“She struck so fast that all I was aware of was a burning pain across my face. I bled freely. I did not realize I was within reach and was behind her at about a 30-degree angle. She had already assaulted the EMS crew that brought her in. … She asked forgiveness from me when the Geodon and Ativan kicked in, and of course, I forgave her.”

Dr. Margaret Staggers, FACEP, an emergency physician at Beckley (W. Va.) Appalachian Regional Hospital and past president of the West Virginia chapter of ACEP, was assaulted by an elderly psychotic patient last July. Such violent patient assaults against emergency physicians led to an ACEP Public Health and Injury Prevention Committee objective focusing on workplace violence.

The exact number of assaults on emergency physicians remains unknown because it’s underreported. However, the Bureau of Labor Statistics has provided sobering information on the reported prevalence in the entire health care/social services sector, estimating 900 deaths and 1.7 million nonfatal assaults annually. Physicians say many health care workers fail to file a formal report because of:

• A perception that assaults are part of the job.
• A belief among employees that reporting will not benefit them.
• A concern that assault will be viewed as evidence of poor job performance.
• A lack of institutional policies.

Overcrowding and long wait times appear to increase the likelihood of emergency department workplace violence, with increased exposure to the disgruntled. One example is a 1993 incident when a patient opened fire and critically wounded three emergency physicians at Los Angeles County–USC Medical Center. The Los Angeles Times reported that the patient wanted a painkiller.

In 2009, the Emergency Nurses Association (ENA) initiated an annual survey focusing on the extent of current ED violence, estimates of underreporting, and trends in ED violence against nurses.

The survey revealed last year that 54.5% of the 7,169 emergency nurses responding had experienced physical and/or verbal abuse from a patient and/or visitor in the previous week. Of the nurses who experienced physical violence, a sixth were assaulted more than four times in the previous week while working in the ED.

Unfortunately, only a third filed formal reports.

This underreporting could still be an improvement from the way such violence was handled in years past. Emergency physicians who practiced during the early years of emergency medicine reported that such violent encounters were just part of the job. Dr. Richard Hencke, FACEP, a veteran emergency physician in northern California, relates two incidents when he tackled violent patients to prevent tragedy. In 1977, Dr. Hencke wrestled a patient in custody who had managed to grab the arresting officer’s gun. Dr. Hencke said it took the officer some time to intervene and retrieve the gun while Dr. Hencke attempted to subdue the woman with a physical hold from behind.