VIOLENCE IN THE EMERGENCY DEPARTMENT - 08/09/11

Doi : 10.1016/S0733-8627(05)70093-6

Janice C. Blanchard, MD, MPH ^a, Kevin M. Curtis, MD ^b

^a Robert Wood Johnson Clinical Scholars Program, University of California at Los Angeles, Los Angeles, California (JCB)

^b Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (KMC)

Résumé

Violence in the emergency department (ED) is a problem that is poorly documented, inadequately researched, and often not managed optimally. Although well-compiled data on the overall incidence of ED violence are lacking, it is obvious from a variety of reports that violent behavior is neither uncommon nor decreasing in frequency.^{12 Dubin W., Wilson S., Mercer C. Assaults against psychiatrists in outpatient settings J Clin Psychiatry 1988 ; 49 : 338-345

Cliquez ici pour aller à la section Références, 16 Foust D., Rhee K.J. The incidence of battery in an urban emergency department Ann Emerg Med 1993 ; 22 : 583-585 [cross-ref]

Cliquez ici pour aller à la section Références, 17 L Gore Emergency department violence. ACEP Fact Sheet, @www.acep.org, 1998.

Cliquez ici pour aller à la section Références, 21 Lavoie F.W., Carter G.L., Danzl D.F., Berg R.L. Emergency department violence in United States teaching hospitals Ann Emerg Med 1988 ; 17 : 1227 [cross-ref]

Cliquez ici pour aller à la section Références, 24 Madden D., Lion J., Penna W. Assaults on psychiatrists by patients Am J Psychiatry 1976 ; 133 : 422-425

Cliquez ici pour aller à la section Références, 25 McAneney C.M., Shaw K.N. Violence in the pediatric emergency department Ann Emerg Med 1994 ; 23 : 1248-1251 [cross-ref]

Cliquez ici pour aller à la section Références, 27 McNeil D.E., Binder R.L. Patients who bring weapons to the psychiatric emergency room J Clin Psychiatry 1987 ; 48 : 230-233

Cliquez ici pour aller à la section Références, 28 Pane G.A., Winiarski A.M., Salness K.A. Aggression directed toward emergency department staff at a university teaching hospital Ann Emerg Med 1991 ; 20 : 283-286 [cross-ref]

Cliquez ici pour aller à la section Références} This trend reflects both a 10% annual rise in the number of psychiatric emergencies as well as an increase in violence in society in general, with a doubling of the murder rate in the United States in the last 20 years.^{4 Bauer J., Roberts M.R., Reisdorff E.J. Evaluation of behavioral and cognitive changes: The mental status examination Emerg Med Clin North Am 1991 ; 9 : 1-12

Cliquez ici pour aller à la section Références, 17 L Gore Emergency department violence. ACEP Fact Sheet, @www.acep.org, 1998.

Cliquez ici pour aller à la section Références} Despite this trend, many hospitals do not have 24-hour ED security, and most provide inadequate staff education.

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Plan

EPIDEMIOLOGY

ORIGIN

RECOGNIZING THE VIOLENT PATIENT

INITIAL APPROACH TO THE VIOLENT PATIENT

MANAGING VIOLENCE IN THE EMERGENCY DEPARTMENT

Medications

Restraints

Protection From Assault

CREATING A SAFE ED ENVIRONMENT

LEGAL CONSIDERATIONS

FUTURE DIRECTIONS

CONCLUSION

Address reprint requests to Janice C. Blanchard, MD MPH, UCLA Medical Center, Robert Wood Johnson Clinical Scholars Program, Factor Bldg. Rm. B–537, 10833 LeConte Avenue, Los Angeles, CA, 90095–1736