As a first step, all emergency department staff, especially physicians, should be trained in techniques that can keep both patients and staff safe. The most important technique is using an open body posture and listening to the patient’s concern. Additionally, the staff should be aware of a person’s body language and learn to diffuse a situation before it gets violent. If the person has a reasonable request, you or the staff member should try to resolve the issue in a non-confrontational way. In extreme situations, the patient may be briefly restrained and then allowed to emotionally recover while de-escalation techniques are continued.

Some emergency departments rely on professional outsourcing to provide violence prevention training for all staff. These programs focus on teaching interactive skills to staff providers that allow the patients to vent, reassess themselves and have a mutually acceptable non-violent, non-physical resolution. Workshop formats included in these programs also discuss techniques for safely restraining a patient when verbal intervention and de-escalation techniques do not work. At other institutions, the training segments are completed by house staff learners for maximum uptake. ACEP members can access relevant articles and other online resources including www.crisisprevention.com/Specialties/Nonviolent-Crisis-Intervention/Onsite-Training that further address and organize constructive responses to violence in the emergency department. Emergency physicians must resist the idea that violence is expected and to be tolerated. Unfortunately, violence will never be eliminated from the emergency department, but being aware of the problem, learning violence de-escalation techniques and having an expectation to work in a violence-free environment are a start to treating all patients in an ethical manner.

Dr. Delpier is an emergency physician at Union Hospital in Elkton, Md., and Bayhealth Kent General in Dover, Del. Dr. Benson is a resident in Otolarynology, Head and Neck Surgery, at Johns Hopkins in Baltimore.

References

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