Violence, Management of

Basics

EDs and waiting rooms are areas of high prevalence for violence, ranging from verbal assaults to active shooter incidents
Higher risk associated with busier EDs (>260,000 patient visits/year) and urban trauma centers
Nurses at highest risk of experiencing violence in the ED
Violent individuals may be a family member, friend, or visitor rather than the patient
Violence may not only be directed toward a health care worker, but also toward the patient or visitor
Risk factors for physical violence in the ED are not well characterized

Pathogenesis not well understood but typically multifactorial
Acute psychiatric problem:
- Most commonly psychosis or mania
Chronic psychiatric problem:
- “Cluster B” personality disorders: Antisocial, narcissistic, borderline
Substance intoxication and withdrawal
Acute primary medical problem:
- Infectious
- Metabolic
- Toxicologic
- Neurologic
Chronic primary medical problem:
- Dementia
- Intellectual disability
- Traumatic brain injury
Psychopathy or criminal behavior

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