title: Epidemiology of unarmed threats in the emergency department.
abstract: OBJECTIVE
  To evaluate the precipitants, subject characteristics, nature and outcomes of unarmed threats in the ED.
  
  
  METHODS
  A 12 month prospective survey of security codes precipitated by an unarmed threat (Code Grey).
  
  
  RESULTS
  Data were collected on 151 subjects. The Code Grey rate was 3.2/1000 ED presentations. They were most frequent on Saturday and in the late evening/early morning. There were verbal or physical threats of violence made to staff on 104 occasions (69%, 95% confidence interval [CI] 61-76) and a perceived threat of patient self-harm on 114 occasions (76%, 95% CI 68-82). Median time to be seen by a doctor was 8 min (interquartile range [IQR]: 2-21 min) and median time from presentation to Code was 59 min (IQR: 5-222 min). Sixteen subjects (11%, 95% CI 6-17) had a history of violence, 45 (30%, 95% CI 23-38) were affected by alcohol, 25 (17%, 95% CI 11-24) had used illicit drugs and 79 (52%, 95% CI 44-60) had a significant mental illness contributing to the Code Grey. Seventy-one patients (47%, 95% CI 39-55) required psychiatric admission, 49 (79%, 95% CI 66-88) involuntarily.
  
  
  CONCLUSIONS
  Acutely agitated subjects pose a threat to themselves and the staff caring for them. The reason for the agitation is multifactorial and the majority arrive in a behaviourally disturbed state requiring early intervention. The times most likely to result in a Code Grey coincide with least available resources: ED and hospital risk management policies must account for this. A coherent approach by ED to this population is required to optimize patient and staff outcomes.
authors.affiliation: Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia. Jonathan.knott@mh.org.au
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Knott
authors.forename: Dianne
authors.initials: D
authors.lastname: Bennett
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rawet
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D017677:Age Distribution; D000374:Aggression; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D016273:Occupational Exposure / Q000706:statistics & numerical data; D011446:Prospective Studies; D012149:Restraint, Physical / Q000706:statistics & numerical data; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*