A hospital emergency room can be a dangerous place. Along with the common injuries and illnesses that walk through the door, emergency rooms give care to gang members and unstable individuals including those who are often high on drugs. A calm environment can quickly spiral into chaos.

According to a survey by the Emergency Nurses Association, 12 percent of emergency room nurses experienced physical violence and another 59 percent experienced verbal abuse—during just a seven-day reporting period. Staff and patients must be kept safe. But how? Here are some suggestions.

• Train emergency room personnel to assess patients and their family members for potential violence or disruptive behavior and give staff the skills to de-escalate problem situations.
• Emergency Plan. Create procedures so if a serious disturbance occurs, police and hospital security can respond immediately. This may mean installing emergency call buttons in each patient area. An evacuation plan for patients and staff should also be established.
• Security Guards. Position security guards 24/7 in the check-in and waiting room areas and have them oversee patient check-ins if the system is automated. Also consider placing a guard outside the emergency room.
• Security Cameras. Place security cameras around the perimeter of the emergency room entrance. The camera feed should be monitored by emergency room security. The guards should have the ability to automatically lock emergency room doors if they see threatening or dangerous behavior outside.