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Ricardo A. Morales

Sarita Hill Coletrane

Harold Shreves

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Aaron M. Stutz




Strategy: Training Emergency Room Staff To Prevent Violence

Strategy Violence-prevention training for hospital staff and security policies regarding violent patients and visitors reduce the incidence of violence . . .


Violence-prevention training for hospital staff and security policies regarding violent patients and visitors reduce the incidence of violence in hospital emergency rooms.

Crime Problem Addressed

A 1992 survey of 103 hospitals in Los Angeles and other urban areas of California cited in Violence in Our Schools, Hospitals, and Public Places: A Prevention and Management Guide revealed that nearly 60 percent of hospital staff had been injured by visitors or patients. A 1989 study of hospital crime in three hundred facilities across the country found a sharp increase in assaults on staff, half of which occur in emergency rooms. Two-thirds of emergency room nurses surveyed in 1991 reported that they had been assaulted on the job. This strategy combines training in violence prevention and awareness with security procedures, as part of a comprehensive effort to prevent violence.

Key Components

Training in violence prevention helps hospital staff to recognize potentially violent patients and visitors and handle violent people. Preventive security procedures include metal detectors at entrances, photo ID cards for staff, badges for visitors, patient processing policies that minimize waiting time for treatment, controlled access to hospital buildings, secure telephone communications by which staff can report incidents, locked doors to emergency rooms and treatment areas that are not in use, closed-circuit TV monitoring of waiting rooms and parking lots, and trained security guards.

Key Partnerships

Hospital administrators should develop partnerships with doctors, nurses, and staff to understand past events that raised security concerns and devise possible training strategies and security policies to prevent additional incidents, particularly attacks on staff. Administrators should also seek assistance from police or other crime-prevention and security specialists who can assess security issues and recommend action.

Potential Obstacles

Staff training and physical changes in hospital facilities can be expensive. Partnerships with police can reduce training costs. Even expensive changes in hospital facilities can be cost-effective when they reduce staff fear, minimize the staff time lost because of injuries, and minimize maintenance costs resulting from violent incidents.

Signs of Success

Following a 1991 study of violence at hospitals throughout the state, the California Emergency Nurses Association successfully advocated a mandatory four-point action plan aimed at preventing violence and based on the best practices at different facilities. Among other recommendations, the legislature set guidelines for minimum safety features and assessments of needed changes in each facility, minimum educational requirements for staff who work in the emergency room, training standards for security staff and appropriate equipment, and special criminal penalties for violent acts against hospital personnel while they are on the job. Associations in other states now advocate similar policies, using the California law as a model.

Applying the Strategy

Six months after a metal detector was installed at a Detroit hospital, officials reported that they had detected 33 guns, 1,234 knives, and other weapons. A Los Angeles hospital revealed that, among trauma patients treated in one year, 25 percent of males and 31 percent of females had weapons on them when they were admitted. Detection of the weapons prevented possible attacks on hospital staff.

From 350 Tested Strategies to Prevent Crime: A Resource for Municipal Agencies and Community Groups

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