The hospital security guard, who was in a patrol car with his co-worker Glen Dansie, was urgently required for a "personal threat" situation in 8 West 1: the geriatric ward.

About 25 family members were brawling violently following an argument between two women over who should be there with their dying grandmother.

"We didn't know what we were running into. We tried to separate the fighting family members and then they were turning on us, bashing us, kicking, punching," says Pike, 51, who has worked at RPA for five years.

Pike and Dansie were both badly assaulted, resulting in weeks off work. A female nurse had her hair pulled. Other visitors screamed and locked themselves in rooms until the NSW Police Riot Squad arrived.

"We just didn't have enough security personnel to control the situation, we weren't equipped with anything to protect ourselves," says Pike, the hospital's Health Services Union (HSU) delegate.

Pike is a 26-year veteran of the security industry, having worked in nightclubs, shopping centres and on industrial sites.

But he has never seen violence like the current wave gripping NSW hospital wards, partially fuelled by the skyrocketing use of the drug crystal methamphetamine, or ice.

"It's just getting worse and worse; it's out of control and we're losing the battle," he says. "I've got two grown-up daughters who are often asking me to think about changing jobs. My wife is extremely worried; she says she has never seen anything like it."

The security crisis in NSW hospitals deepened this week, following the near-death of a police officer and security guard, allegedly at the hands of a patient in Nepean Hospital's emergency department.

Michael De Guzman, himself a registered nurse who left Westmead Hospital two years ago and had been battling an ice addiction, allegedly took a female doctor hostage on Tuesday night, holding a pair of scissors to her throat.

When police and security guards arrived, Guzman turned on them and, following a short struggle on the ground, allegedly pulled Senior Constable Luke Warburton's gun from its holster and fired two shots. One hit the officer's upper thigh, passing through his femoral artery and almost killing him. Security guard Barry Jennings was shot in the calf.

Guzman, 39, has been arrested earlier that day for break and enter and assaulting three police officers. He was taken to hospital in an ice-induced state, granted bail and left in the hands of hospital staff.

Police have launched a critical incident investigation and the NSW Health Minister Jillian Skinner will meet with the HSU this Thursday to discuss hospital security.

"This sort of thing is happening all over the state," says Pike. "Police bring in violent and aggressive ice addicts. Then the handcuffs come off and they get handed over to us but we've got nothing. We aren't given any powers; we aren't given any equipment. I don't blame the police because they're under-resourced and they do a fantastic job but there is huge pressure on us."

The number of ice-related presentations to 59 public hospital emergency departments in NSW increased more than seven-fold between 2009 and 2014, according to a NSW Health background paper released in September. In the first six months of 2015, there were 1942 ice-related presentations – a 50 per cent increase on the same period in 2014.

NSW Health refused to provide Fairfax Media with any data on assaults in hospitals, saying violent incidents were not categorised clearly so it would be too time-consuming to collate them.

Using freedom of information laws, the Northern Star newspaper found last month that assaults on staff at Ballina Hospital had tripled in five years.

The secrecy around assault data has prompted the NSW Nurses and Midwives' Association to launch their own app for members to log workplace assaults. The HSU conducted its own survey of security guards in 2013, finding that 50 per cent were responding to a duress alarm more than once per day. One in four had been spat on, three in four had been injured badly enough to require medical attention.

HSU secretary Gerard Hayes says he will ask Skinner for a round-table to be convened to get a clear picture of the crisis.

Skinner declined to answer any questions on hospital security before the meeting.

"We've had peak-level meetings before with ministers and they have basically looked at ways of dealing with the current situation without any major changes," Hayes says. "The ministry is of the view that the security function within hospitals is adequate."

In October, the NSWNMA asked NSW Health to put security guards in every emergency department. Ministry of Health workplace relations director Annie Owens declined, saying the current approach was "appropriate".

Several hospital security guards have told Fairfax Media of chronic staff shortages, poor training and mandated powers that render them almost useless.

Guards are not allowed to restrain or detain anyone and are there to "observe and report". They are not allowed to carry restraints such as handcuffs.

Nathan Sing, a security guard at Hornsby Hospital and an HSU delegate, says the hospital usually has just one NSW Health guard and one contracted guard on duty. He says three guards are off work due to workplace injuries.

On November 19, several patients in the mental health intensive care unit turned on Sing and other staff, headbutting and punching a nurse, punching an occupational therapist in the face and grabbing another nurse by the throat to strangle him.

"I was tied up for 11 hours with that incident which meant the whole hospital was left unguarded," he says. "If you walk into an emergency department, there is no guarantee that you're going to be safe at all."

He says violent incidents are a weekly occurrence and "about 98 per cent" related to drug-affected patients.

Police data held by the NSW Bureau of Crime Statistics and Research shows that assaults in NSW hospitals have increased by 5.5 per cent each year since 2012. Yet the raw number of 484 assaults in the year to September 2015 is likely to be the tip of the iceberg.

Hayes says the concept of hospital security needs to be completely rethought.

He wants guards to be immersed in the clinical setting and given training with a medical bent so they can add to a patient's health rather than simply act as bouncers.

He says the hospital security system is still stuck in the 1970s, with security officers sometimes performing menial tasks, such as putting parking tickets on cars.

The Australasian College for Emergency Medicine and Australian Medical Association have both backed a review of hospital security arrangements, saying staff face violence every day.

The AMA has suggested the introduction of "rapid response" teams in emergency departments – a mix of hospital staff tasked with handling volatile situations.

Pike says he has asked for such a team at RPA but has been knocked back.

"At the end of the day, you can't protect everyone 100 per cent of the time," he says. "But we can at least try to minimise the threat and protect staff as best as we can."

A spokesman for Sydney Local Health District said RPA has about three violent incidents per week and adequately responds with a "multidisciplinary" team including clinicians and security staff.

Guards undergo training which "provides them with the skills, over and above those required for their security licence, to de-escalate and manage difficult situations".

A Northern Sydney Local Health District spokesman said Hornsby Hospital spent $1 million on security staffing in the last financial year, with 14 full-time positions.

The hospital "provides regular security and incident response training," he said.