Medical professionals say assaulting or disrupting staff is the worst thing a patient can do in the ER

An alarming rise in verbal and physical violence against emergency department staff has prompted doctors and nurses to warn patients and visitors that the single worst thing they can do in the ER is to assault or otherwise disrupt care.

Health-care workers say incidents range from shouting and threats to outright physical attacks, and that such behavior not only endangers staff but can delay treatment for other patients. "Patients and their families come to the Emergency Department on their worst and most stressful days, and we're here to support them through it," said Dr. J. David Gatz, associate medical director of the Adult Emergency Department at the University of Maryland Medical Center. "We're extremely understanding overall, but we're often seeing many cases at one time, and it's critical that the behavior of one person not negatively impact another."

The degree of the problem is reflected in research and anecdote. One study found that 66 percent of emergency physicians reported being assaulted in the past year, with more than one-third assaulted multiple times. In a separate survey, 71 percent of physicians reported witnessing an assault at work and 97 percent said perpetrators were patients. Every clinician interviewed for this report cited verbal and physical violence among their top concerns.

Gatz described episodes he has seen in his department that illustrate the range and severity of misconduct: equipment and computers broken, windows shattered, bodily waste smeared on surfaces and walls, people throwing food, patients removing their own IVs and walking out while bleeding, and even calls to 911 from within the ER to complain about not being seen.

Clinicians emphasized that crowded waiting rooms and long waits, while stressful, do not justify disruptive behavior. "We prioritize based on acuity," said Dr. Jared L. Ross, a board-certified emergency physician who previously worked as an EMT, paramedic and firefighter. "Unless you have access to 'the board' of all incoming patients, you have no idea how serious your issue really is compared to others." He acknowledged wait times can be "atrocious" in busy departments but said repeatedly demanding to be seen or trying to force attention can create additional delays and safety risks.

Emma W., a second-year emergency medicine resident who requested that her full name not be used, recounted patients who impede care through dismissive or entitled behavior. One patient gave her a rude hand signal because she was on the phone; that patient later complained about slow service, saying they needed to leave for a concert. Another patient insisted on being seen only by a male physician and became irate when none were on duty.

Nurses and nurse practitioners said family members and visitors can also worsen the situation. "The ER is not the place to yell, take phone calls on speaker or bring five people into the room to 'check on mom,'" said Kisha Pickford, an acute care nurse practitioner with more than two decades of emergency experience. Registered nurse Karen Selby said calm, supportive companions can help care proceed smoothly, but large or loud groups increase noise and chaos and can pull clinicians away from patients in critical condition. She added that visitor aggression sometimes forces security intervention and can delay care.

Clinicians urged patients to practice basic courtesy and to be thoughtful about where they seek care. Many people use emergency departments for nonurgent problems that could be treated more quickly and cheaply at urgent care centers or with a primary-care visit, clinicians said. "ERs are designed to prioritize life-threatening conditions first, such as heart attacks, strokes and trauma," Selby said. Patients who come in with minor issues may wait hours while more critical patients are treated, and ER visits are typically more expensive than other care options.

Ross said it can help to "self-triage" before deciding to go to the ER: if symptoms are not life-threatening and could be evaluated at urgent care or by a primary physician, those venues may be faster and less costly. He and others stressed, however, that anyone who suspects a true emergency should not hesitate to seek care.

Clinicians also recommended practical behaviors that keep the department functioning: inform staff if symptoms change or worsen, avoid repeatedly demanding to be seen, refrain from removing medical devices such as IVs, and limit the number of visitors who accompany a patient. Such actions, staff say, protect both patients and providers and help maintain focus on those with the most critical needs.

The guidance comes as emergency departments nationwide grapple with staffing shortages, higher patient volumes and the unpredictability of when mass-casualty events or spikes in infectious disease will occur. In that environment, clinicians say civility and cooperation from patients and families make a measurable difference in the ability to deliver timely, effective care.

"Demanding to be seen 'right now' will disrupt staff focus, scare other patients and create unnecessary tension in an already high-stress environment," Pickford said. "Courtesy and patience go a long way."