Nearly half of the more than 3500 emergency physicians who responded to a survey conducted by the American College of Emergency Physicians (ACEP) report having been spit on, punched, kicked, scratched, or bitten at work, and more than 60% of respondents say that the incident happened in the previous year.

"Nearly half of these incidents resulted in injury," said ACEP President-Elect Vidor Friedman, MD, who presented the findings at the group's scientific assembly in San Diego.

Although "the results of this poll are not a surprise," he told the audience, they are "quite troubling."

An invitation to complete the online survey was sent by email to 32,714 current ACEP members in August. Of the 3538 physicians who completed the survey, 47% said they had been physically assaulted and 71% said they had witnessed an assault.

In addition, 24% of the respondents said they had experienced two to five violent incidents in the previous year, and 1% reported experiencing more than 10 assaults.

But it's not just physical assaults. Inappropriate comments or unwanted advances were reported by 96% of women and 80% of men who work as emergency physicians.

"And the physicians are the least likely to be affected," he pointed out. Nurses and other healthcare workers are even more likely to be victims of violence in the emergency department. "But there is gross under-reporting."

"It's a noble specialty; we don't turn anyone away," said Leigh Vinocur, MD, from the University of Maryland School of Medicine in Baltimore, who is a former chair of the ACEP committee on emergency department violence.

We get into medicine because we are compassionate and recognize that this behavior can be part of the disease process, she told Medscape Medical News.

The first time Vinocur was assaulted was by a patient suffering from a drug overdose who had presented to emergency.

"An intern gave the patient a big dose of Narcan — a drug used to reverse the effect of opioids — directly into his IV. He bolted," said Vinocur. "He started screaming that we ruined his high."

"He grabbed me by the throat and started choking me. Most of the team scattered," she recalled. "My necklace broke. Then the radiology tech put him in a chokehold." And Vinocur said she vowed to never wear jewelry to work again.

More needs to be done to protect medical staff and ensure that patients don't suffer the consequences, Friedman said.

"We need better law enforcement and better security," he explained. "We have to develop a culture of zero tolerance." This is an "ever-growing problem," he pointed out, "but we don't know if it's because people are starting to report it, or if there's an increase."
Changes in Violence
Fear in the workplace is increasing, according to results from a study that looked at changes in the incidence of violence in the emergency department over a 13-year period, which was also presented at ACEP today.

Surveys looking at violence in an emergency department in Michigan were conducted in 2005 and 2018 by Terry Kowalenko, MD, from the Oakland University William Beaumont School of Medicine in Michigan, and his colleagues.

The team compared data from 268 respondents who responded online from each of the 2 years.

Emergency physicians experienced a 10% increase in physical assaults from 2005 to 2018 (38.1% vs 28.1%). The percentage of respondents who reported experiencing "any" type of violence remained stable over the study period, at about 72%.

And respondents reporting "feeling fear at work" increased from 1.2% in 2005 to 8.1% in 2018.

We're not saying that every ER needs a metal detector, but it needs to be something the institution takes seriously.
An increase in security guards, cameras, metal detectors, and visitor screening might be needed. "We're not saying that every ER needs a metal detector, but it needs to be something the institution takes seriously," said Kowalenko.

"We would like to do the front-end stuff — security and de-escalation — better," he added.

Under-reporting is a big problem, he explained. Only 3% of respondents to the ACEP survey said they pressed charges for an incident of assault. Many people are under the impression that law enforcement does not support them.

"We know of a nurse who brought a civil suit against someone and was told, "you knew what you were getting into; this is part of the job," Kowalenko said.

Although reporting is important, education for healthcare workers is key. In many states, such assaults are felonies, but the downside is that a victim has to make a complaint, he added.

Recognizing the Signs
Vigilance and a constant awareness of potential behavioral changes are important, Vinocur said, as is training on de-escalation.

"Is this a victim of gang violence, or is it related to gang violence? Substance abuse? Are they manic?" she asked. "You have to make sure you don't let them get between you and an exit."

He grabbed me by the throat and started choking me.
Much of the time, violence in the emergency department can be attributed to drug abuse, overcrowding, or the boarding of psychiatric patients who are waiting for a bed and appropriate treatment, she said. "The emergency room is a reflection of society as a whole."

LINK:https://www.medscape.com/viewarticle/902857?nlid=125355_381&src=WNL_mdplsnews_181005_mscpedit_wir&uac=65325SY&spon=17&impID=1760643&faf=1#vp_1

quote:

Emergency physicians experienced a 10% increase in physical assaults from 2005 to 2018 (38.1% vs 28.1%).

It's a useful article, I just wish the author could do simple arithmetic. Oh wait, it's even worse. I just wish the author could write simple English.

Not surprising ... ER docs (and many lawyers too) are big 2A folks because of potential retribution from clients and their families. Been that way for decades.

The hospitals where I used to live often had shootings in the ER parking lot and I can recall at least one in the ER itself.
The Yoop hospital amazed me when I moved here. Almost no security and I was free to roam the entire building.

Doctor: Hi....I'm here to save your life!
Patient: {whack}
Doctor: Fine-go to back of the line and die.......NEXT!

I know a number of drs who carry in belly bands and such under scrubs.

Sounds eerily similar to the recent post about teachers being assaulted.

Many years ago I worked with an old-timer ER doc. Every night he brought a box of Ritz crackers with him to work and set it down in front of his area of the nurses station. We never did see him ever eat any of them, however.

Finally, one night my curiosity got the better of me and said, "Jack, every night you bring that box of Ritz crackers in but we never see you eat any of them. What's up with that?" He just nodded his head towards them in a gesture to take a look.

There weren't any Ritz crackers in the box. There was a .44 snubby in there.

I miss Jack.

When I was earning my EMT certification, i worked in a ER. The first question they asked me in the interview was, can you restrain compative individuals ?

Waiting for Z71 to chime in. He's had some doozies.

"Grossly unreported" yup.

No ties, no jewelry, no stethoscopes around the neck, nothing to pull, grab, yank. Most wont even reply to a survey. But the article is very wrong about LE. Its a baseless, moronic tangent that can't be further from the truth. They watch out for staff and are there every time we need. I can't count the times they have helped.

The Narcan story - those happen regularly. Save a life, DB gets pissed b/c his/her high was harshed, and he/she's out the cost. Restraints are supposedly not allowed......

Narcan - societies worst friend...

dopers, druggies and frequent flyers should be allowed to die

on the spot

no assistance

just pick up the body and move it to a trash bin

quote:

Originally posted by nhtagmember:
Narcan - societies worst friend...

dopers, druggies and frequent flyers should be allowed to die

on the spot

no assistance

just pick up the body and move it to a trash bin

Let’s see you let your child die of a disease that effects ~10% to 15% of our nation’s population.

Most “new” opioid addicts are from pain pills prescribed to a teenager coming from surgery’s. Sure, just let them die <rolleyes>

It happened to me while working in an ER. Details not important but this 100 pound or so woman tried to hit me with all her might. Cut my lip but did not really do any damage. Long story short the local PD quickly showed up to take the woman to the station. They sent the smallest female cop I ever saw. She went into the room and next we see her and the patient in a full on brawl. Ultimately carted away. Even though assault of a medical professional under such circumstances is a felony in that state, never got a call to file a report testify or anything. What I was told is they considered the assault on the officer a higher level crime to prosecute.
And of course the urgent care I work in now has one of those very effective “no gun” signs on the door!

I did not realize this.

Daughters father-in-law has been an ER doc for many years. He still does that but only a couple days a week.

Since I bought my SIL an AR for graduating from Med school, his dad has gotten into guns and shooting in a big way.

As a cop, I can say I've been in more fights in the ER than anywhere else. Pretty much every shitbag in the county goes through there on a regular basis so that the rest of us can pay the medical bills they incurr from their irresponsible lifestyles.

Also, add to that all the doped up/drunk criminals that we have to take there for medical clearance before the jail will book them. Society has dictated that we are somehow responsible for the effects of all the crap that they put into their bodies before we found them. So we can't just lock them up...we have to take them to the hospital and wait for them to be cleared (or have a bac of below .25) before we can book them. This costs the taxpayers money, takes cops off the street for hours, and subjects the ER staff to all manner of poor behavior from these "patients."

quote:

"We know of a nurse who brought a civil suit against someone and was told, "you knew what you were getting into; this is part of the job," Kowalenko said.

Does the nurse not know that civil suits have nothing to do with law enforcement? Now they are upset at hearing this?? Law enforcement has heard that for decades.

Not an ER doc. But I do work in a field where the risk of getting hurt is much higher than the regular med floor. We had 2 recent incidents where 1 patient sucker punched the person doing the 1:1 watch. Another staff just came back from a medical leave after suffering fractured wrist when a patient suddenly jumped over the nurse station and grabbed the staff. One time, a patient came to our unit with a 4inch folding knife hidden inside his waistband. ER failed to properly search the patient. Medical field is a dangerous place to be at sometimes.

quote:

Originally posted by ZSMICHAEL:
"We would like to do the front-end stuff — security and de-escalation — better," he added.

Recognizing the Signs
Vigilance and a constant awareness of potential behavioral changes are important, Vinocur said, as is training on de-escalation.

"or the boarding of psychiatric patients who are waiting for a bed and appropriate treatment, she said. "The emergency room is a reflection of society as a whole."

LINK:https://www.medscape.com/viewarticle/902857?nlid=125355_381&src=WNL_mdplsnews_181005_mscpedit_wir&uac=65325SY&spon=17&impID=1760643&faf=1#vp_1

quote:

Originally posted by SIGnified:

quote:

Originally posted by nhtagmember:
Narcan - societies worst friend...

dopers, druggies and frequent flyers should be allowed to die

on the spot

no assistance

just pick up the body and move it to a trash bin

Let’s see you let your child die of a disease that effects ~10% to 15% of our nation’s population.

Most “new” opioid addicts are from pain pills prescribed to a teenager coming from surgery’s. Sure, just let them die <rolleyes>

Links to where you got those stats please?????

I honestly can’t even count the number of calls where Narcan was administered.
I have encountered ZERO folks claiming it stemmed from a teenage surgery.


As to the article. Our state recently changed legislation in regard to assaults that occur at ER/Hospitals. Police can now arrest for minor assaults in hospital locations that did not occur in the officers presence.

Not just Doctors, nurses as well and anecdotally more than Doctors as the nurse tends to have more contact in term of time with each patient.
My wife when she worked in the ER was assaulted multiple times and to include a sexual assault.

When I was in the trauma center, I treated the staff with the utmost respect and I got treated like royalty.