Evaluating and managing the violent patient.

Emergency department personnel frequently encounter violent patients. Effective management depends on early recognition of clues of potential violence and a response that will defuse the threat. The author presents an evaluation schema which emphasizes diagnostic categories and behavior as predictors of violence. A specific hierarchy of treatment intervention is proposed, with special emphasis on the interpersonal dynamics between staff and patient. The author also discusses general steps that can be taken to reduce the risk of violence in an emergency department setting.