Dealing with Violent Dangerous Patients: The Medicolegal Pitfalls
Takedown” in the Emergency Department an all too regular occurrence that is set to
escalate dramatically in years to come.
It should always be the most senior doctor in the department at the time who makes
the clinical decision that the physical and/or chemical restraint of a person is necessary
and sanctioned by law at that time. This area is a minefield for doctors.
There are times when violent behaviour from a non-patient escalates to the point where that person
becomes a danger to others and himself.
If that person is behaving in a manner that falls beyond what is considered normal,
does it preempt a psychiatric diagnosis and place a duty on the doctor in
charge to consider a medical takedown.
EDs are especially prone to violence. They provide an environment filled with emotional
stress; patients may suffer prolonged waiting times, confusion, and gaps in communication.
In addition, the 24-hour open-door policy and the widespread availability of drugs
and weapons in the community compound the problem.
The 1993 shooting of three physicians on duty in Los Angeles County ED underscores
the tragic consequences of ED violence. The problem is not isolated to a few urban areas.
In a 1988 survey of 170 U.S. teaching hospitals, 32% reported at least one verbal threat
daily, 18% at least one threat with a weapon daily, and 25% reported restraining
at least one patient per day.
Within the previous five years, 7% of the institutions experienced a violent death
in the ED. Eighty percent had a staff member injured due to violence.
Emerg Med Open J. 2019; 5(1): 9-11. doi: 10.17140/EMOJ-5-153
