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Hospitals Upgrade Security After Fatal Shooting in ED

Monday July 3, 2006
Charles Kunkle (left), RN, RN, BSN, CEN, CCRN, CNA, manager of emergency services, stands with Security Guard Phillip Andruszkewicz in the Public Safety Room at St. Mary Medical Center. ED personnel can communicate with patients in the exam room using an intercom located to the right of the window. To the left of the window are gun lockers, where police officers can stow weapons while they accompany a patient into the room. Photo courtesy of St. Mary Medical Center.
Charles Kunkle (left), RN, RN, BSN, CEN, CCRN, CNA, manager of emergency services, stands with Security Guard Phillip Andruszkewicz in the Public Safety Room at St. Mary Medical Center. ED personnel can communicate with patients in the exam room using an intercom located to the right of the window. To the left of the window are gun lockers, where police officers can stow weapons while they accompany a patient into the room. Photo courtesy of St. Mary Medical Center.
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On Sept. 29, 2005, Charles Kunkle,
RN, BSN, CEN, CCRN, CNA, was
having dinner with his family when his pager sounded.
"I get paged for all kinds of things, so I didn't think much of it," says Kunkle, manager of Emergency Services at St. Mary Medical Center in Langhorne, Pa. "Then, I remembered that [Clinical Lead Lisa Goldsmith, RN] was in charge, and she rarely pages me. That's when I knew something was really wrong."
His suspicions were correct: When he called into work, he learned that a Newtown police officer had been fatally shot and another had been wounded in the hospital's emergency department. One of the ED technicians also had been injured.
Kunkle rushed to the hospital from his Montgomery County, Pennsylvania, home. "When I got there, Lisa was in the center of all the commotion giving directions. Everyone had a job to do," he says. "A brand-new patient ambassador had been quick-thinking enough to move all of the patients out of the subacute side - where the shooting took place - to the acute side, where they would be protected. It was a scene that made me proud."
The circumstances surrounding the deadly shooting began with a routine visit to the ED. Police officers had brought Robert A. Flor, 38, to the hospital for blood and urine testing after Flor had been arrested on drunken-driving charges. As reported in the Bucks County Courier Times, Flor appeared calm and cooperative, so the officers had removed his handcuffs to facilitate specimen collection.
"I saw the officer, the shooter, and a second officer go into the bathroom," says Lisa Schmidt, an ED tech who was on duty that evening. "Next, I saw the shooter backing out of the bathroom, which struck me as odd. Next, I saw a flash and smelled gunpowder. I jumped under the desk and heard three more shots in rapid succession."
Schmidt then saw one of the police officers, Brian Steven Gregg, lying next to the desk. "I knew just by looking at him that he was dead," she says. "We sent the second officer, who was shot in the chest, to the OR and began tending our wounded tech. We were shaken to the core, but our whole team came together. I will never forget the noise and the blood, but most of all the smell of the gunpowder."
Gregg, 46, who is survived by a wife and 4-year-old son, was hit by three bullets - two in the head and one in the upper abdomen, Kunkle says. The second officer, Joseph Waruneck, 31, was shot in the chest, but the bullet first passed through the suspect's hand. That might have slowed the velocity of the bullet and saved Waruneck's life, Kunkle says. Joseph Epp, an ED technician, received a bullet wound to the shoulder and also recovered.
While in the bathroom, Flor grabbed Warunek's gun and upon exiting the bathroom fired the five shots. He is currently awaiting trial in Bucks County on charges that include first-degree murder and attempted murder, according to the Bucks County Courier Times.
Time to heal
That night, two disaster-recovery teams -
St. Mary's Employee Assistance Program and the Bucks County Critical Stress Incident Debriefing (CSID) team - arrived to help staff members deal with the incident.
"The CSID team conducted a two-hour debriefing with us," Kunkle says. "They told us about the symptoms of post traumatic stress disorder and what we might expect - like reliving the event through nightmares and flashbacks, problems sleeping, and feeling detached." The hospital also offered counseling to all staff and permitted those who needed time off to stay home for as long as necessary.
Gregg's funeral was a critical part of the staff's healing process. The hospital rented a bus and the
ED staff went as a group, dressed in their blue scrubs.
"As we got in line to enter the church, the hundreds of uniformed officers in attendance actually stepped aside for us," Kunkle says. "Then, one officer appeared and took us to the front center pews that Mrs. Gregg had reserved for us directly opposite the family. It was a touching gesture we will never forget."
Prevention measures
As ED staff members nursed their emotional wounds, the hospital took rapid action to prevent future incidents. A secure, access-controlled patient safety room was constructed off the ED within a week of the incident.
"We spoke to local police captains to get their input on its design and construction," Kunkle says. The new room provides direct entry into a full treatment room, so the prisoner does not need to enter the ED. The room contains a steel bench that prisoners may be secured to with handcuffs. In the adjoining bathroom, there is a pole to which prisoners may be cuffed. Exterior gun lockers are available for police officers to stow their guns while in the exam room. Nurses can communicate with people inside the room via an intercom system and observe them at all times through large glass windows.
In addition, Kunkle has traveled to area health care organizations to give educational talks outlining how the fatal event occurred and how St. Mary responded to it. "I believe that other health care agencies can learn from our experience, and this knowledge can protect the lives of patients, visitors and staff," says Kunkle, whose leadership and innovation during and after the shootings motivated his colleagues to nominate him for a Nursing Spectrum award. He won the 2006 regional Nursing Excellence award in the Management category and is a finalist for Nursing Spectrum's national awards.
Sense of security shattered
"Many staff, patients and community members felt the suburban hospital
was immune to this kind of violence," says Kunkle. "We lost our innocence
that night."
But St. Mary Medical Center isn't the only hospital in the quiet Bucks County community with a tale to tell. "Six months later, it happened again at Frankford Hospitals-Bucks County Campus, just a few miles away," says Kunkle. "But in that instance, the officer was prepared because of what had happened here. He held his gun in his holster, thwarting a second disaster."
According to the Bucks County Courier Times, suspect Luther Baldwin tried to disarm a Falls Township police officer in the Frankford-Bucks ED.
"In this instance, a second disaster was averted largely due to the awareness and training that ensued in the wake of the St. Mary incident," says Maria Slade, a public relations staff member at Frankford Bucks. "Falls Township presented training to their police force, which prepared them for this situation."
Never say never
Workplace violence is a real threat - even in hospitals. According to the U.S. Bureau of Labor Statistics, 17 homicides occurred in health services organizations in 2004.
"In 2000, nearly half of all nonfatal injuries from occupational assaults and violent acts occurred in health care and social services settings," says Kunkle. "Given this data, it's incumbent upon us to develop the training and facilities that will prevent violence."
Joyce Brazino, RN, MPH, is a freelance writer specializing in health care marketing and public relations. To comment on this article, send e-mail to dnovak@nursingspectrum.com.