Main Points

• Emergency physicians are patient advocates who see the problem firsthand and can play an important role in breaking the cycle of family violence.
• Violence against women is an urgent public health problem with devastating consequences for women, children and families.
• Family violence is a widespread problem that affects all ages, genders, races, educational backgrounds and socioeconomic groups.
• ACEP does not support mandatory reporting of intimate partner violence, because it can put victims at greater risk of injury and death. ACEP encourages reporting and referral in accordance with the patient’s wishes.
• Everyone is only one step away from a medical emergency.

What is family violence and who are its victims?

Family violence is a pattern of coercive behavior, including physical, sexual and psychological abuse of a partner or family member by another. It occurs between married and unmarried (current or former) partners, parents and children, children and grandparents and siblings. Victims can be any age, race or gender.

The key point is the establishment of power and control of one individual over another. In 2006, more than 18,000 people were victims of homicide and more than 33,000 took their own lives.

What is intimate partner violence?

Intimate partner violence, often called domestic violence, is also known as partner abuse, spouse abuse or battering. It occurs when one person uses force to inflict injury--either  emotional or physical--upon  another person with whom they have, or had, a relationship. The objective is to establish power and control of one individual over the other in the context of an intimate relationship.

There is no typical victim. Intimate partner violence occurs among all ages, races and socioeconomic classes. It occurs in families of all educational backgrounds. People may be living together or separated, divorced or prohibited from contact by temporary or permanent restraining orders.

How extensive is the problem of intimate partner violence?

Each year, women experience about 4.8 million intimate, partner-related physical assaults and rapes. Men are the victims of about 2.9 million intimate, partner-related physical assaults. (Centers for Disease Control)3

• Intimate partner violence resulted in 1,510 deaths in 2005. Of those deaths, 22 percent were males and 78 percent were females. (CDC)
• Research shows nearly half (44 percent) of women murdered by their intimate partner had visited an emergency department within two years of the homicide.
• Intimate partner violence costs exceed $8.3 billion. Victims of severe intimate partner violence lose nearly 8 million days of paid work, the equivalent of more than 32,000 full-time jobs, and almost 5.6 million days of household productivity each year.

How extensive is the problem of elder abuse and maltreatment?

According to the best available estimates, between 1 and 2 million Americans ages 65 and older have been injured, exploited or otherwise mistreated by someone on whom they depended for care and protection. The majority of abuse is physical.

How extensive is the problem of child abuse and maltreatment?

Approximately 3 million cases of child abuse are reported every year  and four children die every day as a result of child abuse. The rate of child abuse is estimated to be three times greater than what is reported. The majority of child abuse occurs in children from birth to 3 years old. Eighty-three percent of victims were abused by a parent. Of the reported rapes of children under the age of 12, 90 percent knew the perpetrator.

Two-thirds of murders of children under the age of 5 were committed by a parent or other family member. More than three-quarters of the children who die are younger than 4 and 43 percent are under the age of 1. The rate of infant homicide reached a 30-year high in the year 2000.

Child abuse occurs in every socioeconomic level, across ethnic and cultural lines, within all religions and at all levels of education. While 90 percent of Americans polled regard child abuse as a serious problem, only one-third report abuse when confronted with an actual situation.

What are the laws about reporting abuse?

Physicians are required to report cases of child and elder abuse and maltreatment. Few states specifically require reporting of intimate partner violence. A small number of states require mandatory arrest of abusers, and a few jurisdictions aggressively pursue cases of intimate partner violence and prosecute abusers even when victims refuse to press charges.

When emergency physicians detect intimate partner violence, mandatory reporting to authorities — especially against a victim’s will — may not be the best thing to do because it can put the victim at greater risk of injury and even death. Studies show that women who leave abusers are at a 75-percent greater risk of being killed by them.

Virtually all jurisdictions impose civil or criminal penalties for failing to report suspected child abuse or neglect. It is extremely important for emergency physicians to know their state laws and how local criminal justice systems deal with the issue so they can properly and adequately inform their patients.

Is help available?

Yes. Victims of violence should talk with their physicians or call these hotlines:

• National Domestic Violence Hotline: (1-800-799-SAFE) (1-800-799-7233)
• Hotline for Elder Abuse and Maltreatment: (ElderCare Locator) (1-800-677-1116)
• Hotline for Child Abuse and Maltreatment: 1-800-4-A-CHILD® (1-800-422-4453)

ACEP encourages emergency personnel to screen patients for intimate partner violence and to appropriately refer victims. For additional information on this and other health and safety topics, visit www.EmergencyCareforYou.org. See also ACEP’s policy statements on "Mandatory Reporting of Domestic Violence to Law Enforcement and Criminal Justice Agencies," "Emergency Medicine and Domestic Violence," "Guidelines for the Role of EMS Personnel in Domestic Violence" and "Management of Elder Abuse and Neglect" http://www.acep.org/webportal/PracticeResources/PolicyStatements/.