hospitals, only about 22% of incidences are reported in EMS, only about 2. Right. So it's very hard to get any data. And the hospitals are worried because they're going to see initially an increase in. In instances. They're not going to see an increase in instances as long as we take it statistically into account that we should not see more than a five times increase, because that would be statistically significant. EMS is hard. We tend to deal with it and move on. We don't report and that will cause other problems. Had a nurse reach out to me who was molested at a hospital. The same person molested the medic, but they didn't do anything about it. So it just kind of kept going forward and then it was hard to do anything. So part of our problem is that we need to address this as one, even though we have very diverse voices and we need to make sure that we're really taking care of each other and reaching out to the right people and tenacious about it. My goal with, with the project, with the PA and this goes into politics a little bit. One of my things with politics is you don't have to love the person you're using, Use them as a resource. You don't have to vote for the person, even like them, but use them as a resource to get what you need. And so I would like to eventually get a hold of Mr. Kennedy, the new HHS secretary, and see if he's willing to look into this. This costs us billions of dollars a year, is directly responsible for a lot of the.

The lack of recruiting and the people who are turning over and burnout. So that's kind of my goal with this. I'm gonna cut it off there because I see a couple of questions and I want to have time for that.

Yeah. So we're actually going to leave the questions for the end. But there are some alarming statistics right there that you mentioned that I don't think many people have ever known before. The significant under reporting of these events is very concerning.

How are you?

Oh, someone's mic is live there.

75% of all workplace violence occurs in healthcare, and that's taking into account that only 2% are reporting EMS and 22% in healthcare. So in the system.

So, yeah. And this is a perfect segue to our next guest. And Trevor, please stick around because I want you to have be on for questions because I know a lot of people are going to ask questions here, but. Mark Grossman, are you there?

Ah, there he is. Perfect. Let me spotlight you for a second. All right, so let me give a little intro. Mark and I are very good friends. Mark.

Used to live in Miami and was A medical director for Miami Day Fire Rescue, now is up in New Hampshire. He works at Portsmouth Hospital. He's the medical director for a number of EMS systems there. But Mark, like Trevor, is very special person. And he doesn't just do, like, what's good for Mark. He does what's good for everybody. And when I heard the story that he's about to tell, I said, mark, the whole world should know about what you did. So, Mark, if you wouldn't mind telling us how you took it to the very highest level and got a law passed to protect you, your nurses, paramedics, and all healthcare professionals across the state. Take it away, my friend.

Thank you, Peter, for the undeserved accolade. But.

So when I worked in Florida, I was actually assaulted myself. And it was a local police department brought in a patient that was drunk and had to be restrained. He was acting up and violence. And he called me in, said, doc, you know, I just want to apologize. Can you come a little bit closer? And the one extremity that wasn't restrained was his leg. And he kicked me in the head and sort of knocked me down to the ground.

And I called the police, and I said, listen, the guy just assaulted me. He's threatening to assault everybody, basically. And I'm clearing him like, he's awake, and, you know, you could bring him to jail. I got a phone call from the prosecutor a few weeks later that he's agreed to go to inpatient psych for a year as a plea deal instead of you having to come and testify in a trial. And is that acceptable for you? And I said, yeah, of course. I don't want to go to a trial, necessarily. And so I figured that that was the way things worked. And what I. I didn't realize I. I'd seen violence, but I never experienced it personally before that. And I've been doing this for, you know, a while.

But when I moved to New Hampshire, it was totally different. It was. First of all, they just passed a bail reform law, like, a year or two before. And what was happening was they would arrest people that threatened to kill their parents or threatened to kill somebody, and they would bring them to the hospital for clearance and would actually call for a bail bondsman to come and, like, basically bail them out, and then they leave them with us. And I'm like, what am I supposed to do with them? Like, they're not crazy. They're a criminal. Like, they threatened to kill somebody or they tried to kill somebody. They should be in jail. And then what they would do is bring violent patients to us.

And they would say, you know, they. Let's say they would drop them off, leave them with us, and then they'd start attacking other patients or staff or myself. And we call the police, and they'd be like, well, we didn't actually witness it. So in the state of New Hampshire, that's actually a misdemeanor. We'll write them a ticket, and then they'll have a court appearance, but we won't arrest them. We can't take them to jail. And they said, you know, unless we witness it. So then there was an occasion where they witnessed it, and they said, well, it wasn't deadly force. And I'm like, when did. Why do you keep moving the goalposts? Like, at what point do you arrest them? And it's literally if they try to kill you or if they kill you.

So I got involved. I spoke to our governor. It's a very small state. I know both senators. I know one of them very well. And I knew the senator from another occasion, and I called him and I said, we really have a problem here. I'm not sure you're aware of it. And I explained it to him, and I said, you are your constituents. Like, these are the people that you're supposed to be protecting.

And I got a state senator who's a former nurse or I guess a current nurse, but is also like, the trauma coordinator for Dartmouth, and she's been a great advocate. She co sponsored a bill. And I went to the state.

Legislature and I testified three times about violence in the workplace for healthcare workers. And I said, you know, during COVID we were the heroes. And now basically, like, we have no protection. And people are angry, they're frustrated, and they take out their aggression on us, and we're not safe. So they changed the law. They debated it, and there was opposition from the aclu. They said, well, some of them are psych patients, and, you know, we're, like, targeting them. And I said, you know, we need to be safe. PTSD is a huge issue in healthcare, and this is one of the major factors contributing to it. You know, burnout, whatever. This is a very concerning thing. And the ACLU basically couldn't really. Their argument didn't stand, so they changed the law. The law is now that. Oh, and then the other thing they would do is victim shame. So the police would come and they'd say, well, you don't really want to go to a trial, do you? And you don't want to give your name and give your home address. And it's like, well, they never had to give their home address. They could just give the hospital address. So instead of the police victim shaming, they changed the law. You could give the hospital address first. Say the state like hospitals were had to record these events and submit them whether or not the police came any workplace violence issue. And then a year later they changed the law to say that if we call the police they have to respond and they have to remove the silence.

The problem with it has really been the dissemination of the law. So it's still not even. And a lot of the police departments don't even realize that this law exists and have to like show them on Google that this is the law. The law is that you have to remove them. And whether or not they bring them to jail is up to them, but they have to remove them and that person can't come back. If they do, then they get trespassed and then they would go to jail.

What I wanted to mention was there's actually a federal law and I don't know if you discussed this earlier, but the Safety from Violence for Health Care Employees act, which is the SAVE act, which I guess is easier pronounced than. So we. Whatever really would be. It was introduced in 2013. The problem with the law is that hasn't been passed. It's already passed through two congresses and it has to be reintroduced, which hasn't been done yet. But it was co sponsored by Joe Manchin who retired and Marco Rubio, who's no longer a senator. But kudos to Marco Rubio for supporting this. And this would basically give federal protection for healthcare workers against violence across the country, no matter what the setting is. And it's the same protections that are afforded to airline and airport employees, which is an enhancement. It basically becomes a felony to attack a healthcare worker. What I would urge everybody to do is reach out, get involved, reach out to your congressional delegation, your senators and your local representative and say you need to support the SAVE Act. That's what I did. I reached out to our state people. So this is me with the governor when he signed it. That's also my son for reference in the middle, just so you can see how tall I am. And he signed this act and I got a free pen out of it that said Governor Chris Sununu. And I was very proud of this moment. And you know, I didn't realize at the time the impact of it, but this really affects every healthcare worker in the state.

Now why do you go from one state to the next and they health care workers aren't protected. It doesn't make sense to me. We really need to get this federal law passed, the SAVE Act. Reach out, do what I did. I actually spoke to Senator Shaheen, who I know very well, I spoke to her health care policy person yesterday, and he said that right now this bill is sort of has to be reintroduced this year and they're looking for sponsors for it. So I'm going to lean on her to be a co sponsor. I also spoke to the New Hampshire Hospital association president yesterday. This is really being supported by the American Hospital association and each state has their own arm of that. But reach out to your local hospital association through your state, reach out to your congressional representatives and your senators and say that this is something that needs to be passed. I know that on the AHA website there are links to like send those automated letters. I would encourage you to do that. And if you have any connections with them, please reach out to them. I know a lot of people that are on this are in Florida. Your current senators really need to pick up where Marco Rubio left off. And we need to get this law passed so we're all safe. And it's a universal law across the country. But we shouldn't have to live in fear, we shouldn't be in danger, and there needs to be consequences. It's about prevention, it's about keeping us safe, and it's about consequences if somebody does that.

Mark, amazing, amazing work. And it's striking to me that this thing was put into play, or at least they tried to pass it over a decade ago. And you have it for the people who work at an airport. You don't have it for the people who are protecting the lives of their community, paramedics and nurses and doctors. So hopefully everyone got out of this some very kind of overall broad points, which is that this happens quite a bit. It's under reported. There aren't laws that are in favor of protecting the healthcare professional. And in order to make things happen, we have to advocate and the concept of advocacy on the hospital side. I think hospitals have to get involved on the EMS side. So namsp, I know, has a big advocacy program. So we all need to get involved. So here we are. I'm going to bring Dr. Pepe in because I know he's about to pop over to his other webinar. But Dr. Pepe, you've heard what you heard. You want to make a couple of comments before you.

I just want to say this. We ought to, we could continue this conversation further, I just want you to know is that Ray Fowler is kind of a relative hero. We all know Ray. And beloved, beloved Ray Fowler. And he was shot at, almost got, almost got killed with a gun in the emergency department itself. And so just, I'm saying we could continue this even further. There's a lot more to it. This is just the beginning. But the most important thing is what you heard from Our players from St. Louis and Mark in New Hampshire to get legislation done. And making this something known is really an important thing. We have lessons to learn for them so we can make sure this happens. It was very interesting because today I heard a report from local Dallas television station and what they said was that the legislator, legislature was looking at all these various bills they want to put through, which had nothing to do with the. What the general population wanted to get done or thought was supposed to get done. So it just, you know, so as we heard, the political aspects of this, what it took four years, he said, you know, that kind of thing. Right. So are important. So we got to get at it now. That's that. So very good. Good job. This is very nice, everyone. Thank you so much. And Mark, good to see you again, buddy. Give my best, Give my best to library.

Yeah, thanks.

I'll see you later.

Bye. Bye.

All right, well, we will be right on the other side. Dr. Pepe, let me, let me bring it over to my co host Tanner Smita. Tanner, I see that you posted an abstract. Give us your thoughts and then we'll open it up to the crowd.

Sure, yeah. So again, in leading up to this presentation, I looked for some data to kind of contextualize this to EMS clinicians. Specifically in the out of hospital setting. You know, we could be perceived as being at even greater risk than in the hospital setting given the fact that there's limited personnel, there might be multiple assailants. Sometimes you're by yourself one on one with the person in the back of the ambulance who might be bigger or stronger than you. And so just to start out in terms of kind of the epidemiology of violence against EMS providers, the first prospective study I was able to find was published in the Annals of Emergency Medicine in 1998. Senior author Corey Slovis I think is known to many of us. And they found that in their single EMS system, which served a population about half a million people, they had one instance of violence about every 40 hours in their system. Another more recent characterization. The first author Here is Saranya McGuire, who's published a ton on workplace violence in EMS. It was a prospective study within a large multi state EMS agency associated with the Mayo Clinic. And they found that it was about 1 in 100911 calls were associated with workplace violence, which was defined as either verbal abuse, physical assault, or both. And as we've touched on previously in this presentation, only 2.7% of those runs that were captured by this, they kind of modified their charting software to require reporting of workplace violence for every 911 call. They found that only two points, 7% of the violence that was captured by that tool was actually reported through official processes. And they found, and if this is, I guess, kind of a way that we can move forward as EMS agencies and as medical directors implementing that kind of online required reporting, with every EHR that I think it multiplied something by like a factor of 30 the report reporting of Workplace Violence. And so then moving on from that, right? So, so we have an episode of violence every 40 hours or 1 in 100911 calls. I went on and tried to see, okay, so what have people done? What has been published about mitigating violence against EMS clinicians and making our clinicians safer out there in the field? And I found a really interesting paper that was actually published just at the end of January, January 29th, in the JAMA Network Open Journal. Once again, first author, that's Sir Anya McGuire, who's published a ton in this space looking at the association between equipping EMS clinicians with body armor and then some, some consequences both for clinicians, then also for processes of care, including patient refusals. And so they actually found that clinicians who opted to wear body armor, it led to increased patient refusals in the field. And so it's possible that a consequence of protecting our providers with stab proof vests, bulletproof vests, might actually impact the care that we're providing the patients, which I thought was a, an interesting perspective. It also actually increased workplace violence for crew members who wore ballistic vests. So it increased it from 0.85 cases per 101 runs to 1.11 cases of workplace violence per 100 runs. So an interesting piece of data that was published recently from the same group, so the Mayo Clinic Ambulance Service, they also recently published, it was actually presented at NEMSP this year, a survey of EMS clinicians looking at how behavior could possibly be modified if we collect the data on who had enacted violence against EMS clinicians in the past and then provided pre alerts along with dispatches to addresses where violence had occurred before or if you know, patient names were identified for patients who had, you know, perpetrated violence against police officers, EMS clinicians, et cetera. And they found that the majority of respondents would modify their behavior so they would either, you know, wear ballistic vests, they would make sure that medications for chemical restraint were more readily available, they would contact supervisors, request a police response. And so moving forward, as we think about ways to protect our providers, potentially these kind of pre alert systems, keeping track of who is perpetrating violence in our communities and enabling our providers to better prepare when we're dispatching them into dangerous situations, that might be an avenue moving forward. So, but again, thank you all very.

Much for presenting wonderful review and that's some fascinating data right there.

And I love this idea of. It's almost like AI right, we ought to know who we're going to, we ought to know their history, what they've done before and obviously doing it in a manner that's appropriate so we're not also doing it in the reverse and stereotyping, which I know some people would be offended about as well. But thank you so much. Tanner. Let me, let me open it up and I see, Sarah, I believe you on LinkedIn or Twitter said that you wanted to get involved in this conversation. Am I right? Is that you?

Yeah, that's me.

Thanks for joining us. Appreciate it. Tell us who you are.

I.

I know and have seen and lived this for 25 years. This is nothing different. Where I struggle is the lack of action, you know, and it really. We can talk about all the data we want. We can look at all of the invalid support systems that are, we think are out there. It is time that everybody just gets real, you know, and because where's the action? It's not going to come from senior leadership. We've seen that. Yes, we're very fortunate that this, the gentleman who spoke and his CEO is there. But that is the, that's the rarity. And you know, I don't.

It's going to be from saying no and it's going to be from saying no to senior leadership. You know, there's all this stuff that happens in what I said in my post. We're lumping this on mental illness. It is not mental illness. It is not, you know, and it's cushioning it. It's dismissing real mental illness. It is excusing. And if you go back and it's just what has been done. The legal system is not on our side, it does not protect us. So we're in a position that either we do this ourselves or we're done.

Right.

You know, and it does require, I'm speaking from a woman's perspective. It requires the men to speak up and say no to the senior leadership. Because the women saying no looks like we're meek, we're weak, and we don't want to do it, that it's too much. But until the men start to say to the CEOs, no, we're not going to do it.

Have fun.

Have fun with your ER swamped. Have fun with the streets filled.

Have fun.

I mean, action is where this is. At this point.

We're not dealing with anything new.

It almost makes me wonder with how, how bad it's gotten, especially since COVID and you know, you, you make a very emotional plea here. How do they even recruit and retain people anymore? Right?

They don't.

Who are, who, who are the people coming into this profession to get beat up, to get spit on, to get.

We have nurses walking onto our floor and turning on and walking right out.

That's right. The, the emergency department is a, is like a one year stepping stone now. And they go to the PACU they're in and they go somewhere else where it's safer, it's, it's, it's cleaner.

And it's a big problem. And I agree with you that the hospitals need to step up. They have a big lobby. They have a very big lobby. Earlier, it wasn't really mentioned, but the way and Paul mentioned it, but the way laws get passed is you have a lobbyist and the lobbyist goes and changes the law. Little folks like us, they'll talk to us, they'll shake our hand, but then they unfortunately look for more than money.

I believe, and I don't mean to jump in, but I believe that's where we're deluded. We are seeing very clearly how this system is run globally that sometimes.

But I will tell you, I wrote all of my bills with legislators and, and I had. It was my language that was chained a little bit changed a little bit. But it has been, I'm sorry to say we've gotten a lot of positive toward the hospital association, but it's been. The hospital association has been blocking a lot of my things. They've actually been kind of my antithesis. And one of them, we had almost $4 billion that was about ready to be taken out of some of the unused Covid stuff to go toward workplace violence prevention in the nation. That was unfortunately defunded. So we didn't get it. But it was actually the hospital association that nearly blocked it because we didn't want to just put training in there. Now we've been trained to death. Retraining is the weakest form of reform. So all the training. I'm sorry, but we shouldn't be using new funds for. To fund old things. I'm sorry, I'll leave it there.

No, no, no. I agree with you 100% because we're not the problem. We're not the issue. So why are you trying to train us? What, to survive? I could go into the military. That's my choice. But to your point, yes, we can spend all this time and money and legislator, but guess who's making the final decisions? The 1%.

Right.

And that's it.

Right. And so just for the sake of time, I know we have a lot of other people. Sarah, thank you so much.

Yes, sir, absolutely. Thank you for letting me talk.

And you're always welcome here. Let me get Gordon Gordon out of DeSoto Parish EMS out in Louisiana. I love your comment, want you to say it out loud.

Yeah.

So violence is violence. Unfortunately, healthcare workers are expected to be held to a different tier than like law enforcement. I have a perspective from both. I've been a SWAT medic for 16 years, and if I have a violent incursion in that part of my profession versus in an ambulance, there's two different continuums of force that I'm going to take. If I'm in a law enforcement aspect and you try to hit me or assault me, it's going to be a very bad day for you. In an ambulance, I have to dial back that continuum of force a little bit. In law enforcement, we use what's called a continuum of force. It's basically how much force we respond to force put on us. So we usually level up. So they try, you know, hands on, we may go taser, chemical dispersant, baton. Lethal force is lethal force, unfortunately, and I have seen it many times where healthcare workers are expected to just take that if somebody is trying to cause physical harm to you, you should be able to defend yourself. That is a human right and what you should be able to do. And unfortunately, you know, there are people that don't understand that somebody who makes a decision and gets drunk, that is not a medically induced thing. They made that decision just as if they got in a car and drove and caused negligent body bodily injury to somebody or killed them, they would be charged for that. It's the same thing as hands on violence and it should be looked at like that. These patients Are they're not medically induced patients. It's not some kind of medical reason. It's narcotics or alcohol that they've chose to do, and that's a decision they've made.

Yeah, great, great point. And great to get your perspective from both sides. I was recently on a call with a guy who we had. We had the police there, they had all the prolific, you know, gear on, and they saw that and the guy got more aggressive and we finally talked him off the ledge. But then I found myself riding in an ambulance with a guy who's former military drunk, and I'm sitting right next to him. He wasn't restrained because I'm just trying to talk him down. But I could just imagine if this guy wanted to kill me on the spot, he could have very, very scary moment for me. And it really made me aware of what our folks go through in that little, little box. Right. And also in a small hospital room. So.

I want to, I want to close it down, but I know that there's some other people here. Is anybody else I see, Brett or anybody else want to make a comment before we, before we end? Go ahead, Brett.

Dr. Greenfield, make a quick comment. Thanks, Peter. And this was absolutely enlightening. I mean, I've had my fair share of, you know, encounters in the emergency department and in the out of hospital environment. And everybody is spot on. We are just not considered essential.

Right.

We are looked at as a commodity and the workforce is stressed. We are beaten down, no pun intended. And it's really a shame when you see people trying to defend themselves and then you're told by administration you should not have raised your hands to a patient who's literally potentially trying to take your life. So, you know, there's legislators to hear that hospital associations are, you know, kind of advocating for the usual. Let's just educate our clinicians. They're not educated enough. It is frankly just so waning. And to see what happened at Palms west, you know, thank God this, you know, everybody responded the way they needed to. Although you're right, there's a lot of clickbait nonsense that was on there. And you have to take everything for granted. Well, you have to really kind of look at what's being put out on social media. So everybody just has to be safe. I mean, we're fighting right now with our legal department, where I have a major concern about psychiatric patients who are voluntarily being transferred to a locked unit with 10 touch points to get out with full time security into an ambulance, whereby regulations I cannot lock and if it's voluntary, we are not allowed to restrain them. And you know, we had our sentinel years ago where somebody consented to, you know, go to the hospital for behavioral health care having a psychiatric emergency. And literally we have it on video, 10 seconds she was outside. So when everybody says call for help or ask for backup, you're talking about seconds. Nobody's going to be there in seconds. It's you and that's it. So, yeah, we have a lot of, you know, systemic and structural problems that need to be addressed in every environment. So, yeah, I really appreciate everybody being very honest. I think we all are in solidarity about what's going on. The question is, who do, whose ear do we get to get things done and taken care?

Yeah, great, great comment. And on the pit last night, the administrator came down and was totally clueless, right. And Noah Wiley basically said like, you don't get it, what's going on here. So once you watch that episode and then Jana Alley. I think this is the second time Jana has joined us here at the Florida EMS webinar. Yeah, go ahead and make your comment. Thanks again for joining us.

So I was assaulted in the ER watching that show last night on the pit. You better believe watching her get punched. I was punched in my face. I was urinated on and it was a Baker act patient. I am in Florida. This was two years ago. Listening to everybody is saying, I agree with everybody on so many levels. And Trevor, you and I need to get together here and have some conversations. I am involved legally. I am doing a massive three part series on nurse violence on nurse.org coming up.

What Brett said. I screamed for help and nobody came and I was beat and there was no security. When after I was done, I had my face punched in. I had just had a bloody lip, broken it like I fractured finger. My friend got bit trying to help me out. I was forced to finish my shift with an ice pack on my face and I was not able to go to CT to get care. Best part, the hospital sued me for payment. Long story short.

Wait, wait, they sued you?

Why?

They sued me when I sought to get help after for ptsd. They said that they, I put it under workman's comp. They said I did not and they went after me and they sued me and put me in collections because I would not pay the bill. Anyway, that's taken care of. What I want to talk about really quick and I want everybody to think about this is I actually went back and got my MBA specifically to learn how to fight the system. And I recently finished my MBA because healthcare is a business. I am a future lobbyist. That is my number one goal is to lobby for nurse and healthcare, not just nurse. This is a health care problem. I constantly speak in Volusia county where I am about how ridiculous the EMT and paramedic pay is. The fact of what these, what you guys do and the pay that you're paid is a joke. So I'm constantly looking to ways to help healthcare any way I possibly can. This is on the hospital. Why are we at the burden of putting in metal detectors and why are we signing and lobbying and you know what, here's the deal. I just went through a metal detection system here in Michigan at a hospital that I'm working at right now. I just walked through and you know why I walked through? Because I'm a female and I smiled. I put my thing with my, my bag with my, my computer.

That.

That's not it. The, the, the metal detectors are not it. And that's to say I was punched in my face. People are getting thrown. We don't need a gun. I mean, I'm not against it. Don't, please don't think I'm saying that we shouldn't have it. We absolutely should. But we need to go after it. Where reimbursement rates are concerned, we need to have leapfrog involved in this. Leapfrog gives safety ratings and safety grades to hospitals. So why are we not going to leapfrog and saying there needs to be a metric made that depending on the nurse violence and the health care violence. Not just nurse violence. Anybody that steps in your hospital that is being paid, the people who create profits for you, we are making the hospital money. If they are any way assaulted or hurt, Leapfrog needs to report that and it needs to be made a safety grade and it needs to be reported to the public. So we need to get on board. And everybody here needs to reach out to leapfrog. They're an independent. This doesn't have anything to do with hospital. It holds their feet to the fire. We need to go to CMS and we need to say their reimbursement rates need to be affected because the nurses who are beating your, who are getting beat are automatically affecting the care that we are providing to your patients. If I am coming to work, I quit my job because of severe ptsd. And anybody on here who's been assaulted, you know that there comes with a level of PTSD that is it going to happen again? I have been in a CT machine more times for nurse assault violence than I have for my own personal health care. I have been assaulted so many times I can't even count. And this is not right. And it affects the care that we provide for our patients. This is a hospital problem. And while I agree that legislation needs to be made, yes, we can make him a felon. The last assault that I had, the guy has three felonies.

Cool.

He's got a fourth. But what the bottom line is, is we need to make it accountable to hospitals. But like Trevor says, they are going to fight it. You better believe they're going to fight it. So as we're going up to hospitals and we're talking about them, I've done the same thing. Let's get on. Let's get on board. They all they want to do is throw a metal detector at it and say, yeah, we fixed the problem. Let's go to leapfrog, let's go to cms. Let's have the outside sources make the hospital accountable. Because I guarantee you and I know everybody here agrees, if the hospital is reimbursed, less and less money comes in the door based on the principles of how your healthcare staff is perceived and is taking care of at work, they'll make the change and we won't have to do anything. So that's all I have to say. This is my passion. Please, anybody reach out to me with any ideas. I'd love to work with all of you guys. And my goal is to be a nurse lobbyist and that is, I'm well on my way. So love to alert with all you guys. Everybody had great, great things to say. Dr. Grossman, I definitely know who you are and what you've done, and I'm really excited to see where we can go and where we can make our healthcare staff safe.

Thank you, Janet. Let's go to Trevor for a quick comment on that because I know then I want to. I want to close it down. Go ahead.

Sure.

Very quickly. You're right on point, Jana. CMS is my goal to get to Secretary Kennedy and we actually need to make some adjustments to him. Talis, currently, it is rules without responsibilities. It's a wonderful law to protect people, but there are certain things that need to be involved with this that have changed since, what, 1978, I believe is when it was written. So that's all.

Well, I think we have found our champions. So we have Rich Durow, Trevor Wolf, Mark Roseman, Sarah Schaefer and Janet Alley. You all really have done incredible things. You are incredible speakers for this. Let me just go around the horn and give our speakers the last word. So, Mark, let me start with you.

I just want to say right now I'm in a. I don't want to get in trouble. Major trauma center serving inner city population in Boston, like, as of right now, where. It's where I am. And they actually have an interesting system that I've never seen before. They flag patients that are at risk or have had incidents of violence in the past. And they'll do what's called a. Like a rapid evaluation. So they'll bring them back from triage rather than making them sit and wait and whatever. And they'll put them in a trauma room, get them. And the goal is to get them in and out, like in 10 minutes. And they do it. You know, I'm here for a cough. Your lungs are clear. Here's an albuterol inhaler. Please don't kill me, right? And they discharge them. And it works. I've never seen anything like it. It's literally like the fastest in and out that I've seen. And I think that that really makes a big difference. That's the one thing I've seen from a hospital.

Angle that has. That seems to work. You know, this whole thing with metal detectors. Well, we don't like the public perception place like Florida, New Hampshire, where they have, you know, very.

Free carry laws. They say, well, you know, we don't want people. Somebody has a concealed weapon, we don't want them having to take it out. You know, bullshit. Come on. Like, you know, our safety is much more important than public perception. So there. There are simple things, simple tweaks that we can do to keep. Keep ourselves and keep each other safe. Don't stop fighting. I mean, not physically, but don't stop advocating for yourselves. If we don't do it, then nobody else is going to.

I think you ought to join Jana's lobbyist group. Trevor, take us away.

Again. I think, you know, it's multifaceted. From my experience, you have limitations at the state that are federal stuff. And then dissemination, like Dr. Grossman talked about, of laws to law enforcement to see how to enforce things. So it is from the top to the bottom there. Sometimes the big sweeping laws like Save the SAFE act have some pretty major flaws in there. So sometimes I have seen that the small things that pick away will have a lot more benefit. And then again, getting in with your prosecutors in your county to ensure that everybody's on the same page is essential. So another thing that I've seen that always concerns me, looking back, is how we lumped behavioral health in with psychiatry. And ED has become a place for. Obviously, it's appropriate for psychiatric patients, but why are we just dropping off every drunk jerk in the ED and then signing an affidavit saying they're a threat to themselves or others? Because they don't want to deal with them out in the streets. And that just puts us in horrible danger. And that stuff needs to stop. There's no way to legislate a cop. Not saying hospital or jail, but that kind of mentality definitely needs to stop. And, you know, I'll leave it there. I think I opened up a. Another ball of worms.

Yeah. Well, listen, I mean, you have some really smart people on here. I. I have three boys. Right. I think they're all pretty smart kids. None of them want to go into healthcare. Not even close to wanting to go into healthcare. They see what I've gone through in my career, what I deal with every day. They hear the. The calls I take on a daily basis, and they look at me and they're like, that's what is going on in healthcare. Yep, that's what's going on in healthcare. So. But we'll stay positive. We're going to follow the lead of our incredible speakers today, and I'm going to add Jana into that one and really appreciate you guys coming on. Pope is going to get really upset with me that I kept you guys here for an extra 30 minutes, except for myself and Kendrick, Smita. Thank you all so much, and we'll see you on the next next week's webinar. We are booked out till May or, sorry, till June. Now. We have so many speakers that want to come on this webinar. And, Jen, I'm going to give you the invite so that you could be the principal speaker again on the same topic, because I think you're very well spoken, you're doing a lot of stuff, and your story is very powerful. So with that being said, Happy Friday, everybody. Hug your family, stay safe, and we'll see you next time.

Thanks, Peter.

Thanks, everybody. Be safe at work, Mark. Thanks, Trevor.

Appreciate it. Have a great day.

Thank you. Thanks, Tanner.

See you, guys. Bye, everyone.