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All visitors to the Waianae Coast Comprehensive Health Center’s emergency department must now walk through a weapons detection system that uses artificial intelligence to locate and identify dangerous objects like guns and knives. 

By installing the system called Evolv, Waianae Coast Comprehensive Health Center said it is following a national trend of beefing up security at health care facilities as nurses report an increase in violence against hospital staff. Other hospitals around Oahu are doing the same.

Regis Snatchko, security operations director at Waianae Coast, said installing Evolv was not in response to any particular incident locally, but rather a prevention measure to help keep the facility safe. 

“It’s a very, very important facility for this side of the island, it’s a critical emergency room,” Snatchko said of the emergency department, which serves about 21,000 patients per year. “We have to take that responsibility very seriously and keep everybody as safe as possible.”  

While Hawaii data showing the number of attacks on hospital staff was not available, nationally the rate of violent incidents against health care workers went from 2011 to 2018, according to a 2020 report from the Bureau of Labor Statistics. Experts say the trend is fueled in part by a staffing crisis that leaves fewer nurses taking care of more patients.

The recent at the Hawaii State Hospital brought the issue into sharper focus, but health officials say violence against nurses has been on the rise for years.

“It’s an ongoing problem, it’s an ongoing challenge,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii. “Every hospital is having to invest in enhanced security.”

Taking Action Across The Island

Waianae Comprehensive’s Evolv system works by using sensor technology to read the metal density of objects that pass through it. It also uses artificial intelligence to recognize patterns over time and distinguish between harmless objects (like nail clippers) and weapons (like knives), Snatchko said. 

It’s also quicker and less invasive than sweeping someone with a metal detector wand or patting them down, Snatchko said. 

“It enhances the experience for the patient and the employees that come through,” Snatchko said. “You can picture what we go through when we travel at the airport. This system is nothing similar to that.”   

So far, the machine, which screens about 7,000 people per day, has caught a few wrenches and tools and caused one person coming into the emergency department to surrender a large pocket knife to security personnel before walking through, Snatchko said. 

The hospital has taken other measures, such as creating a security committee, adding an additional security guard at the main entrance, hiring a security operations director and tinting glass in certain areas. The cost of all the new security initiatives, including the Evolv system, was about $400,000, according Ian Ross, spokesman for the hospital.

The Queen’s Medical Center-Punchbowl installed its own Evolv system in July, according to Cedric Yamanaka, spokesman for the hospital. It is the only Queen’s hospital location with the machine. 

Yamanaka said he could not provide statistics for the number of attacks on staff members at Queen’s but said the hospital has seen an increase. 

Hawaii Pacific Health does not have metal detectors, but has other security measures in place, such as around-the-clock guards and alert systems that allow staff to call for help by pressing a button, according to Troy Branstetter, the company’s vice president of general services. The network of hospitals is in the process of acquiring weapons detection systems.

Kristen Devitt, regional director of security at Kaiser Permanente, said its Moanalua Medical Center has a weapons detection system in its emergency department, and all Kaiser facilities have access control devices and security cameras. The hospital also conducts magnetic searches at all of its facilities and provides security escorts for visitors or patients who have histories of violent or threatening behavior, she said. 

“It is frustrating that we are having to spend significant amounts of money to keep our staff safe, but unfortunately, it’s a necessity,” Raethel said. “We do need to let our staff know that we’re doing whatever we can to protect them.”

But nurses say that while they want to see machines like Evolv and metal detectors installed at hospitals, those systems can’t stop all attacks.

A Dangerous Job 

Steven Hobbs, who retired as an emergency department nurse from The Queen’s Health Center-Punchbowl two years ago, said he experienced many physical attacks over the course of his 30-year career. 

“I don’t think a year ever went by when I was not assaulted in some way, shape or form,” he said. 

Hobbs remembered one incident in the late ‘90s when a woman who was brought into the emergency department via ambulance pulled a pistol out of her pocket. 

“They opened the door, and she ran down the length of the ER and, for whatever reason, felt the need to fire several shots as she was going out the door,” he said. 

No one was injured, he said, but after that, he remembers the hospital drastically increased its security measures. 

“That was the beginning of the metal detectors when you come into the entrance of the hospital,” Hobbs said. “In the old ER, a lot of the windows were changed to bullet-proof glass.” 

Dan Ross, president of the Hawaii Nurses Association, said he believes metal detectors and weapons scanners should be installed in all emergency rooms and hospital entrances. 

Ross said he didn’t know how many attacks have occurred at Hawaii hospitals, but he cited multiple recent incidents, including a pregnant nurse who was punched and knocked unconscious at The Queen’s Medical Center-West Oahu, another who was choked with a hospital gown at The Queen’s North Hawaii Community Hospital and a nurse who was severely bitten by a patient at Kauai Veterans Memorial Hospital.

None of those attacks could have been prevented by a metal detector or weapons sensor.  

One of the major contributing factors to violence in hospitals, he said, is a shortage of nurses combined with overcrowding.

“Obviously (patients) aren’t getting the attention that they need,” Ross said. “That’s going to fray people’s tempers and exacerbate things.” 

A lack of available hospital beds also leads to more patients with psychological or behavioral issues being admitted to medical floors without specialized care, he said.

If the rising trend of violence continues, Ross fears it will turn more nurses away from an already struggling industry.

“You get into the profession because you want to help people,” he said. “When you become the victim for it, sometimes people re-examine.”

Civil Beat’s community health coverage is supported by , Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and .