Pediatric Psych Ward/In Patient--MacGuyver Time

[neorxnawang]

This is another one of my "I'm writing a scenario and would enjoy a little kibitzing" threads. It's a modern day one shot. The PCs are children between the ages of 8 and 14, both genders. They are in a small, self-contained in patient pediatric psych ward at an urban hospital. These are moderately disturbed children under short term lockdown for observation and/or stabilization: suicide attempts, psychotic breaks, acting out from abuse, self-cutters. No one dangerous to others, they may be dangerous to themselves.

The entire ward is in one wing of one floor, locked down with a double buzz in access door, and up several stories. Don't worry about anyone getting out; for reasons I don't want to get into, they're not getting out. They can try to call out or email out but that will not do any good, for reasons I don't want to get into. Brief Internet access might happen if they play their cards just right (its complicated). There are some research opportunities in the medical intake files and psych literature in the psychiatrist's office.

At the back of the wing through another security door is an isolation ward for violently disturbed patients, along with a treatment room.

Something awful happens. The adult staff is butchered; maybe there is one horribly injured one clinging to life. The children/PCs are essentially stuck on the ward itself. No meaningful help will be forthcoming from outside the ward.

I have read up on standard design manuals for psych wards.

What sorts of weapons, defensive measures, or other things could a determined group of children get their hands on if there is no staff intact enough to stop them? What other sorts of useful things might they get access to? There might be some sedatives that were being prepped for use lying about loose in the isolation ward, but I wouldn't think they would be likely to be kept in the locked ward at all (except maybe under lock and key in the treatment room)?

[Graeme_P]

Fire suppression equipment: fire extinguishers are probably the ultimate modern era improvised weapon (especially the CO2 based ones, although these are not likely to be present in hospitals) - used right, they can deliver a spray of blinding chemicals and when empty remain heavy enough to be used as bludgeoning implements. Fire axes are not likely to be present, though. Enterprising youths might be able to rig a smoke or fire detector to go off - possibly direct dialing the local fire department (or at least the hospital security desk) and setting off sprinklers. Puddles of water on the floor could be combined with stripped electrical wiring to... well, you get the idea. Then there are the usual improvised weapon standbys of broken table legs, billiard balls in a sock, etc.

Things to bear in mind for modern era include whether any of the staff have personal cell phones (or are smokers, with associated paraphernalia... such as matches and lighters). Staff might also have been issued with personal attack alarms to call for help, depending on the facility. One possibility might be to signal for help by flashing the lights on and off in Morse code (...---...) to attract attention. Using gurneys as a battering ram is possible, but will probably futile from your description. Janitorial closets might also reveal a variety of toxic chemicals - bleach, ammonia etc. Mixing some of them could generate chlorine (or worse), but might be a double edged sword. These are things I would consider trying, as well as barricading yourself into a "safe place" (office, closet, etc.) and just waiting for help.

Graeme

[bintz]

I second everything that has been said so far. I'd just moderate a bit the fire extinguishers since it depends a lot on the size/age of the children: it could proove very heavy to operate!

You can also consider your PCs finding the psych ward kitchen (if they're held there for more than a day, there is certainly an industrial kitchen or something like that). There, they could find all sorts of knife, set things on fire, trap something/someone into a cold room, etc.

[Camillus]

From my experience working in a medium secure psychiatric unit I'd make the following observations:

• Fire extinguishers will be locked away in unmarked compartments or absent completely. If they are locked away the nurse in charge will have the key. They will be CO2 or water. Remember that CO2 extinguishers can do more harm to the user than the target.
• Injectable drugs will be in locked cabinets in the treatment room. The nurse in charge will have the keys. Most will be of little use because although they are sedatives they don't necessarily work quickly. There are a couple of options that could be available though:
• If there a patients with seizures on the the unit then there might be drugs for controlling status epilepictus which are rapidly sedating but they are normally given IV or rectally (which could be tricky with some mythos creatures).
• If the unit does ECT then there will be anaesthetic drugs including paralysing agents and the kit to deliver the shocks.
• There might be a crash cart with emergency drugs such as adrenaline (epinephrine) and possibly a defibrillator, which, if it isn't a modern automated one will make a serviceable weapon.

[Skyman]

So to add to what has been said. Depending on where this is taking place there may be some different level of context on how in patient lock down psychiatric ward and the term of 'moderately' emotionally disturbed children sometimes doesn't warrant locked down facility IMO. From what you describe as self harm behaviors I get the impression you are refering to 'severly' emotionally disturbed kids...so i will go with that. Also the ages may make a difference if it's a psychiatric setting or locked residential because folks don't usually want to mix adolescent kids with pre-adolescent kids.
I'll break it down to two types (Hopefully doesn't over simplifies):
Acute Screening facility- Kind of a 72 hour hold. Can have 4 point restraints gurney and a 24 hour registered nursing staff. Smaller population of kids ratio to staff. Smaller area to work with and I really don't think this is what you are shooting for. If it is I can detail more.

Short Term Residential/hospital inpatient locked-From what I remember the stay is less than 3... or 6 months. 24 hour (mostly)Child care counselors with a higher ratio of kid to staff 6:1. If this is what you are aiming for. The some things they might have access to is various things but nothing outright helpful. Most would require a break into some room or closet that is accessible to staff only. Fortunately staff are dead and maybe the kids have access to the body because they would know that they have the keys. Recreation room would have foosball table(for some reason this like the popular thing to have) and TV bolted in. Storage cabinet would have brooms and buckets and vaccums. Kids personal storage would have clothes, personal effects, Hygiene products (Shampoo),belts and shoes (laces). Nurses station would have meds, contra-ban items picked off kids coming in and electrical med equipment as mentioned above. Kids have access to bed sheets, pillows, matress (bed fram is probably bolted down), cheeked pills, toilet paper, more importantly toilet lid to swing, furniture (chairs because tables would be bolted down), They could pull the plastic border off where floor and carpet meets, bust (with concert effort of other kids) a weak foor pneumotic hinge thingy, night table (maybe), books, magazines, and thats all I can think of right now. Kitchen would be locked within a locked room and the frig with a lock and food cabinet/closet also locked (most likely reinforced). Also Kitchen might not be anywhere close to the kids wing if this is more of a hospital setting.

[brasso]

I have read up on standard design manuals for psych wards.

Could you link to these if possible? Or let us know the ISBN? Thanks - I'm a resource junkie.

[neorxnawang]

Courtesy of our friends at the Veterans' Administration (US)

http://www.cfm.va.gov/til/dGuide/dgMH.pdf

[ElijahWhateley]

The kitchen is probably not an option, since if it is at least a moderately sized hospital the kitchen will be next to the hospital cafeteria, which will be on an entirely different floor (there's no point putting people who aren't allowed to walk to the cafeteria next to the cafeteria).

Obviously the entire facility is designed to minimize the possibility of improvising weapons, but there will probably be some form of furniture - not all furniture in psych wards is bolted down. There may also be at least one television, almost certainly an older one (so not a flatscreen). If the children are strong enough to pick it up and smash it into someone or something, it will do a lot of damage, especially if the screen is shattered. Even if it isn't plugged in, the television will still hold a charge for some time (weeks to months to years, not minutes) that is strong enough to severely injure or kill a healthy adult (and the broken glass won't, or rather will, hurt). Clothing and bedsheets can be made into ropes, that in the hands of a small group can be used to trip, entangle, and tie up a solitary assailant. Even simply throwing a thick sheet over a person's head will momentarily blind him, and then they can take advantage of the opportunity to pile on or use another improvised weapon.

Assuming they can loot keys and access cards from the bodies of the staff - or the heavily wounded survivor says "take this and run, at least you'll have a chance" - they should be able to get into at least some of the medical supplies the staff have on hand - probably no more than a day's worth of medication for the patients (since the ward will receive new medications and refills on at least a daily basis), plus some first aid supplies. If you know what problems the inmates have, you could probably do some googling to see what the common prescriptions are and get a good idea of what might be on hand. While any particular drug isn't likely going to be that harmful, if they just blindly mix everything together they've got a good chance of getting something fairly dangerous, thanks to all the drug interactions. If they find syringes, they don't necessarily need any sort of sedatives or poisons; injecting a syringe full of air into the blood vessels of a human (or other terrestrial animal) is going to be deadly, although I don't know how long it will take. Filling the syringe with any common antiseptic, like hydrogen peroxide or alcohol, will also make a pretty dangerous weapon, and even chilled tap water (if they can keep it in the fridge long enough to get near-freezing cold) can be immensely painful - blood vessels really aren't meant to be flooded with foreign substances.

[neorxnawang]

[QUOTE=ElijahWhateley;250852]The kitchen is probably not an option, since if it is at least a moderately sized hospital the kitchen will be next to the hospital cafeteria, which will be on an entirely different floor (there's no point putting people who aren't allowed to walk to the cafeteria next to the cafeteria).

All very helpful everyone. EW is right that there is not going to be a kitchen or kitchen facilities in the locked ward and the design is conscious to make improvised weapons or opportunities to self-harm difficult. To sneak in a little more of the plot, the children/PCs have some serious problems but have been screened out of isolation (meaning they are not deemed likely to harm anyone else or themselves, but still, the ward is designed not to take many chances). On the other hand, they are well enough to be allowed in the day room, where there is a (bolted down) TV and other rec activities. Food, meds and plastic utensils are brought in and brought out at appropriate times. My thinking is that there is an ECT room at the back, and a locked cabinet with a limited supply of things. Sheets are definitely a possibility and when all hell breaks loose, they should be able to grab keys or swipe cards off of a horribly mutilated body or two. There may be some plastic utensils in the day room, since a Halloween party of sorts is underway for the kids who are well enough to participate. There will be condiment packages and fruit juice boxes and other harmless snacks not needing a utensil on the ward.

[ElijahWhateley]

Another thought - wards these days often allow portable music players with headphones to be used under supervision; either CD players or older-model iPods without all the other features. If the catastrophe occurs when one is in use, so the kids keep hold of it, someone might be able to devise a weapon from the battery or the electronics, maybe a garrote from the headphones, and perhaps a crude slashing implement from a sharpened fragment of a CD.

The unconsidered option is contraband. While the hospital staff will be very thorough, they're only human, and one or more of the inmates could have snuck in something typically banned that could be used as a weapon. It would have to be a very small item, naturally, and the player might want to explain why the item was of such sentimental (or other) value that his character felt the need to sneak it in. Detwiller's Insylum briefly mentions how an inmate could hide the edge of a razor in the seams of clothing (not that the inmates will necessarily have their original clothing). Prestidigitation, body cavities, or the nurse just having a bad day and making a careless mistake during the initial search all are possible ways for items to be snuck in; once in the ward, the inmates will not be subjected to regular body searches.

[Skyman]

Ahh good more info...they can break the foos ball table and use the poles to defend themselves. Also the rec room would wave a closet of games and sports equipment and art supplies...just saying. Might be locked but with enough kids pounding on it it should break. Not sure ECT room would be so close IMHO. There should also be a serving cart that can be taken by the kids. Dead staff may have a cake knife that the kids could use. Nice to know the kids are not in isolation or on a 1:1 because that would be tricky. They can also unhinge the doors or cooperatively pull down the lighting fixtures and wire for obvious defensive use. Is there an onsite laundry facility? BTW The VA hospital link is cool but keep in mind, from what I skimmed & know, it is for adults.