Jennifer Casaletto, MD, an emergency physician in Charlotte, North Carolina, and an ACEP board member, said violence in the ED became a greater concern after she moved from a large academic trauma center with a responsive hospital security force to a smaller freestanding ED in 2010. “As we went through that decade, the threats and violence became more prevalent,” she recalled. After several “pretty egregious episodes,” the facility failed to respond while the police informed the on-duty nurses that pressing charges for assault would require them to leave the hospital and come to the precinct mid-shift.
The new state law, informed by ACEP members such as Dr. Casaletto and backed by the state’s chapter, also requires hospitals to collect and report data on violent incidents and makes assaults that cause physical injury to hospital and medical practice personnel a Class I felony.
The reporting requirement could overcome the reluctance of many hospitals to voluntarily detail violence that may reflect poorly on their institutions. “Nobody wants to put their own dirty laundry out there,” Dr. Manfredi said. As Dr. Casaletto and other doctors pointed out, however, the problem is nearly ubiquitous. “I think one of the big things that we all need to realize — hospitals included — is that this is not unique to one hospital, to one type of hospital, to a state, to a region and not even truly specific to a type of patient,” Dr. Casaletto said.
Dr. Rabrich said reporting could take the form of anonymized data to avoid singling out any one institution. To make informed decisions about violence prevention and enforcement, however, he maintained that data from every institution are necessary to clarify the patterns and magnitude of the problem. Advocates are also pushing for federal requirements that would make violent incidents reportable safety events. “We do that with medication errors, and we do it with falls; we do it with hospital quality issues,” Dr. Bass said. Similarly tracking violence could help point out where interventions are most needed.
Increasing penalties for assaulting health care workers, as North Carolina and other states like New York have done, could provide another important deterrent. At the federal level, ACEP and ENA have advocated for the Save Healthcare Workers Act, introduced in the U.S. House and Senate in May 2025. Mirroring protections for airport and airline workers, the law would make assaulting hospital personnel a federal crime and institute harsher penalties for assaults during a public emergency or under certain other scenarios. Some critics have worried that harsher penalties could effectively criminalize mental illness, but Rep. Reeder noted that ED workers have expertise that could be tapped by law enforcement to help distinguish between a patient who becomes violent due to an underlying condition such as dementia and someone who is “truly volitional” in their actions. ACEP also maintains a state legislative dashboard to keep up on regulatory issues, including those designed to protect health care staff safety.
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.