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In this video, Alex Skog, MD, president of the American College of Emergency Physicians (ACEP) Oregon Chapter, discusses ACEP survey data on the prevalence of violence against emergency department (ED) physicians and staff. ACEP offers several resources for ED staff, including the campaign, and ways to environments. Skog is an emergency medicine physician at the Providence Willamette Falls Medical Center in Oregon City, Oregon.

The following is a transcript of his remarks:

Unfortunately, we have seen a drastic increase in the amount of threats and actual violence against not only ED physicians, but also nurses, technicians, and the entire staff of the ED in the last several years. This was, of course, reported in the recent survey of emergency physicians across the U.S., but has also been replicated in near identical numbers on other surveys of emergency nurses and other staff members.

There's the perception that's increased, but there's also the data behind it. In the , about 8% of emergency physicians reported assault; that number , so three times as high. Just from my personal experience, in training and early in my career, I feel like everyone had a story of once or twice where they knew of someone who was assaulted in the ED. That history of knowing that it sometimes happened has changed to a near weekly occurrence of us experiencing either threats or actual violence.

The reasons for the increase in violence in the ED are certainly multifactorial. It will come to no surprise to anyone, there is a huge amount of stress and discontent and sometimes distrust that has grown in our society and community as a whole, and that's reflected in the ED and what we see in the ED.

The violence in the ED has certainly increased over the COVID pandemic. People are having less connection with their community, are more isolated in general, being in public less would even lead people to be a little bit more reactive, very high stress, concerned about their own health when they're in an environment around many other people in the ED.

But you layer on top of that a lot of the misinformation that we've seen around the COVID pandemic that has made people even more distrustful of the motives behind the people that are caring for them. I have had quite personal experiences with family members threatening with guns to kill myself and my family because they believe that I'm trying to kill their family after I diagnosed them with coronavirus and told them that they had to be admitted to the hospital. So the amount of stress and anger that's come from the misinformation around COVID has exponentially increased the threat of violence in the ED.

The ACEP supports a number of policies, and this is a little bit difficult because the one thing that I have noticed, both working in an urban environment, rural environment, large ED, small ED, is that there's not a universal set of these specific things you implement in an ED and you'll then have a safe ED. So a lot of things need to be very specific, not only to the state or the community, but to that individual ED.

However, there are things that we can do in broader strokes that can support communities and hospitals in developing safer work environments. I think that there's a number of federal acts that are important. I think that it is really important to have a degree of accountability for the people that are in the ED, if they do commit an act of violence against a staff member, they're to have some accountability with that. While don't necessarily dissuade every single incidence of violence, there are a number of people that I've seen who have red flags on their chart, who had previous episodes of violence. and continue to recommit violence because now they know that there's no consequences for when they do.

In my state [Oregon] and in many other states in the country, when there's only misdemeanor crimes for , there is frequently a lack of prosecution of people that commit these crimes. So they can come in and as we are obligated to do by EMTALA [, we must provide care. I think it's very important that we provide care for anyone who is sent to the ED, but then they know that they can receive care, they can come in as frequently as they want, and they can face essentially zero consequences for acts of violence.

I think that that needs to change. We as a community need to stand up and say that there are very specific, real, and consistently implemented consequences for committing an act of violence against someone who works in a hospital.

Not only do we need to help prevent those who would perpetrate violence, but our entire communities who access the care that we provide, we need their support in having a safe environment, and understanding the challenges that we face when they go into the ED, and understanding the stress that you may see me in when I walk into your room in an ED. Understanding the stress that I'm undergoing and realizing how difficult it is to see every patient when we're under this constant threat of violence.

Just that appreciation and that understanding from our other patients can do huge amounts to improve job satisfaction and keep people in their jobs, and help decrease the huge problems that we're seeing now, particularly in nursing, where you're just not having the staff. People are losing their drive and ability to continue to work in healthcare because they're having these episodes of [patient] violence, they're putting themselves under risk with the recent coronavirus pandemic, and then they are also just not feeling the same amount of appreciation that they had in the past from the community for the sacrifices that they've withstood.

The one thing I think we as a community need to do is we need to reestablish our connections as a healthcare community with the larger community as a whole. I think that this speaks of course to violence, but even to a larger degree what we came to medicine to do.

All of our healthcare providers are experiencing a higher level of burnout now and more difficulty, and I just hope that we as a community can slowly but methodically reestablish those bonds with our patients, those bonds with our community, that trust in our community that reminds us why we went into medicine, what we're doing, helps us provide better healthcare for our patients, and helps us avoid the unfortunate consequences of the last 3 or 4 years of worsening distrust, violence, anger, aggression, and an adversarial relationship.

I have hope that we as a community with time, effort, and dedication can get back to why we started to do this in the first place.

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