In the second incident a few years later, he rescued a paramedic from the grips of a suddenly psychotic patient and spent minutes locked in physical entanglement with the patient until hospital security arrived.

In recent years, incidents of emergency department workplace violence have captured the attention of risk management and physician groups that do not consider being physically assaulted a “part of the job.” However, recognition alone of workplace violence by such groups does not fully address the issue.

After her experience with workplace violence, Dr. Staggers noted, “No changes were made because of this incident, but it was suggested that I file for worker’s comp. We aren’t covered by compensation.” This lack of coverage adds insult to injury for the many ED physicians who work as independent contractors and are assaulted at work.

In January 2012, a Los Angeles emergency physician who asked to remain anonymous said he was assaulted by a patient in the ED who wanted to be admitted solely for a place to sleep and had no medical complaints. When the patient was told he was not going to be admitted, he jumped on the doctor and punched him in the face multiple times. He recounts that it took the security guards a few minutes to get to them and pull off the offender. The doctor said he suffered multiple injuries to the face and a fat lip, but thankfully, no permanent intracranial injury.

“I did end up leaving that evening after the assault. Fortunately there was a backup person on call,” he said. “I was a little bit shaken up – and ugly-looking – so it would have been tough to do a good job if I kept working. On the other hand, we do what we need to do. They asked whether I wanted to press charges. I said, ‘Yes.’ They took a statement. I got a call the next day saying that he was out already, that he had pled guilty and that there was a restraining order. He was back at outpatient psych the next day. It is a little bit frightening that this guy, with a history of poor impulse control, now can focus on my name as the person who is causing problems for him at the VA, with parole, etc., and that with about 30 seconds and a web browser, he can find out where I live.”

ED Commitment Reduces Violence

Hospital administrators and emergency department leadership need to recognize workplace violence as a major issue and take the necessary steps to ensure that violent incidents are reported without repercussions for the affected employee. Appropriate actions should address safety, legal, and psychological ramifications these employees may face. There is reason to be optimistic that further cultural changes can provide a safer work environment for all emergency care providers. The ENA survey found that nurses who practiced at facilities where hospital administration and ED management are committed to minimizing workplace violence had fewer violent incidents. Emphasis on descalation training, environmental changes, and, most important, a zero-policy toward workplace violence can foster peace over violence.

Resources Available

The ACEP Public Health and Injury Prevention Committee works to increase awareness of violence in the ED. Most recently, the committee published a compilation of resources on emergency department violence (tinyurl.com/ED-Violence). More work is forthcoming as the committee attempts to ensure violence-free ED environments for all health care providers.

Please Take This Workplace Violence Survey

The ACEP Public Health and Injury Prevention Committee launched a survey for emergency physicians to document the extent of workplace violence as an impetus to help change the current culture of ED violence and prevention. Please take the opportunity to participate and to help safeguard the longevity of our practice of emergency medicine. Go to www.acep.org/snapsurveys/2012workplace/2012workplace.htm.