Emergency departments (EDs) are increasingly having to manage violent, aggressive or agitated patients and are responsible for preventing patients from absconding when they are deemed a risk to themselves or others.

Yet, there are increasing concerns over the variability of provision and standards of security in circumstances where patients may require restraint.

In December 2020 the Royal College of Emergency Medicine (RCEM) published the results of a survey that asked ED clinicians about their experience of managing violent and behaviorally disturbed patients in their departments, and specifically what security services were available to support them.

The results showed a striking lack of consistency and standards across trusts with ED staff and patients being subjected to frequent potential harm. Altogether:

• 98% of respondents reported that their ED had felt unsafe due to agitated or violent patient behaviour
• 32% reported that their ED felt unsafe on a daily or weekly basis

As a result of the survey, the RCEM recommended that: 

• There is an urgent need for national standards for security services for acute hospitals. This should involve specifying the numbers of staff, training and skills required.
• Training in conflict resolution should be mandatory for all ED staff as well as the opportunity to undertake training in breakaway techniques.
• Security staff in an acute hospital should have training in mental health as well as safe restraint and legal basis for restraint. They should be familiar with NICE guidance for violence and aggression and be able to safely restrain a patient at risk to facilitate rapid tranquillisation. This process should be led by a clinician.
• Acute trusts should have effective policies for zero tolerance of violence and aggression against staff. This should include the use of security to protect staff and patients, steps to exclude patients if they are a significant risk to others and appropriate reporting and use of the criminal justice system.

Doc Player: RCEM National Survey on Security and Restraint in the Emergency Department. December 2020
NHS Digital: Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey
The Health Foundation: Latest data highlights a growing mental health crisis in the UK