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Emergency personnel worldwide witness the effects of violence in society while caring for its victims. Over the last decade, ED personnel have also witnessed an increased prevalence of violence within the ED. Multiple factors contribute to verbal and physical assaults on ED staff members: unlimited and unrestricted access to patient care areas, family and friends of critically ill patients who have heightened levels of frustration and anxiety, patients who are substance abusers, prolonged waiting times, staff shortages, overcrowding, patient financial problems, and high expectations of the patients. ED personnel have very close interaction with the public and handle drugs, both of which are workplace characteristics that make violence more likely.1 As a 24/7 operation, the ED is also exposed to the increased violence that occurs at night.2 As the problem of violence in the ED has increased, so has the body of literature that addresses this issue (see PubMed search hits for violence and emergency department by decade in Table 293.1-1).

Table 293.1-1 PubMed Search Hits for “Violence and Emergency Department” by Decade

Workplace violence at educational institutions and government facilities captures the headlines, but more than any other profession, physicians and nurses are victims of nonfatal violent crime.3 More than 96% of ED physicians, nurses, and paramedics indicate that they have witnessed violence within the ED in the prior 6 months.4 Violent acts occur during 5% of EMS calls, and 69 health care workers were killed between 1996 and 2000.5–7

ED personnel are victims as well as witnesses of violence in the ED. One hundred percent of nurses working in a Florida hospital noted that they were victims of verbal abuse while at work, while 81% were victims of physical abuse while at work over the past year.8 Almost 12% of ED attending physicians in a single survey had been confronted by an agitated or violent patient outside of the ED, with an additional 3.5% citing a stalking episode within the past year.9 Sixty-two percent of residents and new graduates surveyed worry about their safety while working in the ED.10 In the last data published, which are now 2 decades old, only 62% of departments had a 24-hour security presence on the premises.11

Violent events and confrontations have consequences for both the patient and staff members. Immediate consequences include delayed care for other ED patients due to the time and labor-intensive nature of dealing with a violent individual in the department. Delayed consequences include physical and psychological trauma suffered by staff, resulting in decreased productivity, lost work time, lowered morale, and, finally, burnout. Reports indicate that 48% to 83% of workers experience reduced personal morale and ...

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