NJ Hospital Group Teaches Gang Awareness

Here's a pop quiz on street gang affiliation: Can you tell the difference between a Crip and a Blood, or a Latin King, a Neta, an Aryan Brother, a Pagan, or an MS13? More importantly, can your staff identify a gang banger when he walks through the doors of your emergency department seeking treatment, or helping a wounded "posse" member with a work-related injury?

So far, we appear to have dodged a bullet – literally and figuratively -- on the issue of gang violence spilling into the hospitals. Violence, however, is intrinsic with street gangs, and there is an uneasy fear that at some point, somewhere, rival gangs seeking treatment for their injured friends could confront one another in the emotionally charged confines of an emergency department.

Police estimate that there are hundreds of thousands of gang members of every race and ethnicity in every state in the union. That being the case, it's probably a good idea to provide staff with education on street gangs, how to spot them, and how to respond when they're in your ED to defuse potential violence. 

Since 2007, hospital and law enforcement officials have been preparing for that contingency. The New Jersey Hospital Association has worked with the state's Parole Board to offer a one-day crash course called "Gang Awareness Training for Healthcare Workers."

Mary Ditri, director of professional practice NJHA, said the hospital trade group decided to address the issue before a violent gang-related incident occurred. "We know this is something our communities struggle with, gang violence, and it's not going away," Ditri says. "The training is really not geared to have healthcare workers do things they shouldn't be doing. It's geared toward giving them the tools they need to help them do what they do better, focusing on environmental safety for the patients, their families and the providers and their colleagues."

Lt. Daniel Riccardo, Field Coordinator for New Jersey State Parole Board Street Gang Unit, has brought gang awareness to dozens of hospitals across the Garden State. "I couldn't give you an exact number statewide of how many gang members there are in New Jersey. Let's put it this way: a lot," Riccardo says. "They should all be considered a threat because they have a violent nature that can come out at any given time."

"When one of them gets shot, or stabbed, or beaten up, where are they going to go? The ER. And the first people they are going to deal with are ER staff," he says.  

Chances are that injured gang member and his running buddies aren't looking for trouble at your hospital. You aren't a threat to them, and they need treatment. The problem is what happens if the rival gang shows up. Maybe they've got a wounded friend who needs treatment too. That's when things get dicey. "If you have reason to believe you have a gang member you may want to put them in a separate room. You may want to put them off to the side so they aren't in the main view of the general public," he says.

It sounds easy to "profile" a gang member. Maybe he's wearing red or blue clothes, or he's covered with tattoos, of flashing hand signals. Maybe there are five guys in the waiting room dressed like him. They might be gang members, or not. Unfortunately, there really isn't one iron clad signal that will announce the presence of a gangbanger. "Self admission alone isn't good enough. Just because you tell me you're a Blood that is not enough. You could be a wannabe," Riccardo says.

Instead, he says hospital staffs need to understand a wide array of clues and behaviors that could signal gang affiliation and if suspicions are aroused, call the police. "I emphasize, do not confront them or ask: 'what crew are you running with?'" Riccardo says. "I don't want hospital personnel to say anything in regards to gangs with someone you believe is in a gang. I'm just saying if you have reason to believe let somebody know and let them deal with it. It's a safety issue. If law enforcement comes to the hospital, they talk to the person and he isn't a gang member, so be it. I would rather be safe than sorry and have a violent incident in the ER."

Riccardo says the gang awareness program is something that could easily be replicated in other states, because there are gangs in every state in the union, "including Hawaii and Alaska."

You may even consider expanding the scope of the training to include domestic violence, which perhaps poses an even greater threat to patients, and providers if the angry spouse walks into the ER.

We cannot control much of what goes on outside of the hospital doors. It's hard enough to control who walks through the hospital doors, with 24/7 access to everybody required by Emergency Medical Treatment and Active Labor Act (EMTALA) and usually with no security screens to walk through. That's why it's imperative that hospitals have a plan in place to react to violence. Even better, provide staff with the tools to identify the potential for violence before it occurs.