aggression among patients and their companions, The Royal Gazette has learned.

The level of violence has escalated to the point that some staff are calling for Police to stand guard during busy weekends and holiday nights when most disturbances occur.

In the last three weekends alone, patient care has been interrupted by confrontation and violence -- much of it fuelled by alcohol and drugs.

Recent incidents highlight the situation: Frightened staff were confronted by a knife-wielding patient who was tackled and disarmed by a doctor and nurse -- both of them women; People in the department's waiting room were horrified when a blood-covered man ran about screaming obscenities and spraying them with blood; Fighting broke out between groups of young men whose members, hurt in a street fight, were being attended by doctors.

Hospital spokesmen say the regularity of such incidents is damaging staff morale, creating a climate of fear and interfering with patient care.

Dr. Carol Ferris, who has been in emergency for 10 years, said violence there reflected increasing violence in Bermuda.

"There is no doubt it has become worse,'' she said. "There is a much greater percentage of patients we see who are there as a result of violence. Stab wounds used to be relatively rare. Nowadays, we can see several in a week.

"The number of instances where we have been threatened is increasing along with that. There are lots of people willing to come down here and throw their weight around.

"We're very concerned here because we can't lock doors. When we see someone prone to this kind of behaviour -- or more often when we hear them come in -- everyone becomes wary,'' she said.

The situation, which is well-established in US city hospitals, is being studied by local officials. No concrete steps have yet been taken to control it.

"We're looking into those concerns with a view to protecting the staff and the public from this behaviour,'' hospital director Mr. Hume Martin said.

One critical question is whether Police should be deployed at the department on busy nights.

It is understood the staff is of two minds: Some feel a Police presence is necessary while others feel it could inflame situations.

Dr. Ed Schultz, director of Emergency Services, believes Police should be stationed in the department at danger times.

"The presence of authority is good,'' he said, adding that private security staff at the hospital do not have authority to make arrests.

"When we're outnumbered six to one by hostile and aggressive people, it's a very uncomfortable position to be in. It would be helpful if we had a person with power, with the ability to make an arrest.

"When you negotiate from a position of weakness, the chance for violence is greater. If people think an arrest if possible, they are less likely to fight.'' Two years ago, after a pack-racer's death sparked a riot in the department, the hospital asked for a guaranteed Police presence on bad nights. The Police Commissioner answered that manpower shortages prevented it. However, he did say off-duty officers were available if the hospital paid them. Nothing was done.

Dr. Schultz said many North American hospitals now employ off-duty officers.

"It's very expensive,'' he said.

Dr. Schultz also said the hospital can improve department safety by restricting access to the department. Its three entrances are too many to limit people's movements.

"Access is far too easy,'' he said. "We need to be able to close down the department, to control access to it. We need a better way to deal with hostile, aggressive people.'' Dr. Schultz said intoxicated and aggressive groups of young people coming into the department was one of the most disturbing developments. Many staff, particularly women, had acknowledged feeling intimidation and fear.