We see a lot of interesting cases in the ED. Some traumas, mostly medical but also psychiatric. Some of our psych patients prove more challenging than our traumas.

“Code green to 18” - a common announcement over the intercom during a night shift in the emergency department. What is a “code green”? A “code green” means a staff member is requesting assistance with an unruly or combative patient. This could mean somebody threatening violence to staff, themselves or another patient, but it could also mean they have actually gone through with their threat! Luckily that doesn’t happen often.

What happens during a typical code green? Everybody shows up in the hall to see what is going on. What should happen? A doctor, police officer and paramedic show up, often with a mental health specialist and another nurse. The patient is assessed first by LE to make sure there is no immediate threat to anybody. Once the scene has been secured, the doctor will assess the patient.

If the patient calms down and stays in their room, everything is ok. But sometimes they don’t want to calm down or stay in their room. Sometimes they want to try to leave when they have a medical hold requiring them to stay. Sometimes medication is needed to help calm them down, other times physical restraints are needed to prevent anybody from getting hurt.

The other night, after running a rapid COVID test, I was on my way back to my area when I spotted some trouble. Ahead of me in the hall was a patient being walked back to their room. The patient did not appear to be very happy.

Suddenly the patient started yelling “please don’t kill me!” Next thing we know they are trying to run. The police officer and other staff with the patient held them up against the wall and the yelling continued.

For the patient's safety and the safety of staff and other patients, the patient was going to have to be restrained. The struggle increased and the patient seemed to be winning. I should have stayed back, but I didn’t want to watch one of our officers get hurt.

So I jumped in and held the patient's legs down. But before I could, a foot came flying toward me and caught me in the eye. I saw it coming so I moved back and didn’t feel the full force, but it still hurt. My eye ended up swelling and I had abrasions above and below my eye, but I was ok. Everybody was ok.

The patient ended up being ok too, but not before putting up more of a fight.