FARGO - Hospital emergency rooms here are seeing more violent outbursts from patients, a trend officials link to drug and alcohol abuse and increased cases of mental illness.

At MeritCare Hospital in Fargo, security officers are summoned an average of once for every 50 patients, said Mary Jagim, a nurse who manages the emergency center.

Jagim said the reasons vary, but she points to substance abuse and psychological problems.

Methamphetamine cases at the emergency room have more than doubled in the past year. Records also show more patients who have been drinking or have paranoid schizophrenia.

The emergency room at Fargo's Innovis Health also has noted an increase in violent behavior, for the same reasons, officials said.

"We have definitely seen an increase in violent behavior in the ER in the last year or so," said Jodi Baumgartner, an Innovis spokeswoman.

The emergency room at Innovis used to go a week without a violent incident. Now, it is typical to have several outbursts a week, Baumgartner said.

"The meth has really been a challenge," Jagim said. "They're very agitated. They don't want anybody touching them. They can be very violent."

Violent patients - including those involved in fights or domestic disputes - often are brought in with police escort handcuffed and lying face down on a gurney.

Because physical restraints can fail, MeritCare emergency room Dr. Greg Bjerke prefers to use fast-acting sedatives when agitated patients pose a danger to themselves or others.

"We sedate them aggressively and then they go to sleep usually," he said.

The need for sedation could be reduced when isolation rooms become available. MeritCare's emergency department hopes to add two safety rooms next year.

The emergency room, with its glaring lights, beeping monitors, needles and invasive questions, may unnerve patients who are on edge emotionally, workers said.

"What we do in the ER is pretty intrusive, drawing blood from them, asking about their history," emergency room nurse Nate Tiedeman said. "I think they feel claustrophobic at times."

Bjerke, who has been an emergency room physician for 22 years, tries to catch a patient's aggression before it has a chance to escalate.

"You try to recognize that before it happens and deal with it," he said. "It can be very disruptive."

Jagim recalls hearing police sirens while returning to work one day in the MeritCare emergency room.

When she arrived, Jagim saw found that a patient had pulled a knife and a police officer had drawn his gun to subdue the man.

The man with the knife apparently was paranoid - he thought the officer, who was escorting another patient, was after him. Nobody was hurt, but Jagim said her legs shook for the rest of her shift.

Tiedeman, at 23, is a battle-hardened emergency room nurse.

"I've been kicked, punched, bit, spit on multiple times," he said.