The Restrained Intoxicated Patient in the ER Lot
You are a hospital security officer working the 23:00-07:00 shift. At 02:15, a 34-year-old man in the emergency department parking lot is yelling, punching a car window, and refusing to leave. He is bleeding from his knuckles and smells of alcohol. Two nurses say he was 'just discharged' and is angry about a bill. He is not armed as far as you can see. He is between you and the ambulance bay doors. Backup is 4 minutes away; a city officer is on another call. The lot is well-lit and there are no bystanders within 30 feet. Your department policy authorizes handcuffs only after a subject is controlled and only with a supervisor's approval when feasible.
1. Apply a use-of-force decision framework to this situation. What options are available, and what should you do first?
Read the worked answer
Use a graduated, totality-of-circumstances framework: presence, verbal, empty-hand control, intermediate weapon, deadly force - choosing the lowest option that is reasonably likely to be effective.
First steps:
- Assess threat: He is agitated, bleeding, and property-destructive, but no weapon is visible and no one is within 30 feet. The immediate risk is escalation and injury to himself (bleeding) and property, not imminent deadly threat.
- Position and distance: Keep a reactionary gap, avoid standing between him and an exit, and keep the ambulance bay accessible.
- Verbal de-escalation: Identify yourself, use a calm, non-threatening tone, give simple choices ('You can wait in the lobby, or I can call a clinician'), and avoid arguing about the bill.
- Summon resources: Request medical staff for his bleeding and confirm backup ETA; ask dispatch to notify the city officer.
- Escalate only if necessary: If he advances or tries to enter the ambulance bay, empty-hand control or a team control technique may be justified; handcuffs only after control and per policy.
Document the force used, the reason, and any injury.
2. He begins walking toward the ambulance bay. What is your response, and what documentation is required afterward?
Read the worked answer
The ambulance bay is a critical access point; blocking it is a legitimate safety objective.
Response:
- Verbally redirect: clear, single instruction ('Stop - you cannot go past this point').
- Position yourself to the side, not directly in his path, and keep hands visible.
- If he continues, a soft empty-hand escort/redirect may be justified to protect the access point, using only the force reasonably necessary.
- Call for backup and medical; if he is injured, ensure treatment.
- Do not use a chokehold or strike to the head; avoid techniques that risk positional asphyxia if he is placed prone.
Documentation:
- Incident report with time-stamped narrative, exact words, and physical actions.
- Use-of-force report per policy (level, duration, target areas).
- Injury report and photos if permitted.
- Witness statements from the two nurses.
- Notification to supervisor and risk management.
- Preserve any CCTV footage.