An individual in our community was recently arrested after a shooting spree in his own house, his second arrest involving a weapon. No one was injured, but he was brought to the hospital for a psychiatric evaluation, and then committed to a psychiatric facility. As he left, he made veiled threats about future events, and it is well known that he has animosity toward the hospital and its staff.
As of this writing, he is free of both commitment and incarceration, and we're scared. Why shouldn't we be? We practice in a small, rural hospital that has armed police officers for eight hours of the night, Thursday through Sunday only. Other than that, it's unarmed security with pepper spray, handcuffs, and expandable batons. We don't have secure entrances, and so we don't have any really effective way to prevent him from coming back and continuing his shooting spree at our facility.
'Tragically, we aren't taught to defend ourselves.'
Of course, we can call 9-1-1. We live in a 9-1-1 society. That is, our cultural tendency is to think that whatever trouble we encounter with dangerous people, the answer is a quick speed-dial to the police. The problem, as every doctor knows, is that it only takes a second to wound a human being fatally, whether with a firearm, knife, blunt object, or bare hands. And there are only so many laps one can run screaming around an emergency department while being chased by a murderous lunatic until that fatal wound occurs. The police cannot magically transport themselves to our hospital to save us. They are constrained by time and space and by their day-in, day-out work of trying to keep the general community madness to a minimum. Even the tragedy at Columbine High was basically completed before law enforcement made its assault to stop the carnage.
This makes our job frightful at best. We see people all day and all night who are potentially and actually dangerous. I have learned down the years how to shake hands with and do a thorough exam on someone wearing handcuffs. But those are just the ones who have been caught. What about the others? What about the agitated, angry drunks, or the paranoid schizophrenics? What about the group of young men and women I saw late one night who, it turns out, were wanted for armed robbery in another state, and were considered armed and dangerous? In the face of so much danger, both malicious and psychiatric in origin, wouldn't it seem rational to protect ourselves?
I'd like us all to have police officers available all day, every day. But it usually isn't practical. I'd like us to have at least armed security officers, but many hospitals are squeamish about that idea. So we're left with ourselves. Tragically, we aren't taught to defend ourselves. In fact, as a group, physicians seem to consider this an unacceptable thought. We cite our role as healers, our Hippocratic Oath, and our duty to help even the craziest and most dangerous patients. But we forget our other duties, like the ones we have to our co-workers, our rational patients, our families, and most of all, to ourselves. In point of fact, one of the most fundamental rights of humanity is the right of self-protection and self-preservation. But we have decided, because of our great mass of psychosocial baggage, that this is someone else's responsibility.
Although it's typically better when our security is left to trained professionals, there may be a moment one day when we can intervene to save our lives and the lives of others. I believe we should learn a few simple life-saving techniques. Learning is power. Physicians, nurses, paramedics, and others should ask around their communities for good instructors in self-defense skills, especially the skill of identifying dangerous individuals and diffusing conflict before it starts.
For those going to the ACEP Scientific Assembly in San Francisco in October, there will be a class taught by John Benner of Tactical Defense Institute of Ohio. Mr. Benner is a retired police officer with years of experience in the military and law enforcement, and in teaching self-defense to law enforcement officers, military personnel, and civilians. He has developed a course of hand-to-hand self-defense that uses simple, easily practiced motions that would be very useful to anyone dealing with dangerous patients.
I met Mr. Benner two years ago at his school in Ohio where I took a three-day pistol course, in which we fired almost 2000 rounds of ammunition. A few blisters later, I was a much more proficient and disciplined shooter than I had ever been in my life. I talked with Mr. Benner that weekend, and we discussed his self-defense philosophy. I intended to go and take his unarmed defense class, but I have yet to make it. Still, I'm confident that his class at ACEP will be outstanding if his on-site shooting course was any indication. (See www.tdiohio.com.)
Still, the class in San Francisco may be full, it may be too late to enroll, and most of you won't be there, so you may need to consider other options. For the passionate in need of a hobby and exercise, enrollment in a traditional school of martial arts that teaches Karate, Kung-Fu, Tae Kwon Do, Aikido, or Ju-Jitsu (or whatever is available in the area) may be an option. It may mean taking a less traditional path like learning the Israeli system called Krav Maga, which is very street defense-oriented. Or it may simply mean asking local law enforcement to give a class and frequent refreshers. The officers who live on the street know many practical ways to save their own lives, many of which can be learned easily. And they like to take care of their friends in the emergency department.
My point is not that we all become trained killers, but simply that we consider options in addition to phone-jitsu. Sadly, we have very few. Physicians, nurses, and paramedics are assaulted all the time, but the general mentality for years has been that it's just part of the job. (Try assaulting a local judge in his court to see how differently things go.) We seldom press charges, administrators often don't want to make the issues public, and changes usually occur only after someone is seriously injured or killed.
In the end, I think it would be better to go down struggling with my attacker than with a knife in the back while running away. Maybe I'm crazy, and maybe after 25 years of martial arts practice, I'd still be inadequate. But there's nothing wrong with being prepared. I hope none of us ever faces the situation for real. But lately, with an angry, heavily armed man running around with a vendetta toward my workplace, I guess I have to think about it.
© 2004 Lippincott Williams & Wilkins, Inc.