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The Violent Patient: Clinical Management, Use Of Physical And Chemical Restraints, And Medicolegal Concerns

November 1999

Abstract

The growing ranks of aggressive, addictive, and deranged people for whom the emergency department is the last resort."1 No, this is not a classified ad for emergency physicians. Instead, it was a headline from the Los Angeles Times reflecting the escalating violence in EDs.

The violent patient presents one of the most difficult situations the emergency physician will encounter. Often brought in against their will, such patients are agitated, confrontational, and nearly impossible to examine. If not controlled, they may harm themselves or others, including the ED staff, other patients, and visitors. While it's imperative to deal effectively with violence in the ED, it's better to recognize signs of impending violence and to prevent violence before it happens.

When faced with the violent patient, emergency physicians have several duties. They should control the patient and the situation, diagnose and treat  reversible causes of violent behavior, and protect both the violent individual and all other people in the ED from harm. Because restraint involves holding patients against their will, numerous medicolegal pitfalls await the unsuspecting physician.

Violence in the ED affects the entire institution. Incidents dramatic enough to  be reported in the lay press can devastate a hospital's public image and pose major liability risks. In addition, workplace violence fosters an "us vs. them" mentality between healthcare providers and the people we serve. This issue of Emergency Medicine Practice addresses these topics and provides ways to manage the violent patient successfully.
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