Emergency Room Violence Taking a Toll on Workers, Patients

When discussing violence toward emergency physicians, Dr. Alex Skog had to reach back into his memory just two days to pluck a story about a patient who lost it, charged an emergency room technician and cut another doctor who had tried to help subdue the man.

Though the physical trauma from such an incident can be damaging, the strain on the emergency medical system is even more significant. And, according to a recent survey of medical professionals, these terrifying and disruptive occurrences are increasing.

Skog said that after the incident, the violent patient remained in the emergency department because he is so volatile and violent that inpatient psychiatric services still doesn’t feel it has the resources to care for him safely.

As for the rest of the emergency department, it was so paralyzed with so many staff having to help manage the situation that it caused hours of delay in the care for other critically ill patients who were already in the emergency room.

Skog is president of the Oregon chapter of the American College of Emergency Physicians (ACEP), which conducted the survey.

According to the 2022 poll, 66 percent of respondents indicated they had been assaulted in the past year, and more than a third of those said they had been assaulted more than once in that time span. Emergency physicians almost unanimously (89 percent) agree that the occurrences of violence in emergency departments have adversely affected patient care by increasing wait times and discouraging patients from staying to see a doctor.

The violence is exacerbating the already high incidence of burnout and impacts health-care workers’ mental health, which is already in poor shape. Additionally, 85 percent of emergency physicians reported feeling emotionally traumatized because of violence. In the last survey (2018), 45 percent of respondents said they believed violence had increased compared to 85 percent this year.

“When we talk about violence being experienced, the definition is there so you understand it is not only verbal threats, but it’s actually a real credible threat,” said Dr. Chris Kang, ACEP president-elect. “It’s not just, ‘I’m unhappy’ or ‘I’m frustrated,’ it’s ‘I’m going to get back at you’ or ‘I’m going to go get my gun and come back and kill you.’”

Sometimes it’s the patients who get violent, but it can also be friends and family, and they usually leave the hospital with little or no accountability or punitive actions taken.

“As emergency departments are no longer respected as safe zones, inadequate protections for emergency medical professionals and staff, and patients, combined with insufficient accountability from hospitals, communities and assailants can only encourage violence to continue,” Kang said.

Although violence may have been on the increase before COVID-19, the pandemic has helped erode trust of patients with emergency personnel.

Emergency medical physicians want the violence addressed and have reached out to legislators to do something. There is federal legislation in the offing that would help, and one item being presented mirrors the Transportation Security Administration legislation that protects airport workers from being assaulted. Physicians are also calling on the Occupational Safety and Health Administration to issue enforceable standards, requiring health-care and social service employees to implement workplace violence prevention plans.

“Violence is not only bare but it continues to rise,” Kang said. “Unfortunately, we believe this cycle is going to continue to rise, and that overall not only affects us physically, but emotionally and psychologically.”