BALTIMORE — Baltimore's Gregory Jasani considers himself "very lucky" to have never been a victim of violence while working as an ER doctor in Maryland. After all, a recent poll showed more than 50 percent of his colleagues have.
"I certainly saw a lot of it in my training and my day-to-day job. As you can imagine, an emergency department in inner-city Baltimore sees a lot of, I guess you consider them high-risk patients," said Jasani, now an assistant professor in the UMD School of Medicine who worked for three years in their emergency department and also worked in a small community hospital in Prince George's County.
He recalled three of his colleagues who had been attacked by the patients they were trying to help.
"When I was in my training, there was a nurse, friend of mine, who actually got kicked in the chest by a patient. She needed to have X-rays just to make sure she didn't have any broken ribs. Another colleague was tackled by a patient suffering from an acute... psychiatric illness who felt, for whatever reason, that a sacrifice had to be offered - for what I don't know, but [the patient] decided that my nursing friend was going to be that sacrifice. And then a third colleague was actually choked by a patient that we Narcaned [administered the anti-opioid treatment Narcan] in the street in front of our emergency department. We got called out that there was a person slumped over unconscious in their car and we gave him some Narcan, which worked, woke him up, but then he reached out and began choking the nurse... [Violence] is very prevalent in the emergency department."
Jasani is far from alone. A recent poll done by the American College of Emergency Physicians showed 85 percent of ER doctors believe the rate of violence has increased in the past five years, and 45 percent said it has increased greatly.
Also, 85 percent say ER violence has meant longer wait times, 60 percent say the attacks often result in patients leaving without being treated, 87 percent report loss of productivity on the part of doctors and other staff, and 85 percent report emotional trauma and higher anxiety.
Chris Kang, president-elect of ACEP, noted that only about 2 percent of hospital security pressed charges, and that the lack of punitive consequences has become a larger factor in the rise of violence since 2018.
The study showed that two-thirds of ER doctors believe COVID has played a part in the rise in violence. Almost 7 in 10 also said COVID has led to less trust between patients and doctors.
Alex Skog, president-elect of the Oregon ACEP chapter, recalled how a patient's family member, with a gun holster on his hip, threatened to kill him and his whole family because Skog said the patient had to be admitted because he had COVID.
In a recent ACEP press conference on ER violence, Skog said he has seen multiple incidents of serious violence. About 2 months ago, he heard a scream in the ER after an intoxicated patient was taken down the hall. Skog said he saw the male patient strangling a nurse that hew orked with, wrestling her to the ground and repeatedly punching her in the head. Skog and others helped wrestle the patient off the nurse.
In another case, a patient threatened others with a knife, injuring police and charging an ER technician, wrestling him to the ground. A doctor was cut on the forearm and another employee was kneed in the abdomen while trying to remove the patient.
He noted:
"When this happened, the whole ED was essentially paralyzed... We had to divert all ambulances to other hospitals for several hours."
There are now two bills moving through Congress that aim to address ER violence, said ACEP's Kang.
The "Workplace Violence Prevention Act for Health Care and Social Service Workers" would have OSHA issue a standard requiring healthcare and social service employers to implement plans to prevent workplace violence. Also, the "Safety from Violence for Healthcare Employees (SAVE) Act" would set federal penalties for violence against healthcare workers, and criminalize intentional assault or intimidation against healthcare workers.
Jasani said he has seen a "huge impact" on staff from ER violence, and said there are certain factors in Baltimore specifically that could make the problem worse.
"I do think, certainly within Baltimore, there are a lot of very high-risk individuals, who, regardless of staffing, regardless of whether the pandemic ever happened, would certainly be at risk for delivering violence unto us in the ED. Baltimore City, as I'm sure you're aware, has very high rates of homelessness, psychiatric illness, substance abuse. All three of those things put you at risk for perpetrating violence in the community and certainly in the ED. I don't have any numbers for Baltimore specifically as compared to the state, but... just anecdotally it seems we certainly have higher rates of some of those things."
Jasani also said the COVID pandemic and labor shortages have played a part in the frustrations people are experiencing. He noted that when hospitals have trouble filling essential positions, such as techs, it leads to overcrowding and patients not being seen in a timely fashion.
"Unfortunately, that just creates a perfect environment for violence. Some people unfortunately react that way when they're stressed... and don't necessarily know how to express themselves in any other way."
Besides the two bills moving through Congress, more security (such as lighting and security cameras) could help curb violence, said Jasani.
"You need a robust security response in place, because, for all the mitigation efforts that a hospital may try to do, unfortunately this kind of thing is going to happen."
He also said one of the most important things is active training on those events, how to react in those situations. He noted he never had any training or simulation on what to do if someone assaults or hits you.
With more awareness on everyone's part, perhaps more serious efforts can be taken to address ER violence and stem the tide of turnover among healthcare workers.
Jasani said one of the nurses who was assaulted said: "I can't work here anymore. Every time I come to work, I think of that."
"She was so traumatized by that event that she left clinical medicine.... She was a very good nurse for our department and it was a shame to lose her, and that was before COVID."
