The incident in question also highlighted the impact that workplace violence and mental health can have on the victims who are present during such events. Those of us who were on shift at the time of the suicide attempted to resuscitate our colleague while still treating many other sick patients simultaneously.

The continuous hum of quiet voices, footsteps, alarms, the occasional shriek of a patient who just received a needle stick on a busy evening with a packed waiting room, was interrupted suddenly with a “BANG!” Did a patient just fall and smack their head? Did a stack of printer paper fall off the top shelf? Did a pile of crutches just go crashing to the ground? The gut-wrenching screams that followed solidified the reality of the situation.

The smell of gun powder hung in the air. Lying by my feet, someone was injured—or worse. Did he plan to do this today? Did something happen on shift to lead him to this? What was the last thing I said to him? Did I even say hello to him today? Was my calling in emergency medicine designed for this moment?

What happened next was a combination of the human spirit and fundamental training in its most raw state. A tornado of organized chaos managed to transport him to the resuscitation bay as the tasks of life-saving maneuvers began. In the end, I walked out of the resuscitation bay with a defeated look on my face and blood-soaked shoe prints that trailed behind me. A crowd formed outside the room of his colleagues and close friends. Hope turned into sadness and anger as reality became apparent. This traumatic experience left many of those who were there that night with moral injury and some with post-traumatic stress disorder. All were forever changed. The smells, the sights, the sounds, and the constant replay of every detail of what happened, persist as nagging psychological scars.

Reflecting on this, there were no obvious warning signs. Previously established mechanisms for staff and patient safety did not work and were not designed for this. Now I realize we need to be proactive and heed the opportunities that cross our paths every day. For example, the Journal of the American Medical Association recently reported that mental health related emergency room visits spiked between 2011 and 2020.⁴ Anyone complaining of mental health struggles, violent tendencies and warning signs must be taken as seriously as any high-risk chest pain patient stating that their chest pain feels just like their last heart attack!