With great interest, [we] read the recent ACEP Now article, “Workplace Violence in the ED: In Search of Lasting Solutions.” The legislative progress described the No Silence on ED Violence campaign, and ACEP’s peer support network represent meaningful, hard-won gains that address real gaps. The article is right to highlight these as genuine progress.

Yet the dominant framework remains oriented toward legal deterrence and post-incident response. The published literature offers little support for criminal penalties as a standalone deterrent; post-assault accountability does not prevent the initial act. True prevention requires proactive measures that reduce risk before incidents occur.

Lasting solutions require upstream prevention as a central priority. Health care has a well-established model to identify and mitigate hazards before harm occurs, using the same logic that underpins surgical safety and infection prevention. When applied, this means integrating structured behavioral risk assessment into patient triage, using standardized protocols to recognize threats before encounters, embedding de-escalation competency into training alongside clinical skills, and conducting rigorous post-incident reviews that do more than document events. The Joint Commission’s requirements for staff training, a designated program lead, and violence prevention policies provide a strong foundation. Health care leaders must build cultures where risk is anticipated, safety assessments are operational rather than administrative, and post-incident findings drive real change.

The goal should not only be justice for staff who have been harmed, but measurably fewer staff experiencing harm at all. Workplace violence prevention programs are strongest when guided by an interdisciplinary triad of nursing, physician, and security leaders who can translate policy into frontline reality.