Author Beware: The Right Patient Placement

Coming across inaccurate medical scenarios in books is common for me so to have one raise my ire enough to blog about it generally means a pretty big eye roll was involved when I read the passage.

Scenario: An elderly male dressed in sweats is found wandering the streets of New York in a confused state.

The author's solution: The police take him to a nursing home.

Well, yea, just--- no.

If police find an elderly male, let alone any confused individual, wandering the streets without any ID the first place that person is going is straight to the ER likely via ambulance.

The reason? One, is to make sure nothing medically is wrong. Chronic diseases such as dementia and Alzheimer's are not the only reason the elderly people become confused. Something as simple as an electrolyte imbalance could be the cause. In any new onset confused state, other minor and major medical conditions need to be ruled out first. What might some of those be? Electrolyte imbalance. Brain Tumor. Stroke. Head Injury. Brain Bleed.

Secondly, there is not a nursing home in the United States that will take in an elderly person unknown to them without a medical evaluation first. Plus, do you know all that's involved for nursing home admissions? A lot.

In this instance, if the patient is deemed to not have anything clearly medical (that could be fixed or treated) causing his confusion, then the hospital would involve the police and likely social services for placement.

But no drive by drop-offs at the nursing home.

Choke Holds: A Police Perspective Part 3/3

Today I'm concluding a three part series written by Deputy Karl Mai that gives accurate inside information on police choke holds/stunning techniques, how and when they are applied. 

Follow the links for Part I and Part II.

Welcome back, Karl!

Some final words about all of these techniques.

First, they rely on the effects of a fluid shock wave to have the desired results. It’s not enough to simply strike/punch the target in the described area. Police are taught to strike and hold the pressure of the strike on the targeted area for a second, so to send a fluid shockwave through the body tissues. Also, and this would apply to a carotid restraint as well, police are taught to not let the target simply fall to the ground uncontrolled after using these techniques.

An uncontrolled fall can result in unexpected injuries, especially to a person’s head. After striking the target, if the target goes limp, or gets weak in the knees, police will try to grab hold of the target and guide them to the ground to prevent unwanted injuries. This may not be feasible depending on the dynamics of the fight, or if there are multiple attackers, but the goal of preventing unwanted injuries is always there.

In the case of your secret agent, former Special Forces guy, the writer should consider how the character will restrain the target after incapacitating them, knowing that the target will get up fairly quickly and be very capable of continuing the attack/pursuit.

Some suggestions:

1. If going up against the police or other agents, would be to use the officers own handcuffs or flexi-cuffs (basically large zip ties) to restrain the officer during the precious few seconds they are incapacitated.

2. Have the main character carry handcuffs, or flexi-cuffs of his own.

3. Simply have the character apply the technique, safely guide the target to the ground and use those seconds to run away. If there are additional pursuers, would the character want to waste time handcuffing the officer while other officers/agents are closing in on him?

Another thing to consider is, how would other officers/agents respond to witnessing the main character apply these techniques to one of their fellow officers?  The answer to that question is it raises the stake . . . a lot. 

If a cop sees someone attacking one of their own to the point of incapacitation, it allows for a lethal response. In other words, the character who is actually taking special measures not to have to kill the officer/agent, may suddenly find themselves getting shot at. Or the officer/agent who is being subjected to the technique will likely respond with lethal force if they can manage to do so.

In reality, the officer can’t know what their attacker’s intentions are or what they will do to the officer once incapacitated. Will the attacker simply walk away? Will the attacker continue to assault the officer causing further injury to the officer when the officer is incapacitated? Will the attacker take the officer’s gun and kill the officer, kill other officers, or kill other citizens?

Therefore, when facing incapacitation, loss of consciousness, or being put into a seriously inferior position (such as down on the ground with an attacker on top of the officer), an officer may respond with lethal force. Other officers witnessing this happen to a fellow officer may respond with lethal force as well.

Karl, my personal thanks to you for all of this great information. I know it will definitely make my novels more accurate!

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Deputy Karl Mai is a 16 year veteran of the El Paso County Sheriff’s Office in Colorado Springs, CO.  He has mostly worked street patrol and as a Field Training Officer (FTO), but has also worked in the county jail and as a Detective.

Choke Holds: A Police Perspective Part 2/3

Today we're continuing with a three part series on police choke holds from a law enforcement officer's perspective. 

This is Part II which covers the physiology and mechanism of these strikes. Great details for authors to use in their novels. You can find Part I here.

Welcome back, Karl!

Getting into the physiology of choke-hold techniques would be good background information for the writer/reader as well. First off, let’s clarify one thing. The police don’t “choke” people. Choking implies obstructing a person’s airway and limiting their ability to breath. Because a person can hold their breath for several minutes when calm, or even a mere twenty to thirty seconds while in the midst of a fight, this would be a bad technique for incapacitating someone.

The officer would not only have to apply enough strength to cut off the airway (which is a lot), but also overpower the target long enough for that person to lose consciousness. Using a technique that requires literally all of the officer’s own personal strength for twenty to thirty seconds is not feasible.

What the police actually do, and what you see in MMA, is generally one of several different carotid restraints. Blocking off the blood to a person’s brain at the point of the neck can cause a person to pass out in only a few seconds and requires far less strength to apply correctly. But again, the effects last only a few seconds.

In MMA and in police training, the technique usually involves applying external pressure to the carotid arteries, while not actually interfering with the person’s ability to breath. Some simple internet searching would provide names and a detailed explanation of the techniques for the author to use in their writing.

PLEASE NOTE: Many police departments actually frown upon use of carotid restraints in response to anything less than a serious attack, or even a lethal force situation, because it is very dangerous and can cause death. The police generally don’t have an MMA referee right there watching, telling the officer when to release the restraint and there’s no team of medics standing in the wings ready to immediately render aide, like there is in the world of MMA.

When talking about a strike to a nerve center with the goal of causing incapacitation, there are generally three proven techniques.

The first is called the brachial plexus stun. This is a strike aimed at a massive nerve complex in a person’s neck. The target is about half way between the shoulder and jaw bone and just forward of the major neck muscles on the side of a person’s neck. You can easily find the area by kneading the tips of your fingers deep into the skin of the described area. You’ll find that one spot that is dramatically more painful under the same amount of pressure than the areas around it.  That’s the brachial plexus nerve center.

The strike can be delivered with a normal closed fist punch, an open palm strike, or a forearm strike. If done correctly, the strike literally overloads the brain with pain and causes something akin to an electrical surge that will stun the attacker, make them get weak in the knees and possibly cause a very temporary loss of consciousness.

The police officer must take advantage of these few seconds to put handcuffs on the attacker or get them into some kind of restraint hold that will prevent the attacker from continuing to fight when they get their senses back.

The second technique is known as the, “Gerber Slap.”  This is an open palm strike targeted at the base of the skull, right where those big muscles on the back of the neck attach. The person delivering the strike is trained to slightly cup the hand, so the pressure of the strike actually comes through the fingertips and from the meaty part at the base of one’s palm. Similar to the brachial plexus stun, this causes a massive sensory overload in the brain and a stunning effect, or even a temporary loss of consciousness.

The last one is called the, “Super Scapula Stun.”  This is a strike that you might commonly associate with Hollywood, when the secret agent walks up behind the target and delivers a sharp, Karate type chop, with the blade of their hand, to the target’s shoulder and the target falls to the floor, unconscious.

In reality, it is much harder to pull off and requires significantly more force and pressure than Hollywood ever depicts. The target for the super scapula is the meaty portion of the trapezius muscles, within a couple inches of the neck. The strike is delivered in a downward and inward motion, usually with a closed fist, hammer like motion (as if to stab downward at the target with a knife).

For the best results, both fists should be used, striking at both sides (left and right) simultaneously. Police are often trained that if the target is standing, jumping up to deliver the strike from a higher position is preferred. The police are also trained to kick the target in the back of the legs hoping to drop them to their knees before delivering the strike, again allowing for a strike to come from above. The reason is simple combat physiology. You can hit something harder using that hammer fist strike that is well below shoulder level, than something which is at or above shoulder level.

We'll conclude with Part III next Tuesday.

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Deputy Karl Mai is a 16 year veteran of the El Paso County Sheriff’s Office in Colorado Springs, CO.  He has mostly worked street patrol and as a Field Training Officer (FTO), but has also worked in the county jail and as a Detective.

Author Question: Assault Injuries

Author Question: My MC, a 17 year old female, is beaten up by her father. He was drunk, angry, so backhanded her across the face, which knocked her into a bookcase. Then while she was on the floor he kicked her repeatedly with sharp-toed cowboy boots, though runs out of steam fairly quickly and goes off to his bedroom. (She managed to curl herself into a ball to protect her internal organs.)

So right now this is what I'm looking at for her injuries:

1. Mild concussion (from hitting a shelf with her head -- this would also possibly produce a small cut/gash because the edge of the shelf is sharp.)

2. Bruising to the face (from where he backhanded her.)

3. Broken ribs (I have 3 for now -- is that too much?)

4. Pneumothorax from one of the ribs -- just punctured, NOT collapsed.

5. Crack in the mid-shaft humerus of her right arm (from being kicked.)

Lots of bruising (obviously.)

First of all, are these injuries plausible given the scenario?

Jordyn Says:

These are a "good" array of injuries that would be plausible as a result of this type of beating. However, you can't have a punctured lung without some amount of air getting out. It may be a small amount that would not require chest tube placement but there would likely be some if the lung were "punctured". That's likely the only way the medical team would know the lung was punctured was by evidence of air on the chest film. So, it might be easier to just go with cracked ribs.

Question: Would she be able to drag herself a few feet across the living room to get her father's cell phone (left on a table), then crawl out the front door to the porch (the living room is just inside the front door)?

Jordyn: Yes, she should be able to do this.

Question: What might she experience? (Obviously pain, but I would assume she would have a great deal of trouble breathing, get oxygen-deprived, light-headed, nauseated ...)

Jordyn: Yes, great pain. Rib fractures are quite painful and inhibit a person from taking full breaths so the patient tends to take more shallow breaths to prevent the pain. This could lead to lightheadedness (as well as the head injury), increased breathing rate, and increased heart rate (from pain, anxiety, fear.) If you go with a more serious lung injury (like a collapsed lung) then this could lead to lower oxygen levels, increased work of breathing, and diminished level of consciousness.

Question: What would be the ER procedure when she is brought in by her best friend's family? It's a very small-town medical center that barely qualifies as a hospital. When she's brought in the staff is already busy on a multiple-patient car accident. Would it be plausible for the ER team to keep her waiting for a while after they take her back to an exam bay? Or would they worry about internal injuries and get her x-rayed right away? (As I said, it's small-town, so goof-ups are possible.)

Jordyn: It depends on her presenting condition. If she's awake, alert and oriented and doesn't appear to be in imminent distress (such as significant difficulty breathing from whatever lung injury you choose) then it is plausible for her to wait while the car accident victims are being taken care of.

An ER evaluation is going to include vital signs, a medical history and history of the event, and then targeted x-rays for everything that hurts. So, chest film and right arm films at the least. Her head wound wound be irrigated and stitched closed if needed. Staples would be used if the wound is in the scalp. Tetanus shot needs to be within five years. CT of the head isn't necessary for her head injury unless she has a focal neuro deficit (like I can't move one arm) or unconsciousness. Depending on the x-ray results-- her arm, at a minimum, would be placed in a sling until pain resolves. A stable fracture to the humerus can't be splinted-- only placed in a sling. 

This is the basics any ER should cover. 

This beating is a reportable injury so if the police haven't been contacted-- the ER staff should do so.

Question: The way I wrote it in the original draft was that she was taken to an exam bay right away, but then left to wait for a couple of hours. Then she was x-rayed and because of the pneumothorax, was taken back to a procedure/operating room to be intubated. The doc and a nurse came in while she was being prepped, to tell her friend's family what her injuries are. (Would they put a cast on her arm? At what point would that happen, before or after the intubation?)

And then, how long would she be in the hospital?

Jordyn: Intubation is not the primary treatment for a collapsed lung-- otherwise known as a pneumothorax. Placement of a chest tube is. This is what is required to safe the patient's life. If you intubate and don't place a chest tube the patient will die anyway because they will continue to accumulate air into their chest-- especially with positive pressure ventilation-- the machine forcing air into your lungs. Usually, just placement of a chest tube is enough.

A sling to her arm as noted above.
 

And then it depends (as with all things in medicine) how long the chest tube would stay in. I would say three-five days at the shortest. The lung has to re-expand, it has to stay expanded off suction, then the tube is removed. The patient is watched maybe one more day to make sure the air doesn't come back.

Author Question: Police Death Notification

In my writing life, I've met some fantastic police officers. My own brother is a county sheriff close to where I live so I use him a lot for questions. I've also gotten to meet many other great police officers and one was very helpful in giving me a detailed SWAT scenario for my most release, Peril.

Darcie sent me some police type questions and I passed them along to Seargent S. Tarr and he provided the following insight.

Darcie asks:

What I learned so far is that if my Main character (Kelley)'s parents' bodies were found along a hiking trail near Glenwood Springs, the Denver Police would visit her house to break the news since Kelley lives in the Denver area.

Sergeant Tarr: Yes, if a person is found to be deceased the next of kin is notified by the jurisdiction that the person's family is located. They would usually send a marked patrol unit and a victim advocate. We call it a death notification. Sometime the coroner will also go if it’s in the same jurisdiction. 

Darcie: That leaves me now with, since at first this appears to be a hiking accident, where would the bodies be? Coroner? 

Sergeant Tarr: It doesn’t matter if it appears to be an accident or not. The coroner would handle the investigation into the cause of death and police in the manner (like a homicide, scene traffic accident, suicide etc..) So it would be a joint investigation regardless. The only time the coroner and law enforcement don’t do an investigation is if it happens in a hospital or in the care of medical staff. So the coroner would take the body and most likely perform an autopsy. Would be very uncommon for them not to. The coroner would then rule on the cause of death ie: natural, suicide, accidental, etc.. 

Darcie: Would there be an autopsy? 

Sergeant Tarr: An autopsy would be performed by the jurisdiction that the death happened. The pathologist could be from Denver. I know for example that the pathologist from Fort Collins comes down to Denver to conduct autopsies. The Arapahoe examiner has also traveled to other coroner's offices to assist. 

Darcie: Would Kelley have to go ID them even though they had drivers licenses etc on them?

Sergeant Tarr: This depends on if a positive ID can be made with the id or not. Like if their face was ripped off, sorry to sound crude. They can also put their fingerprints through AFIS to see if they can get an ID that way also. Sometimes the family has to ID the body if no positive ID can be made. It is usually the last thing done. Once the coroner releases the bodies it would be picked up by a funeral service. They would transport the bodies back to Denver for the funeral arrangements.

News Stories for Authors: Police Sue Woman

Honestly, sometimes you just don't have to go very far to get plot ideas. They are in the news every day.

This news story totally shocked me-- and honestly it takes a lot to do that for me these days.

Evidently, a woman called 911 yet "failed to report how serious a situation was" though evidently did say a man was on bath salts and acting belligerently. The situation became volatile and the man was shot and killed but one deputy was injured in the scuffle. He's the one that's suing. Here's a link to the news story.

Very early in my nursing career, a man was transported to us via ambulance. He had passed out and cut his head open on a rock mowing the lawn in the Midwestern heat and humidity. I mean, who wouldn't, right?

Now, if you know head lacerations-- you know they bleed pretty severely. Even small wounds can bleed impressively and this man had a significant laceration and blood was everywhere. He wasn't all that coherent when we tried to ask questions and get a history so we bypassed that and began his medical treatment. The physician and I were gloved up and raking through his hair when his sister arrived and we began asking her his history.

"Does he have any medical problems?"

"Yes, he's HIV positive."

I mean-- we both just froze and I remember thinking I wish I'd been in the habit of triple gloving. The physician and I were fine because, as healthcare providers, we assume EVERYONE is infected all the time and we should be using precautions based on that assumption. Always assume the worst case scenario.

Which is why I can't reason this officer's actions for the following reasons.

1. Every responding officer should assume they are going into a volatile situation until proven otherwise. I don't think it's routine to put on Kevlar after you get on scene.

2. People aren't good at disclosing details that may be pertinent to your job when they are having an emergency. They are thinking of only a few things. "I need help." "Come as quickly as you can." "Did I say fix this now?" It's up to us as emergency responders to ask for the information that we need yet realize even then-- the answers may not be accurate.

3. This is a workman's comp issue. If you're injured in the performance of your duties-- this becomes a workman's comp claim and I have no idea why a police officer thinks suing her for money will engage the public trust.

I am a HUGE supporter of the police. My brother is a police officer. But, we don't want civillians worried about getting sued when they truly need help. I hope the courts throw this case out.

Please.

What are your thoughts?

Author Question: Police Response 2/2

We're continuing with Amy's question about police response.

In short, police are responding to a presumed intruder though the intruder thinks he's rented the place! The genre is romantic comedy. You can read the first post here.

4. Firearms drawn?

If they are carrying long guns, then obviously the weapons are out and ready to be used. It would be typical to have their side arms drawn in this situation. It’s justified for two reasons. The first being that the man in the house called to report an intruder on his doorstep, which is felony in progress.

The second is that they know this girl and they are automatically suspicious of the man inside the home, which is also a potential felony. Felons automatically get that kind of special attention.

5. If this is plausible and the cops immediately detain the man for suspected foul play, how would they detain him? Cuffs? Secure him in the back of a cruiser until they make sure the girl is okay? Pin him to the ground?

They are going to give him some verbal commands to exit the house, come to them, face away and put his hands behind his back. They would cuff him and they would probably place him in a patrol car. They could also just sit him down on the lawn and keep a knee in his back. It’s a little more aggressive and humiliating which looks to be the goal here.

However, this guy is going to be scared and confused and he may not like the cops ordering him out of his own place (or so he thinks) at gun point. This could cause him to hesitate and/or verbally object to complying with the commands being given to him, which would result in the police using a more aggressive, hands on approach.

6. The man is holding the woman at gun point until the cops arrive, and he tells the police this when he first calls 911. It turns out to not even be loaded, and he puts it away before he the police arrive. But if the cops believe he has a gun, and he's the one to open the door, how would they react/respond? (i.e. guns drawn, telling him to put his hands where they can see him, patting him down for a weapon? etc.)

Okay… This question may actually change some of my previous answers, especially for question number three. If the man is holding her at gun point and he has informed dispatch of this, then the cops are going to roll all the way in lights and sirens. They would probably shut the sirens off at the end of the block so they can communicate over the radio easier. Cop cars don’t have a lot of sound proofing and the sirens really do hinder listening to and talking on the radio.

Secondly, they will use their cop cars to establish a barrier or cover for themselves at the street. Other responding units are going to spread themselves out to establish a perimeter around the home. Verbal commands are going to be shouted (or possibly called out over the public address (PA) speaker on the patrol car) to the home for the man to come out with his empty hands up and he’ll be detained as previously described. Mostly likely they would cuff and stuff him in a patrol car, as the cars are now right in front of the house. The general rule of thumb is always cuff then search the suspect before putting him in the car.

Also, the cops are going to clear the house to make sure there is no one else inside. This means a room to room search of the home with weapons drawn. They are going to open all the closet doors, check under the beds, check the showers, check the cupboards, check the crawlspaces and the attic, basically anywhere a person could fit into. This would be done immediately after the man in the home is detained. They don’t need permission, they’re just going to do it.

They will ask him, “Is there anyone else in the house?” They will proceed no matter what the answer is. They will announce themselves at the front door. “This is the Police! Is there anyone inside the home? If there is anyone inside the home you must announce yourself and come to the front door with your hands up. This is the police, we are coming in the house.” Two or three cops will clear the house together so they can provide over watch of each other and maintain security of areas that have not yet been cleared.

Finally, let’s not forget that the responding officers are going to get a coded channel on the radio before arriving on scene. This means that one of the police channels is dedicated to the units that are involved in this call for service and all other normal police traffic is goes to another channel. Depending on how quickly the situation is developing, the primary police channel may be coded and normal traffic goes to an alternate channel. However, since these cops in this scenario have to travel to this location and this is not a situation that just blew up in their face, the responding officers would likely use the alternate channel for their priority traffic and all other normal traffic would stay on the primary radio channel. Some typical radio traffic would be.

Lead Unit: “3 Adam 12, I need a code on channel two.”
Dispatch: “Copy… All units stand by for a code.” A two second, high pitched tone comes over the radio. “All units be advised that channel two is code for units responding to (address). All other traffic remain on channel one.”

After it’s all over and everything is secure and safe some typical radio traffic could be:

Lead Unit: “3 Adam 12, all units are code four; you may clear the code.”
Dispatch: “Copy.. All units stand by.” They do the two second tone again. “All units the code on channel two is now clear. All radio traffic return to the primary channel.”

Many thanks to my brother, Karl, for taking the time in answering these police questions.

It's always good to have an expert on hand.

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Amy Drown has a History degree from the University of Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.

Author Question: Police Response 1/2

Amy asks:

I'm writing a contemporary RomCom novel, and my opening scene involves the Colorado Springs Police Department. It starts as a sort of comedy of errors when my heroine returns from an extensive trip to find someone else has accidentally moved into her half of the duplex she rents. The man she finds there thinks she's breaking in and calls the police. What he doesn't know, however, is that my heroine is the daughter of a former police officer who has died and is very well known by the other officers on the force.

Amy contacted me as she was needing some police help, STAT, and my brother happens to work for a police department. Even though the questions are not medical in nature, the information was too good not to post here.

What follows is the scenario and her questions-- my brother's responses are below each question.

A special shout out to my brother, Karl, for giving such detailed answers. Part II follows next post.

Amy says:

The way I have written the scene, the officers responding to the call know exactly who lives at that address because they've known the heroine for years, ever since she was a little girl, and are rather protective of her since her father/their fellow officer passed away. So when the man who actually called about the break-in answers the door, they immediately suspect HIM of foul play.

One officer physically detains him on the front porch while the other verifies that the girl is OK. The man is confused by the fact that the woman whom he thinks just broke into his house is on a first-name basis with the cops, and why they are so protective of her when he is the one who called them. Of course, it is all resolved when they realize the man was given a key to the wrong half of the duplex and is supposed to have moved into the second story unit.

1. Is this plausible? Might two officers who personally know the address and the occupant immediately jump to this conclusion about her safety despite the fact that the man made the call?

If the cops know this girl and already feel an obligation to protect her due to the loss of her father, then it is very likely that they would take this stance no matter what the situation is, possibly even if she were doing something wrong herself. I will say that Colorado Springs is not like New York, we’re not going to give every cop’s kid or wife an automatic pass, but they will take care of their own and they would be ultra-protective of this woman who has a stranger in her home.

2. Would two officers arrive in one single cruiser, or two separate? The scene takes place in January -- what color is the typical winter uniform?

CSPD typically rides in single man cars. So if there are two cops on scene, there will be two cars. CSPD’s uniforms don’t change for the season. They wear blue shirts (short sleeve or long sleeve) over midnight blue pants. The only difference would be if they are wearing midnight blue jackets over their uniform shirts due to colder weather.

The jackets have some reflective striping on the arms above the elbow and the badges used for the jackets are embroidered patches. The cops might be wearing a mock turtle neck, or some guys still go for the outer sweaters. They are also authorized to wear plain (no logos), black, cold weather, knit caps on their heads.

3. Assuming the man calls it in as a burglary-in-progress, are two officers enough, or would more units respond? Would they arrive silent/dark, lights only, or lights+sirens?

Only two officers would typically be dispatched to a call for service like this, but more would possibly respond for a couple of reasons. First, if more are available and they assign themselves to the call, then more will show up. This is typical because a burglary in progress is considered a high risk call for service and cops like to look out for one another and catch bad guys.

Second, if this girl is so well known within the department, anyone who can respond, probably would. It may be a way for the author to really drive home the girl’s popularity or the sense of protection the department has for her, when six cops, a sergeant and a shift lieutenant all show up on scene. The police would respond lights and sirens, but the rule of thumb is to shut that stuff down several blocks away. If it is after dark, they may role down the block blacked out and no matter what time of day it is, they will park two to three houses away and walk in. One or two them could pull out some long guns too (shotgun, patrol rifle).

Tune in next post for the remaining questions.

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Amy Drown has a History degree from the University of Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.

ED Issues: Cop versus Nurse

My brother works in the next county over as a deputy sheriff. I always say a writer is blessed if they have a law enforcement officer and a medical person in the family. That helps cover a lot of manuscript issues. My brother does patrol so, at times, he'll bring a person in custody to the ER for drug testing. After a frustrating interaction with the ED staff, I'll get an irate call from him, "Why did the ER do that!" Most often, it has to do with making him wait.

Personally, I have a great respect for the police and know their time is valuable as they would rather be on the road than stuck in the ER. Most areas of conflict come up when we don't understand the other's work. ER nurses get upset with the floors when they don't take an admission quickly because we can't stop what walks into the department even if we close to ambulances. The floors think the ED didn't do enough of an evaluation and left too much for them to do. Nearly every agency that receives and hands-off people to someone else has sources of conflict-- this is guaranteed.

When my brother called to complain about how long he'd had to wait for his prisoner to get his lab work, I immediately wanted to defend the ER workers.

These are the first things I thought.

1. The prisoner is a low priority. We're going to take care of sick patients first. The higher the acuity in the ER, the longer the wait time is likely to be. We have to save lives first.

2. Confusion on what needs to be done. I remember this from my adult ER days. We're not drawing blood or doing drug testing on prisoners every day. Since it's not something done often, there are likely questions on the proper procedure. We're going to want to make sure it's done correctly, particularly if it goes to court. The delay could be the staff actually researching how to handle the situation (what tubes to put the blood in and what paperwork to fill out).

3. The prisoner has a babysitter. I know that's a horrible term for a police officer. Generally, a police officer cannot leave someone who is in his custody. So, as the ER staff, we know there's an extra set of eyes on that person and we will worry less about something happening to them.

What other sources of conflict do you see? Have you written a scene with a mix of ER and law enforcement?