As many of you know, I am writing a book on gunshot wounds (forensic and technical aspects thereof mainly) and one of the things I am adding as an appendix is the handling of armed patients. In the Johannesburg hospital where I worked, we would frequently get armed patients coming into the X-ray department. Most of the time these patients would not be any trouble, but excpetions have and do occur. Now bearing in mind that most radiographers in SA are female and do not own firearms themselves, and also bearing in mind the type of security staff employed by most SA hospitals (unarmed), I have to come up with a protocol for the safe handling of these patients in the X-ray department. The premise being that most of the time the patient cannot be X-rayed while carrying a gun or magazines or sundry items related to the gun, for reasons of artefact and positioning and safety. With this in mind, here is what I have come up with. I would appreciate any feedback on this.
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APPENDIX A – X-raying the Armed Patient
(Advice for the South African radiographer)
In South Africa I have frequently had to X-ray patients who have arrived in the X-ray department carrying concealed firearms. The fact that the weapons were concealed explains why the patients were not challenged by security. Even patients attending medical casualty departments can arrive armed. A typical example would be a patient coming to hospital to attend a clinic. He is seen by the doctor, who may or may not notice the firearm during the physical examination. If the doctor notices the firearm but suspects that the patient will not be admitted, he will usually send the patient along to the X-ray department without commenting on the weapon.
When the radiographer takes the patient into the room, the patient may reveal the firearm, asking whether it will affect the X-ray procedure. You might say it is simple: we must take the weapon from the patient while he is having his X-ray. This is where we start running into problems. Firstly, who must take the weapon? An obvious choice is hospital security, but let’s think it over first and see if there are pitfalls:
a) There is time wastage while security responds.
b) Hospital security guards in South Africa are usually not familiar with firearms, being armed with batons only, in the majority of hospitals. It would be unreasonable for us to assume that the hospital security staff would be trained to the same level as airport security. While it looks good, legally, that the security guard had the firearm at the time (should there be an accidental discharge or loss of some sort) I don’t believe there is much merit for having the security guard take charge of the weapon, from a safety point of view. The patient would have to claim the weapon from the security office when he leaves the hospital; an inconvenience he will not take kindly to. There is also a remoteness about the security office which would make a patient worry about the whereabouts and integrity of his firearm. This may cause him to want to rush the examination or not pay proper attention to the radiographer. I would not be very comfortable handing over my weapon to a hospital security guard in South Africa.
c) An over-zealous security guard may ask the patient if he has a license for the weapon. In fact, most hospital firearm safe registers require that the serial number and license number of the firearm be logged. Depending on the circumstances, this can result in conflict.
The patient cannot keep the weapon on his person during the examination because:
i. There is the possibility that it will cause an image artefact. Support lanyards and holsters will also cause artefacts.
ii. In supine work it will be uncomfortable for the patient to roll over for any lateral views as he may roll over the gun.
iii. The patient may not have a proper holster and there is the risk of the weapon falling onto the floor during positioning. If the gun falls onto the floor it could discharge. Many gun owners do not even use holsters. They stuff the weapon down the back or front of their trousers or leave it loose in a pocket.
iv. Pistols are more popular than revolvers in South Africa. Spare magazines are usually kept on the opposite side of the body to where the gun is kept. These can also cause artefacts and will cause discomfort during positioning.
I recommend that you use these guidelines while handling a patient who reveals, or volunteers to hand over, a firearm prior to being X-rayed:
a) You have to accept that you do not know enough about firearms to be able to make every weapon safe. I accept that myself. Making a weapon safe involves removing all cartridges from the weapon so that it cannot be fired accidentally or intentionally. You cannot guarantee that any actions taken to make the weapon safe will not result in an accidental discharge, or damage to staff, patient, X-ray equipment or even the firearm itself.
b) You cannot assume that the patient is competent or fit enough to make the weapon safe, himself. He is, after all, at the hospital because there is some problem with him physically or mentally. The hospital surroundings are alien to him and he may be especially apprehensive because he is worried about his diagnosis.
c) No member of staff can swear that the weapon is safe to handle. It may have been modified or abused in some way that results in it being a dangerous item to make safe. The gun may have a defect that not even the owner is aware of, which could result in an accidental discharge if the weapon is handled. Even a trained professional would need the proper laboratory facilities to examine the firearm and comment on its structural and functional integrity. The hospital is no place to do this.
It should be obvious to you that if we are not going to let the patient hold the weapon and if nobody is going to make the weapon safe, then the best course of action is if nobody holds the weapon. If nobody is holding it and nobody is fiddling with it, then there cannot be an accidental discharge. Ideally, every examination room and X-ray room would have its own safe for storing patients’ valuables. Cost and logistical factors in the installation of such safes, as well as abuse of such safes and keys by staff, means it is impractical to have a safe in each X-ray room in South African hospitals.
You should follow these guidelines:
(continued)...
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APPENDIX A – X-raying the Armed Patient
(Advice for the South African radiographer)
In South Africa I have frequently had to X-ray patients who have arrived in the X-ray department carrying concealed firearms. The fact that the weapons were concealed explains why the patients were not challenged by security. Even patients attending medical casualty departments can arrive armed. A typical example would be a patient coming to hospital to attend a clinic. He is seen by the doctor, who may or may not notice the firearm during the physical examination. If the doctor notices the firearm but suspects that the patient will not be admitted, he will usually send the patient along to the X-ray department without commenting on the weapon.
When the radiographer takes the patient into the room, the patient may reveal the firearm, asking whether it will affect the X-ray procedure. You might say it is simple: we must take the weapon from the patient while he is having his X-ray. This is where we start running into problems. Firstly, who must take the weapon? An obvious choice is hospital security, but let’s think it over first and see if there are pitfalls:
a) There is time wastage while security responds.
b) Hospital security guards in South Africa are usually not familiar with firearms, being armed with batons only, in the majority of hospitals. It would be unreasonable for us to assume that the hospital security staff would be trained to the same level as airport security. While it looks good, legally, that the security guard had the firearm at the time (should there be an accidental discharge or loss of some sort) I don’t believe there is much merit for having the security guard take charge of the weapon, from a safety point of view. The patient would have to claim the weapon from the security office when he leaves the hospital; an inconvenience he will not take kindly to. There is also a remoteness about the security office which would make a patient worry about the whereabouts and integrity of his firearm. This may cause him to want to rush the examination or not pay proper attention to the radiographer. I would not be very comfortable handing over my weapon to a hospital security guard in South Africa.
c) An over-zealous security guard may ask the patient if he has a license for the weapon. In fact, most hospital firearm safe registers require that the serial number and license number of the firearm be logged. Depending on the circumstances, this can result in conflict.
The patient cannot keep the weapon on his person during the examination because:
i. There is the possibility that it will cause an image artefact. Support lanyards and holsters will also cause artefacts.
ii. In supine work it will be uncomfortable for the patient to roll over for any lateral views as he may roll over the gun.
iii. The patient may not have a proper holster and there is the risk of the weapon falling onto the floor during positioning. If the gun falls onto the floor it could discharge. Many gun owners do not even use holsters. They stuff the weapon down the back or front of their trousers or leave it loose in a pocket.
iv. Pistols are more popular than revolvers in South Africa. Spare magazines are usually kept on the opposite side of the body to where the gun is kept. These can also cause artefacts and will cause discomfort during positioning.
I recommend that you use these guidelines while handling a patient who reveals, or volunteers to hand over, a firearm prior to being X-rayed:
a) You have to accept that you do not know enough about firearms to be able to make every weapon safe. I accept that myself. Making a weapon safe involves removing all cartridges from the weapon so that it cannot be fired accidentally or intentionally. You cannot guarantee that any actions taken to make the weapon safe will not result in an accidental discharge, or damage to staff, patient, X-ray equipment or even the firearm itself.
b) You cannot assume that the patient is competent or fit enough to make the weapon safe, himself. He is, after all, at the hospital because there is some problem with him physically or mentally. The hospital surroundings are alien to him and he may be especially apprehensive because he is worried about his diagnosis.
c) No member of staff can swear that the weapon is safe to handle. It may have been modified or abused in some way that results in it being a dangerous item to make safe. The gun may have a defect that not even the owner is aware of, which could result in an accidental discharge if the weapon is handled. Even a trained professional would need the proper laboratory facilities to examine the firearm and comment on its structural and functional integrity. The hospital is no place to do this.
It should be obvious to you that if we are not going to let the patient hold the weapon and if nobody is going to make the weapon safe, then the best course of action is if nobody holds the weapon. If nobody is holding it and nobody is fiddling with it, then there cannot be an accidental discharge. Ideally, every examination room and X-ray room would have its own safe for storing patients’ valuables. Cost and logistical factors in the installation of such safes, as well as abuse of such safes and keys by staff, means it is impractical to have a safe in each X-ray room in South African hospitals.
You should follow these guidelines:
(continued)...