been severely cut back to control an alarming increase in unruly and sometimes violent users.

The hospital has also installed "panic buttons'', increased security personnel and offered staff training courses in "protective intervention'' should they be threatened.

The steps were made in the wake of a growing incidence of aggression and violence among department patients and their companions.

In comments last month to The Royal Gazette , doctors and nurses indicated they felt besieged by outbreaks of disorder -- many of them fuelled by alcohol and drugs.

Reported incidents included staff and others being threatened by a knife-wielding patient. Fights have broken out between rival gangs.

Yesterday, hospital director Mr. Hume Martin said he hoped the security steps would put an end to the incidents.

"Incidents have been down in the last two weekends,'' he said. "We don't know if this indicates the measures have been effective. Perhaps the public listened to our calls for more cooperation. We're just not sure.'' The steps at least go significantly toward restricting public access to the department -- one of the key complaints among staff.

Its three entrances were described by Dr. Edward Schultz as too many. Mr.

Martin said doors are "being locked throughout the hospital systematically.

The only door open after 9 p.m. is the main entrance to the emergency department.'' Two security guards are now stationed at the department at all times. In addition, the hospital has asked that only one person accompany each patient into the department. Mr. Martin described that condition as a "general rule'' that would be relaxed in instances such as two parents accompanying a child.

The restriction, however, was adopted to control the growing tendency of groups of people accompanying a patient and becoming unruly or confrontational.

Mr. Martin said plans were in place to provide all staff, including security guards, with training in protective intervention. He said the training was similar to the programmes that are part of staff training at St. Brendan's Hospital.

"This is training to help staff learn how to deal with violent or disruptive patients or members of the public,'' Mr. Martin said.

"It will help teach our staff how to calm people down or to manage violent reactions in terms of physically restraining people.'' Another change reflecting the deteriorating condition at the department is the installation of panic buttons at its security office and nursing station. The buttons link the department directly with the hospital's security firm.

Mr. Martin said the buttons were to be used "if we need their help. We also have a direct line to Police.'' The level violence and confrontation at the department in recent months had escalated to the point that some staff wanted Police to stand guard, particularly during busy weekends and holiday nights when most disturbances occur.

Police declined saying they did not have the manpower for the job. Last night, Mr. Martin said: "We think these measures will effectively address the problems we've been experiencing.''