急診職場暴力的處理與預防

Management and prevention of workplace violence in emergency department

張豐圃(Fong-Pu, Chang)

《中華職業醫學雜誌》 24卷2期 (2017/04) Pp. 103-113

摘要

急診暴力是所有在急診職場工作的人隨時都有可能遭遇的重要議題，不只造成醫護人員身心永久的受創，更可能延誤急重症患者的搶救，造成他們不可逆的傷害。從流行病學闡述近年來急診暴力對急診醫護與健康照護體系的衝擊，我國急診醫師在2006年經歷言語暴力及肢體暴力上的比例分別為89%及37%，2014年已爬升至92%與31.7%，護理師也有類似的結果。可見數年來急診暴力的盛行率並沒有因為社會進步而減少，且國外的統計顯示其急診工作人員亦身受其害。本文從環境、病人、與醫療人員三方面討論急診暴力的成因，並提供應變的參考。雖然急診暴力發生率逐年上升，但絕非不可預防。本文列出高危險病人的特性，使急診職場的人員可以警覺，並且討論暴力行為的三個階段：焦慮期、防衛期、與肢體暴力期，與每個階段的因應之道。而醫院與行政部門若能重視急診暴力議題，在環境、硬體、教育訓練給予全方面的幫助，配合法令的逐步修訂與執法機關的配合，才能逐漸打造一個安心的急診工作環境，朝向急診「暴力零容忍」的目標前進。

關鍵字

職業傷害 ； 急診室 ； 暴力 ； 醫療法

並列摘要

Workplace violence(WPV) in emergency department(ED) is a serious issue that anyone working in emergency department could confront anytime. The experiences of violence not only leave permanent damage to medical staffs both physically and mentally, but also delay the rescue of seriously ill patients, causing irreversible mortality and morbidity to them. Discussing the effect of violence on emergency department and the healthcare system by epidemiology, we can find out that the prevalence of verbal and physical attack on ED doctors on 2006 was 89% and 37%. Compared with the prevalence on 2014 which was 92% and 31.7%, we can conclude that the prevalence of violence in ED did not decrease at all in spite of the progress of socioeconomic development and progress. Similar data could also be found in studies on nurses and other countries. This article discusses the causes of WPV in emergency department through the aspect of environment, patient, and medical staff, and provides a reference of future response to workplace violence in emergency department. Although the prevalence rises year by year, it is not possible to prevent violence in emergency department from happening. We listed several characteristics associated with violent behavior so that ED staff can be aware in advance and take possible prevention. We also discuss the 3 escalating phases of violent behavior: anxiety, defensive behavior, and physical aggression. Each phase has its own clues, and it is often possible to diffuse a situation with an appropriate response to the person exhibiting anxious or defensive behavior before physical violence occurs. If the hospitals and administration can pay attention to the issue of ED violence by enhancing the ED environment, equipment, and educational training, combined with the legislative amendment of medical care lawsand the cooperation of law enforcement authorities, we will be able to build a reassuring ED workplace. And the goal of zero tolerance for ED violence can be achieved in the future.

並列關鍵字

occupational Injury ； workplace violence ； emergency department ； medical care law