Violence in the Emergency Department: Resources for a Safer Workplace

Expert Opinion

Understanding Agitation: De-escalation
Deescalation is an effective technique that can help prevent attacks on emergency department staff and, in many cases, the need for restraint and sedation. In this video, Scott Zeller, MD, Vice President of Acute Psychiatric Medicine for CEP America, demonstrates a verbal de-escalation technique that can be used to calm an agitated patient. Dr. Zeller will present his approach to de-escalation live at innovatED during ACEP17.

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Design Considerations for a Safer Emergency Department
Jon Huddy, MArch, BA, AIA, NCARB, helps you identify the best possible design solutions to make your department safer for staff, patients, visitors, physicians, and all other providers.

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Your Experiences

What you’ve done to make your department safer
ACEP members responded to a survey on the violent incidents they’ve experienced, best practices to deal with them, and safety tips and other suggestions to prevent them in the first place. Read the results.

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James J. Sullivan, Jr., MD
Dr. Sullivan is Chief of Emergency Medicine at Harrington HealthCare System in Southbridge, Massachusetts. He recently shared his thoughts on the June 14 attack in his emergency care center, in which a nurse was stabbed 11 times by a former patient.

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CME Lectures

The Shooter is in Your ED: Practical Guidance to Maximize Survival
Your ED is full, you’re boarding critical and psychiatric patients, and now, all lives are threatened by an active shooter, including your own. What do you do? The speaker will describe workplace response approaches with a special focus on the hospital and emergency department environments.

Cool, Calm and Collected in Chaos: How Learned Psychological Skills Enhance Performance Under Pressure
Many professional athletes, business executives, and elite military special operations teams use comprehensive psychological skills and techniques that allow them to remain calm, think clearly, and stay focused in very challenging and stressful situations. Data from psychology, cognitive science, and human factors analysis will be utilized to present novel performance enhancing psychological skills that can aid the emergency physician in optimizing cognitive function and in the retention of fine motor skills during both typical and the most extraordinary and uncommon stressful ED situations.

Physician, Heal Thyself: The Importance of Creating Resilience
Emergency medicine can be extremely rewarding but it can also be extremely draining. Longevity in the specialty are tied to the emergency physician's ability to be both emotionally and physically resilient. These traits are partially inborn, but can be learned and developed. The speaker will define "resiliency" with respect to emergency medicine, review the research behind the benefits of developing resiliency, and provide ways for the practicing emergency physician to foster and maintain a resilient mindset that can improve your life and the care you give to your patients.

Podcasts

ACEP Frontline: Dealing with the Agitated Patient
Ryan Stanton, MD, FACEP talks to Reuben Strayer, MD on dealing with agitated patients in the ED and strategies to implement best practice for patient care in these difficult situations.

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ACEP Now Articles

A Safe Space: Violence Toward Emergency Department Providers Isn’t Just Part of the Job – June 2016
James P. Phillips, MD, defines workplace violence and discusses both criminal and non-criminal offenses. He shares insights about reporting barriers and gives suggestions for improving the awareness of Work Place Violence (WPV) in emergency medicine.

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Run, Hide, Fight: How to React When There’s Gunfire in the Emergency Department – June 2016
Howard K. Mell, MD, MPH, CPE, FACEP discusses weapons in the ED and looks at the reality of facing an active shooter.

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Workplace Violence Remains a Part of the Emergency Department – June 2012
Workplace violence isn’t always an individual with a weapon. Physical assault is all too common in the ED. In this article, the authors explore why assault might not be reported in the emergency department and suggests solutions to help providers who suffer assault on the job. Note: Survey link at the end of the article is no longer active.

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Annals Articles

Hospital-Based Shootings in the United States: 2000 to 2011
Workplace violence is a frequent occurrence in health care settings, but how often is gunfire involved? This article looks at reports of hospital-based shootings with at least one injured victim from 2000-2011.

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Protection from Violence in the Emergency Department
The American College of Emergency Physicians (ACEP) believes that workplace violence is a preventable and significant public health problem and that optimal patient care can be achieved only when patients, health care workers, and all other persons in the emergency department (ED) are protected against violent acts occurring within the department.

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161 Design Interventions for Preventing Workplace Violence in the Emergency Department: A Systematic Review Leading to a Checklist of Deployed Interventions
Members of ACEP’s Public Health and Injury prevention committee provided a useful resource in April 2011 for WPV prevention based on the guidelines recommended by National Institute of Occupational Safety and Health (NIOSH).

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A Survey of Emergency Physicians in the State of Michigan
Seeking to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians.

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ACEP Policies

Protection from Violence in the Emergency Department
The American College of Emergency Physicians (ACEP) believes that workplace violence is a preventable and significant public health problem and that optimal patient care can be achieved only when patients, health care workers, and all other persons in the emergency department (ED) are protected against violent acts occurring within the department.

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Emergency Department Violence Talking Points
Use these talking points to begin the conversation about work place violence in your ED.

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Emergency Department Violence Fact Sheet
It just got real… Read up on facts about violence in the ED and how you can prepare and potentially avoid confrontations and dangerous situations. This fact sheet will help you identify and manage incidence of emergency department violence.

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