The identification badge is one of the most visible symbols in modern health care. It communicates trust, role clarity, and institutional legitimacy. In many hospitals, its placement location is non-negotiable: high on the chest or suspended from a lanyard. Yet, in the emergency department (ED), where volatility is intrinsic and arguably unavoidable, this ubiquitous object may represent a preventable occupational hazard hiding in plain sight.

Health care systems have become increasingly sophisticated in mitigating low-probability, high-consequence risks. For example, needlestick injuries prompted safety-engineered retraction devices; medication errors led to barcode verification systems; even rare sentinel events now drive system-wide redesigns. Against this backdrop, the continued normalization of neck-worn identification badges stands out as an unexamined inconsistency. This standard practice results in many practitioners in the ED wearing a retractable or fixed-loop lanyard, often supplied by the employer upon onboarding, without true understanding of the hidden dangers behind this mandated visibility token.

The risk is mechanical, not theoretical. A lanyard is, by definition, a loop capable of transmitting force circumferentially around the neck. When tension is applied, it tightens. In a clinical environment characterized by agitation, intoxication, delirium, and violence, this design becomes problematic.¹ Evidence from the safety literature confirms that lanyards have been used to pull or choke health care workers during assaults, underscoring their potential as improvised ligature devices.²

This concern is magnified by the epidemiology of workplace violence in health care. Health care workers are disproportionately exposed to violence compared with other professions, with emergency departments consistently identified as high-risk settings.³ Even conservative estimates suggest that a substantial proportion of clinicians will experience physical or verbal assault during their careers, often in environments where close physical contact is unavoidable.⁴

Within this context, the presence of a neck-worn device that can be grasped, leveraged, or entangled is not trivial. It is a design vulnerability.

The broader safety literature outside health care reinforces this concern. Lanyards have been implicated in serious occupational injuries, including fatal strangulation when caught in machinery or subjected to sudden force.^5,6,7 Although the mechanisms differ, the principle is the same: A closed loop around the neck introduces a non-zero risk of catastrophic harm when exposed to external force. Breakaway mechanisms can mitigate this risk, but they are inconsistently implemented, variably effective, and often absent from standard-issue hospital badges.²

Why, then, does this practice persist?

The answer is not a lack of alternatives but a failure of prioritization. Clip-on badges, magnetic attachments, and engineered breakaway systems provide equivalent functionality without creating a fixed ligature point. These options align with the hierarchy of hazard control. They allow for substitution and engineering controls, long recognized as more effective than reliance on behavior or compliance alone.³

Instead, current policies often prioritize visibility and uniformity over contextual safety. The requirement for upper-torso badge display, frequently enforced without regard to clinical setting, reflects a form of administrative inertia. It assumes that the risks of invisibility outweigh those of physical harm, which is an assumption that has not been rigorously examined.

This imbalance reflects a broader asymmetry in health care safety culture. Patient-facing risks are systematically identified, quantified, and mitigated. Conversely, health care worker-facing risks, particularly those embedded in routine workflows, are more likely to be normalized. The identification badge, precisely because it is ubiquitous, escapes scrutiny.

Emergency medicine offers a clear lens through which to reassess this norm. The ED is not simply another clinical environment; it is a high-risk interface between health care and crisis.¹ Policies that fail to account for this distinction risk imposing hazards under the guise of standardization.

Reconsidering badge design is not a radical proposition. It is a straightforward application of established safety principles. At a minimum, institutions should mandate breakaway mechanisms for any neck- or collar-worn device, expand access to non-lanyard alternatives, and make provisions for environment-specific adaptations in high-risk settings. One such adaptation would allow emergency departments and behavioral health units to use non-standard badge locations, such as the beltline.

The identification badge, a simple tool designed for the ease of identification, is intended to signal safety, trustworthiness, and professionalism. It should not simultaneously function as a potential instrument of harm or serve as an implement of a health care worker’s demise.

In a field that prides itself on anticipating the unexpected, the continued acceptance of this avoidable risk has the potential to place health care workers in harm’s way. Both its design and mandated securement location deserve closer examination.

Dr. Stinson is an emergency physician practicing in Salida, Colorado, with a focus on wilderness medicine and the delivery of emergency care in austere environments. He earned his medical degree from St. George’s University and completed his emergency medicine residency at St. Agnes Medical Center in Fresno, California. His professional and personal interests frequently overlap and include wilderness medicine education, whitewater kayaking, and finding medically justifiable excuses to frolic outdoors.

Dr. Howell is an attending emergency medicine physician who recently served as chief resident during his training at Saint Agnes Medical Center. He pairs a strong medical background with an early foundation as an EMT, a biochemistry degree from UC San Diego, and extensive peer-reviewed clinical research. Recognized with honors like the Society for Academic Medicine’s Excellence in Emergency Medicine Award, he is dedicated to resident education, community health leadership, and high-impact patient care.

Dr. Garispe is a board-certified emergency physician. She serves as medical director of the emergency department at Adventist Health Reedley, a Vituity site.  She was formally the associate medical director for the emergency department at Saint Agnes Medical Center and core faculty and research director for their emergency medicine residency program, as well. Her academic interests include equity-focused medical education, mitigating workplace violence, and leadership development.

References

1. Jacob D, Jacob B, Jacob E, Jacob A. Effectiveness of environmental design interventions to reduce aggression and violence in emergency departments: a scoping review. HERD. 2025;18(4):26-42. doi:10.1177/19375867251351027
2. Carvey M, Hage R. Conference lanyards; why does it take so long to provide health hazard-free options? Transl Res Anat. 2021;23:100110. doi:10.1016/j.tria.2020.100110
3. Lim MC, Jeffree MS, Saupin SS, Giloi N, Lukman KA. Workplace violence in healthcare settings: the risk factors, implications and collaborative preventive measures. Ann Med Surg (Lond). 2022;78:103727. doi:10.1016/j.amsu.2022.103727
4. Sari H, Yildiz İ, Baloğlu SC, Özel M, Tekalp R. The frequency of workplace violence against healthcare workers and affecting factors. PLoS One. 2023;18(7):e0289363. doi:10.1371/journal.pone.0289363
5. Occupational Safety and Health Administration. Employee is strangled by lanyard caught between two conveyors. Accident Summary No. 88268.015. US Department of Labor. Published 2016. Accessed May 26, 2026. https://www.osha.gov/ords/imis/accidentsearch.accident_detail?id=88268.015
6. Occupational Safety and Health Administration. Employee is pulled into conveyor when lanyard is caught. Accident Summary No. 111975.015. US Department of Labor. Published 2018. Accessed May 26, 2026. https://osha.prod.pace.dol.gov/ords/imis/accidentsearch.accident_detail?id=111975.015
7. Chinniah Y, Villeneuve S, Ostiguy N. Analysis and prevention of serious and fatal accidents related to moving parts of machinery. Saf Sci. 2015;75:163-173. doi:10.1016/j.ssci.2015.02.004