PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2013 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
37(13)
SUBMITTED BY:
California Chapter
Connecticut College of Emergency Physicians
North Carolina College of Emergency Physicians
Pennsylvania Chapter
Trauma & Injury Prevention Section
Young Physicians Section
SUBJECT:
Establishing Hospital-Based Violence Intervention Programs
PURPOSE: Promote awareness of hospital-based violence intervention programs as evidence-based solutions for
violence reduction and coordinate with relevant stakeholders to provide resources for those who wish to establish
hospital-based violence intervention programs.
FISCAL IMPACT: Staff time and resources.
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WHEREAS, 55,035 Americans died as a result of violent injuries in 20101; and
WHEREAS, The American public desires solutions to the seeming normalcy of daily violence and
increasingly frequent mass-casualty tragedies; and
WHEREAS, Violent injury is frequently a chronic, recurring pattern with urban victims of violence
suffering high rates of re-injury2,34,5,6; and
WHEREAS, Most victims of violent injury are treated solely for physical injuries without attention to
upstream factors leading to the assault, leaving most patients discharged without adequate linkage to vital support
services; and
WHEREAS, Without intervention, victims of violent injury are at increased risk of becoming future
perpetrators themselves7,8,9; and
WHEREAS, Hospital-based violence intervention programs provide a multifaceted approach to injury
prevention and have been shown to reduce re-injury, retaliation, emergency department recidivism for violent
injury, and future involvement in the criminal justice system10,11,12,13,14,15,16,17; therefore it be
RESOLVED, That ACEP promote awareness of hospital-based violence intervention programs as
evidence-based solutions for violence reduction; and be it further
RESOLVED, That ACEP coordinate with relevant stakeholders to provide resources for those who wish to
establish hospital-based violence intervention programs.
References
1
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Fatal Injury Reports. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. (2010). Accessed 5/23/13
http://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html
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Buss, TF, Abdu R. Victims of Violence in an Urban Trauma Center. Violence and Victims 1995; 10(3): 183-194.
3
Goins WA, Thompson J, Simpkins C. Recurrent intentional injury. J Natl Med Assoc. 1992 May;84(5):431-5.
4
Morrissey, T. B., C. R. Byrd, (1991). "The incidence of recurrent penetrating trauma in an urban trauma center." J Trauma
31(11): 1536-8.
Resolution 37(13) Establishing Hospital-Based Violence Intervention Programs
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Poole, G. V., J. A. Griswold, (1993). "Trauma is a recurrent disease." Surgery 113(6): 608-11.
Sims DW, Bivins BA, Obeid FN, Horst HM, Sorensen VJ, Fath JJ. Urban trauma: a chronic recurrent disease. J Trauma.
1989 Jul;29(7):940-6; discussion 946-7.
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Bingenheimer JB, Brennan RT, Earls FJ. Firearm violence exposure and serious violent behavior. Science. 2005 May
27;308(5726):1323-6.
8
Dowd MD. Consequences of violence. Premature death, violence recidivism, and violent criminality. PediatrClin North Am.
1998 Apr;45(2):333-40.
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U.S. Department of Justice Youth Violence Research Bulletin. February 2002. Retrieved January 23, 2012, from
https://www.ncjrs.gov/pdffiles1/ojjdp/191210.pdf.
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Aboutanos MB, Jordan A, Cohen R et al. Brief Violence Interventions With Community Case Management Services are
Effective for High-Risk Trauma Patients. J Trauma 2011;71: 228-237.
11
Becker MG, Hall JS, Ursic CM, Jain S, Calhoun D. Caught in the Crossfire: The Effects of a Peer-Based Intervention
Program for Violently Injured Youth. J Adolesc Health 2004; 34:177-183.
12
Cheng TL Wright JL, Markakis D, Copeland-Linder N, Menvielle E. Randomized Trial of a Case Management Program for
Assault-Injured Youth. Pediatr Emerg Care 2008; 24: 130-135.
13
Cheng TL Haynie D, Brenner R, Wright JL Chung S Simons-Morton B. Pediatrics 2008; 122:938-946
14
Cooper C, Eslinger DM, Stolley P. Hospital-Based Violence Intervention Programs Work. J Trauma 2006; 61:534-540.
15
Smith R, Dobbins S, Evans A, Balhotra K Dicker RA. Hospital-based violence intervention: risk reduction resources that
are essential for success. J Trauma Acute Care Surg 2013; 74(4) 976-82.
16
Shibru D, Zahnd E, Becker M, Bekaert N, Calhoun D, Victorino GP. Benefits of a Hospital-Based Peer Intervention
Program for Violently Injured Youth. J Am Coll Surg 2007; 205: 684-689.
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Zun LS, Downey L Rosen J. The effectiveness of an ED-based violence prevention program. Am J Emerg Med. 2006; 21:813.
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Background
This resolution calls for ACEP to promote awareness of hospital-based violence intervention programs as
evidence-based solutions for violence reduction; and coordinate with relevant stakeholders to provide resources
for those who wish to establish hospital-based violence intervention programs.
The Joint Commission standard PC.010.0.09 states, “The hospital assesses the patient who may be a victim of
possible abuse and neglect.” The Elements of Performance (EP) for this standard direct hospitals to have written
criteria to identify “patients who may be victims of physical assault, sexual assault, sexual molestation, domestic
abuse, or elder or child abuse and neglect.” Further, hospitals are directed to educate staff about recognizing signs
of violence and abuse, use criteria to identify possible victims, and maintain “a list of private and public
community agencies that can provide or arrange for assessment and care.”
ACEP has a number of policies that support violence prevention measures. The “Violence-Free Society” policy
statement supports the unique opportunity and responsibility of emergency physicians to “reduce the prevalence
and impact of violence through advocacy, education and research initiatives.” The “Domestic Family Violence”
policy supports emergency personnel assessing patients for family violence in all its forms and referring them for
help and detailed evaluation. Further, this policy encourages hospitals and EDs to “participate in collaborative
interdisciplinary approaches for the recognition, assessment and intervention of victims of family violence.” The
policy, “Role of the Emergency Physician in Injury Prevention and Control for Adult and Pediatric Patients”
supports the integration of injury prevention into the emergency department (ED) setting by developing and
promoting evidence-based injury prevention education into routine clinical practice to identify patients at-risk for
injury. In addition, the policy supports the development and promotion of interventions (with appropriate funding
support) that address prevention mechanisms and injury surveillance activities.
The ACEP Public Health & Injury Prevention Committee has compiled resources on ED workplace violence
prevention and domestic violence, as well as a Policy Resource and Education Paper (PREP) on the recognition
and management of elder abuse. These resources are available on the ACEP website.
Resolution 37(13) Establishing Hospital-Based Violence Intervention Programs
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The National Network of Hospital-based Violence Intervention Programs (NNHVIP) works with existing, new
and emerging hospital-based violence intervention programs to provide resources including technical assistance ,
webinars, publications and e-bulletins. They have compiled a list of key components for hospital-based violence
intervention programs including patient evaluation procedures, referral, aftercare, prevention, and program
assessment.
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Emergency Care
Fiscal Impact
Staff time and resources.
Prior Council Action
Amended Resolution 14(99) Domestic Violence adopted. Directed the College to encourage screening patients for
domestic violence and provide appropriate referral.
Amended Resolution 22(98) Violence Prevention adopted. Directed the College to establish a national dialogue
between interested parties on this issue and that ACEP encourage the National Institute of Mental Health and
Centers for Disease Control and Prevention among others to make financial support available for research into
this area.
Amended Resolution 11(93) Violence Free Society adopted. Directed the College to develop a policy on a
violence free society and to educate members about the preventable nature of violence and the important role
physicians can play in violence prevention.
Prior Board Action
June 2008, approved “Role of the Emergency Physician in Injury Prevention and control for Adult and Pediatric
Patients” policy statement. Previously reaffirmed October 2002; Originally approved March 1998.
October 2007, approved “Domestic Family Violence” policy statement. Replaced 6 older policies.
January 2007, approved a revised “Violence-Free Society” policy statement. Previously reaffirmed October 2000;
Originally approved January 1996.
Amended Resolution 14(99) Domestic Violence adopted.
Amended Resolution 22(98) Violence Prevention adopted.
Amended Resolution 11(93) Violence Free Society adopted.
Background Information Prepared By: Margaret Montgomery, RN
Emergency Medicine Practice Manager
Reviewed By: Marco Coppola, DO, FACEP, Speaker
Kevin Klauer, DO, EJD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director