VIOLENCE AND GENERAL SECURITY IN THE EMERGENCY DEPARTMENT

Objective: To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security. Methods: Descriptive analysis and case examples of weapons-related assaults in one urban ED for the period 1979-1993. Results: Over a 14-year period, 115 ''incidents'' of weapons-related violence were identified during the management of approximately 980,000 patients. Examples of ED violence are described. Conclusion: Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after Incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the ''sacrosanct'' hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.