Violence in the ED: No Quick Fixes for Pervasive Threat

Abstract

Emergency physicians may be inured to the anger and threats and violent episodes they encounter on the job. That doesn’t mean they’re leaving themselves vulnerable; in Michigan, at least, a survey of attending emergency physicians found that 38% bought a knife or a gun. There are probably more physicians carrying guns and knives for protection in urban Detroit than more rural parts of the state. But the 2002 survey’s finding, reported in the August 2005 Annals of Emergency Medicine, is a sign of the times. A growing body of research indicates that verbal and physical assaults are taking place regularly in emergency departments (EDs) across the country, placing everyone who works in them at risk. The Michigan survey found 75% of emergency physicians had experienced at least one verbal threat in the previous year. Twentyeight percent reported being physically assaulted, 12% were confronted outside the ED and 3.5% were stalked. The survey involved 171 randomly selected attending physician members of the Michigan College of Emergency Physicians. Most (82%) reported being occasionally fearful of ED violence. While researchers say prevalence data are not as complete as they’d like, other surveys carried out over the past couple of decades in the United States and Canada confirm the trend. A 1996 survey of 106 ED employees at St. Paul’s Hospital in Vancouver, British Columbia, found that 57% reported being physically assaulted that year, a quarter took time off because of it, and a majority said violence was becoming more common and more severe.