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HILO, Hawaii Island – Even though its emergency room has about 50,000 patient visits a year, up from 32,000 in 2008, Hilo Medical Center has always had a small town feel, with people walking freely up to the receptionist’s desk or into the waiting area.

Until last month.

“It’s not the same here anymore,” said Justin Rodrigues, the hospital’s security manager.

That laid-back feeling ended soon after a man and punched another in the face March 20. All survived, and police have charged Franklin Poulsen, 21, of Pahoa, with attempted second-degree murder, terroristic threatening and multiple counts of assault.

“All of us, we were very scared because you don’t expect something like that to happen,” said Colleen Doi, a nurse who helped treat a female colleague whose hand was cut.

Victims of the attack have chosen not to speak to the news media, said hospital spokesperson Elena Cabatu.

“We’ve never had any incident of that type,” said Cabatu, who has worked at the hospital for 13 years.

Once was more than enough for the hospital’s administration, which has implemented airport-style security measures not seen at most other Hawaii hospitals. Guards are waving metal-detecting wands over patients and other people upon arrival at both the main and medic entrances to the ER.

It took just two weeks to produce results.

On April 4, two loaded handguns were found on Randolph Lee Yates, 56, who now faces multiple felony charges, including removing the serial number from one of the weapons, after he arrived at the hospital in an ambulance, .

“It was a dangerous situation,” said Rodrigues, who secured the guns and called police.

Hospital security guards are unarmed, but Rodrigues said he hopes they’ll soon be equipped with handcuffs.

Guard Bryson Majamay said about three-quarters of ER visitors have welcomed the extra security. The rest, he said, grumble and question why he has to look in their bags.

One recent morning, several ER visitors said they approve of the heightened security, although others could be overheard questioning the searches while waiting in a short line.

“It should happen,” Arlene Stannard said upon arriving to have her daughter’s injured foot examined. “We shouldn’t need weapons at a hospital.”

Another change involves having intoxicated patients and those seeking care for behavioral health issues wear only a gown so they don’t have pockets in which to conceal a weapon, Cabatu said. “We believe our community understands the need for the added safety precautions and is willing to be delayed entry into our ED for the few minutes it will take to ensure their safety as well as our staff’s safety.”

Hilo Medical Center is not the state’s first hospital to use metal detectors.

The Queen’s Medical Center in Honolulu has used metal detectors and X-ray machines since 1995 and added the security measures for patients at its West Oahu facility in 2014, according to Shereen Johnson, director of security and safety services.

Airport-style security is not used at several other ERs, including Kapiolani and Straub medical centers on Oahu and Wilcox Medical Center on Kauai, said Kristin Bonilla, marketing manager for Hawaii Pacific Health.

The hospitals do have security stations, she said.

Back in Hilo, “We find a bunch of knives,” Majamay said, mostly of the pocket variety.

People can return prohibited items like lighters and multi-tools to their vehicle or pick them up from security on the way out.

“The craziest one I found, other than knives, was nunchucks,” Majamay said, referring to a martial arts weapon.

Three new security positions will be added to the hospital’s 24-member staff, and the hand-held metal detectors could be replaced with a walk-through design to expedite the screening process, said Tracy Arruda, the hospital’s head of security.