An excerpt from our Medical Editor in Chief Dr. Cedric Dark : As you read our August issue, may also notice a theme emerging from some of the other pieces in this issue: they touch on controversial issues. This is both a symptom and side-effect of our current social, political, and professional climate. The topics discussed in this issue are meant to highlight the work, and the worries, of our profession. No matter which side you take, each topic affects us all professionally and personally. Our diversity of experience and opinion is what makes emergency medicine, the American College of Emergency Physicians, and America itself enriching. I hope that you will enjoy reading this issue, and most of all, learn something new from what you find inside.

Violence in the emergency department (ED) is nothing new. A 2005 study showed that between 35–80 percent of hospital staff have been physically assaulted at least once during their careers.¹

COVID-19 may have also exacerbated an already existing truth. In November 2021, a survey conducted by the National Nurses United and the Surgeon General indicated eight out of 10 health care workers experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.² Patients in emergency departments sometimes have violent outbursts; some of these patients have access to weapons—either prefabricated or improvised. In 2020, ACEP Now published statistics surrounding firearms in the ED, revealing that almost 60 percent of health care professionals working in American EDs encountered firearms in or near the ED at least once per year.³ Recent mass shootings, inside and outside the hospital, have directly impacted emergency physicians—either as caregivers or as victims—and reignited the debate over the wisdom of concealed carry in the emergency department.

But a recent slew of gun violence in the ED has prompted debate on the efficacy of workplace safety. In 2016, Parrish Medical Center in Florida experienced an active shooter who shot and killed a 92-year-old patient and her caregiver.⁴ In 2021, a hostage situation at the Children’s Medical Group in Austin, Texas, left two physicians dead, including the gunman.⁵ In June, EMS workers in Conroe, Texas, were nearly injured after disarming a patient who fired shots in the emergency department.⁶

Also in June, the murders of Preston J. Phillips, MD, FAAOS, an orthopedic surgeon, and Stephanie J. Husen, DO, a sports medicine physician, along with two other people by a disgruntled patient at a hospital in Tulsa, Oklahoma, highlighted the dangers posed to health care workers—dangers which ED staff know all too well.⁷