Violence, Management of



  • 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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