Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. 1

Additionally, Emergency Department violence not only threatens staff, but also Veterans in the Emergency Department.

According to the Bureau of Labor Statistics, health care workers are nearly four times more likely to be assaulted and necessitate time away from work due to workplace violence than all other workers in the private sector combined. One national survey of emergency medicine residents and attending physicians revealed that 78% of physicians reported at least one physical or verbal attack against him/her in the prior 12 months, and 21% reported more than one episode.2

The National Institute for Occupational Safety and Health (NIOSH, part of the CDC) offers a number of prevention strategies for Emergency Departments. These include:

• Installation of security devices, such as metal detectors
• Security measures, such as escorts to the parking lots at night
• Installation of enclosed nurses’ and physician’s stations
• Installation of bullet-proof and shatter-proof glass enclosures in reception and triage areas
• Restriction of the movement of the public in hospitals by card-controlled access

It is a reasonable expectation of ED Staff and visitors to have a safe environment. We have, with regularity, found weapons being carried by patients. The staff has received complaints from veterans about the lack of metal detectors when weapons were accidentally brought into the ED. The fear that the presence of metal detectors in the ED would convey a bad public image is unwarranted. Two studies looked into metal detectors perception back in 1997. In the first, 75 percent of patients already felt safe and 68 percent were satisfied with the security. However, 11 percent felt a fear of being physically harmed in the emergency department, and two-thirds reported they would feel better with a metal detector in use. The authors concluded that the concerns over the potential for negative imaging around metal detectors was not warranted.4 In the second study, 80 percent of patrons and 85 percent of employees liked the metal detector, with 89 percent of patrons and 73 percent of employees feeling safer with its use. Thirty-nine percent were more likely to return because of it, while just 1 percent said they were less likely to return as a result.5 Additionally, many of the local Emergency departments have metal detectors including Emory-Clifton, Emory Midtown and Grady Memorial hospital to name a few. Signs in the entrance are not an adequate safety measure alone.

The multidisciplinary staff (ED Physicians, Psychiatrists, Nurses and Techs) of the Atlanta VA Emergency Department are asking for the following security features to be enacted immediately:

• Seal all entrances and exits to Sides A and B of the ED with badge access only. Currently, there are no barriers to entry to Side B and multiple access points.
• Install metal detectors at the entrance of the ED prior to check in and triage area.
• Move triage area to current COVID waiting room with a back door exit to side B for emergency use.
• Increased VA Police presence by having an officer stationed at an open desk in waiting room.
• Long term increased police and security presence in the Emergency Department in the form of multiple walk throughs an hour.

References:

• Ashton RA, Morris L, Smith I. A qualitative meta-synthesis of emergency department staff experiences of violence and aggression. Int Emerg Nurs. 2018 Jul;39:13-19. doi: 10.1016/j.ienj.2017.12.004. Epub 2018 Jan 8. PMID: 29326038.
• Behnam M, Tillotson RD, Davis SM, et al. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med. 2011; 40: 565-579.
• McNamara R, Yu DK, Kelly JJ. Public perception of safety and metal detectors in an urban emergency department. Am J Emerg Med. 1997;15(1):40-42.
• Meyer T, Wrenn K, Wright SW, et al. Attitudes toward the use of a metal detector in an urban emergency department. Ann Emerg Med. 1997;29(5):621-624.