Violence against emergency workers is increasing: Hospital overcrowding a major contributor
· Medical Xpressby European Society for Emergency Medicine (EUSEM)
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Some 75% of workers in emergency medical departments and services have witnessed violence in the past year, according to a survey of more than 1,300 health care professionals in 81 countries.
At the European Emergency Medicine Congress, Luis Garcia Castrillo, a retired professor of emergency medicine at Hospital Marqués de Valdecilla in Santander, Spain, said patients and their friends or relatives were the main perpetrators, often because of alcohol or drug use. Overcrowding in emergency medical departments was an equally important contributor to the violence, he said.
"Workplace violence not only jeopardizes the physical and mental health of health care professionals but also negatively impacts the quality of care they provide," Castrillo said. "The survey reveals that 45.8% of respondents thought that the quality of care was diminished as a result of the violence they encountered."
The international online survey, conducted by the EUSEM Emergency Medicine Day Working Group, received responses from 1,306 health care providers in 81 countries between May and June 2026. A paper was published in the European Journal of Emergency Medicine (EJEM) at the same time it was presented to the congress.
It found that 75.5% of respondents had witnessed violence in their workplaces in the previous year, 68.8% had experienced psychological harm and 40.3% had experienced physical harm.
Verbal aggression was the most common form of violence (87.8%), followed by physical assault (42.3%), property damage (26.4%), sexual harassment (14.6%), race-related violence (14.5%), armed conflict (4.5%), weapon-related incidents (4.1%), sexual assault (3.5%), cyber harassment (3.1%) and firearms incidents (2.9%). Patients were the principal perpetrators (67.6%), followed by relatives or friends (44.1%). Intoxicated patients or visitors accounted for 44% and psychiatric patients for 35.2%.
Nearly half of respondents (48.3%) thought workplace violence had worsened over the previous five years. They perceived violent patients as one of the greatest occupational threats, second only to the risk of infection.
Only half (51.1%) had received formal violence prevention training, while 38.6% reported no formal training. After violent incidents, 57.3% had access to psychosocial support, while 27.1% had no access. Women were more likely than men to report psychological victimization: 72.2% versus 40.4%.
Dr. Roberta Petrino, director of the Emergency Department at Ente Ospedaliero Cantonale in Lugano, Switzerland, co-chaired the EUSEM congress session and is the first author of the EJEM paper. She said, "I would like to underline that the major problem for women working in emergency medicine is verbal violence; this could be insults, sexual references, gender-related harassment and discrimination. Women emergency workers are subjected to this far more than men, and it has mainly psychological consequences.
"Respondents to the survey wanted psychological support, and the problem of violence to be addressed through prevention and better safety processes."
"Another important point is the perception of scarce preparation to tackle the problem of violence; respondents thought the emergency services were more prepared for a mass casualty event than for everyday violence," she said.
Castrillo, Petrino and the other authors of the report called on all providers of emergency services—prehospital services and emergency medical departments—to consider ways to reduce possible triggers for violence.
"Prolonged waiting times, limited resources and high emotional stress all escalate tensions among patients, relatives and health care professionals," Petrino said. "This needs to be tackled through organizational interventions."
She added, "Hospital managers should improve the internal organization of the hospital so as to reduce overcrowding, for instance, by providing good, well-designed spaces that are well-staffed, and setting up policies in the wards to facilitate patients transferring to them quickly from emergency departments.
"This would allow emergency departments to improve patient flow. Managers should consider specific education about how to de-escalate situations and how to communicate well, and they should provide safety systems such as video cameras and security personnel.
"Finally, the question should be addressed about violence against health care providers in war zones: a large number of Ukrainian doctors, 258, responded to our survey."
A strength of the study is the large number of responses from so many countries, although participation varied by country, which could have introduced bias. Other limitations include the voluntary and self-reported nature of the survey, which could have introduced bias in participant selection and responses. The sample size was also reduced because about 40% of questionnaires were excluded due to missing or incomplete data.
More information
Workplace violence and safety perception in emergency medicine system: the Emergency Medicine Day International survey across 81 countries, European Journal of Emergency Medicine (2026). DOI: 10.1097/MEJ.0000000000001375
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Emergency medicinePsychology & Mental health Provided by European Society for Emergency Medicine (EUSEM) Who's behind this story?
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