The first time that Rita Manfredi, MD, FACEP, was assaulted in the emergency department (ED), she was five months pregnant. The emergency physician ducked her chin to her chest just in time to avoid being kicked in the throat by an agitated female patient who was wearing heavy boots and sitting between two security guards. “I walked out of the room on these very jelly-filled legs and said, ‘I think we need some help in there,’” Dr. Manfredi recalled. The hospital, however, never followed up on the incident.
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ACEP Now: March 2026
Dr. Manfredi
About four years ago, an even more distressing incident in a Washington, D.C.-area ED left her and colleagues badly shaken. A very large, mentally disturbed male patient who had been in a car accident rolled off the stretcher onto the floor. Dr. Manfredi helped several nurses try to get the patient back onto the stretcher. “The next thing I know I get smashed into the wall, and then the other nurses around me also got pushed back,” she said. The staff called for security officers, who stood in the doorway and failed to intervene.
About 10 minutes after the medical team calmed the patient and moved him to a resuscitation bed, he again pushed two nurses and then punched a physician assistant in the face after ripping his stethoscope in half. Summoned security officers again remained on the sidelines, and the ED team managed to regain control only by sedating the patient. This time, the team got lawyers and department heads involved; even so, the case was never resolved.
Much of the violence in EDs tends to be blamed on untreated mental illnesses or substance use disorders, Dr. Manfredi said. “But what is truly unspeakable and unforgivable is the system not providing some kind of safety for the [emergency care teams and staff]. That’s where the hang-up is, and that’s truly a bigger problem in emergency medicine now,” she said. “The system is failing us.”
An All-Too-Common Occurrence
Health care workers suffer more injuries from workplace violence than any other profession, reflected by a 2024 poll of ACEP members in which 91 percent of ED physicians reported that they or a colleague were the victim of violence within the previous year. Episodes of violence in which security officers fail to intervene is part of a troubling pattern, according to a majority of ACEP members (68 percent) who described their employers’ response in a recent poll as inadequate.
2 Responses to “Workplace Violence in the ED: In Search of Lasting Solutions”
March 8, 2026
ThomasIt is the responsiility of the hospital to provide a safe working environment for the professional staff. Hopsital CEO’s have records on the number of assaults monthly, which of those assaults end in surgery, and how many staff members quit due to that environment. Hospitals establish rules that result in termination action for staff in self-defense. Hospital leaderhip decides the limits on security intervention and under what circumstance security can go hands on. Hospital administration produces the “duck and cover” response to aremed violence. Yes, PD is responsible for the “tag you’re it” response to dumping unattended violence in the ER, but hospitals can say “No” to unattended “detained, but not arreted” patients. How does the rest of society hold people accountable?
March 9, 2026
StephenInteresting that you didn’t address the violence in the ED precipitated by other specialists ( neurosurgeons, gynecologists, etc) coming into the ED and threatening the ED physician verbally and physically if you don’t do or say what they tell you. And administration never backs or protects the ED physician because it’s easier for administrators to ask for your resignation or tell your”contract employer” to fire you. The latter happened to me in the late 1970’s and was done to me by a “fellow emergency physician” and fellow ACEP member who later became an ACEP national president.