Healthcare professionals face a range of threats in the emergency department, from aggressive patients to armed intruders holding staff hostage. Violence in healthcare continues to escalate across the country, and leaders at every level of a healthcare organization share responsibility for preparing their teams. The question for most emergency departments is not whether an incident will occur, but when.
Real-world incidents reveal critical lessons about what works, what fails, and where dangerous gaps exist in emergency preparedness. A layered safety approach that combines environmental safeguards, transparent communication, and technology like a wearable duress button gives healthcare leaders the framework to respond faster and protect staff more effectively. The following lessons from frontline healthcare leaders offer a practical roadmap for building stronger safety readiness in the emergency department.
The Stakes of Delayed Response in the Emergency Department
Emergency departments see some of the most volatile situations in healthcare. Nancy Shendell-Falik, MA, RN, who formerly served as President and SVP of Hospital Operations at Baystate Health, and as SVP Patient Care Services and the Chief Nursing Officer at Tufts Medical Center, shared some of the experiences she’s witnessed or had been exposed to during her years as a leader: A husband held his wife at gunpoint for five hours, leaving surrounding staff to work without bulletproof glass and with limited information about the unfolding crisis. A young man with a boxing background threw more than 15 punches at a healthcare worker, breaking multiple bones, because help arrived too late.
These are not hypothetical scenarios. They are real incidents from real emergency departments, and they share a common thread: delayed response. Staff lacked an immediate, discreet way to signal for help when a situation escalated. OSHA reports that healthcare workers face a significantly higher risk of workplace violence than professionals in most other industries.Wearable duress buttons aim to compress the time between the onset of a threat and the arrival of support, offering time for de-escalation and threat mitigation. As Shendell-Falik shared in a recent ENA Leaders presentation, “Unfortunately, these situations occur, and it is our role as leaders to do everything we can to mitigate them.”
Why a Wearable Duress Button Is Critical to a Layered Safety Approach
No single tool or policy can address every threat a healthcare organization faces. The Joint Commission has issued formal guidance calling for healthcare organizations to address workplace violence through comprehensive, layered prevention strategies. Effective violence prevention requires multiple systems working together to strengthen the overall safety plan.
Environmental modifications like cameras and controlled-access entry points help identify threats early. Zero-tolerance policies set clear expectations for patients, families, and visitors. Regular training and drills reinforce protocols so staff can act with confidence during high-pressure situations. Risk assessments and periodic safety checkpoints help leaders identify gaps before an incident exposes them.
Technology adds a critical layer to this framework. A wearable duress button empowers every staff member to discreetly signal for help from anywhere on campus, without reaching for a phone, finding a wall-mounted panic button, or leaving a patient’s side. Responders receive immediate notification of who needs help and the precise location of the incident, enabling them to arrive faster and de-escalate situations before they worsen.
These layers are most effective when they operate together. Wearable duress technology paired with digital mapping gives responders the ability to see the exact location of an alert on a detailed campus map, replacing confusion with coordinated action. Training programs that incorporate these tools help staff build muscle memory, so activating the duress button becomes second nature during an emergency.
The goal of a layered approach is clear: eliminate delays, eliminate gaps, and eliminate confusion when seconds matter.
Transparent Communication Builds a Culture of Safety
The impact of a violent incident extends far beyond the individuals directly involved. Word travels fast through a healthcare organization, and gaps in communication create space for exaggerated narratives that erode trust in leadership. Shendell-Falik recalled navigating the hostage situation in her emergency department where the team focused on the immediate crisis but failed to communicate lockdown status and regular updates to the rest of the hospital. Staff on other units filled in the blanks with their own assumptions, amplifying fear and frustration across the entire campus.
Transparent communication is critical before, during, and after incidents. Leaders who share what happened, what worked, and where gaps remain build credibility with their teams. Asking for feedback and acting on it reinforces that leadership takes safety seriously. Authenticity matters, and staff can tell the difference between genuine accountability and performative concern.
This transparency should extend across every department. An incident in the emergency department affects the entire organization. Bringing these events into the light rather than keeping them in the dark helps build a culture where every employee feels empowered to report concerns without retaliation. Conducting retrospective analyses after incidents and sharing findings with teams transforms isolated events into organization-wide learning opportunities.
Accessible, visible incident reporting plays a central role in this shift. Data from wearable duress button activations and other incident reports provide leaders with the intelligence to identify trends, adjust protocols, and demonstrate a commitment to violence prevention through action.
How to Advocate for Stronger Safety Measures
Healthcare leaders who recognize the need for stronger safety measures often face challenges securing prioritization and funding. Three strategies can help build momentum for safety investments within an organization.
First, tie staff safety to the organization’s overarching goals. A key performance indicator for reducing nurse turnover, for example, connects directly to workplace violence prevention. Research consistently shows that healthcare workers who feel unsafe are more likely to leave the profession. Demonstrating how a wearable duress button and other safety tools support retention goals reframes the conversation from a cost to a strategic investment.
Second, build cross-functional support by identifying champions across the organization. Colleagues in risk management, human resources, operations, and the board of trustees all have a stake in safety outcomes. Employee safety is not a department-level concern; it is an organizational priority that extends through every level of governance. Gaining buy-in from multiple divisions creates momentum that a single department cannot generate on its own.
Third, build a strong business case. Collect stories and input from frontline staff, and quantify the cost of inaction through workers’ compensation claims, lost productivity, and turnover-related expenses. Injured workers often require extended leave, and some experience lasting psychological effects that prevent them from returning to the clinical environment. The financial and human cost of delayed safety investments is substantial. A recent report outlines how to build the case for safety and includes tools for estimating return on investment in workplace safety.
Strengthening Safety Readiness With the Right Technology
Emergency preparedness is no longer optional for today’s healthcare organizations. Collaboration, continuous learning, and a commitment to layered safety planning are all essential for building a more resilient workforce.
The CENTEGIX Safety Platform® serves as the center of a layered safety plan, integrating wearable duress technology, digital mapping, accessible reporting, and visitor management into one comprehensive solution. The platform works to eliminate delays, eliminate confusion, and eliminate gaps in emergency response. Staff equipped with a wearable duress button can signal for help immediately and discreetly from anywhere on campus, and responders receive precise location information when seconds matter.
Healthcare organizations ready to strengthen their emergency preparedness can learn more about the Safety Platform and its capabilities for the healthcare environment.
