Many studies conducted in various emergency departments show that rates of violence in the emergency room are higher than in other hospital departments. These studies examined violence and intimidation against emergency room staff in various forms. These included intimidating behavior, verbal abuse, yelling, physical threats, attempts at physical aggression and even physical assault. The Emergency Nurses Association (an American organization) surveyed 3,500 nurses and found that 86% had experienced physical violence at work in the past 3 years and 72% said they felt unsafe at work. A Canadian study, which interviewed emergency room workers at St. Paul's Hospital, a hospital in downtown Vancouver, obtained similar results. Of the 163 staff members who completed the survey, 97 percent said they had experienced physical threats while working in the department, and 92 percent said they had experienced verbal abuse and physical assault. Worryingly, 68% of respondents believe the frequency of emergency room violence is increasing over time. The high rates of emergency room violence have multiple direct and indirect factors. The National Institute for Occupational Safety and Health (NIOSH) produced a list of risk factors for workplace violence in 1996. Nearly 20 years later, these factors are still relevant, and many of them apply to emergency room environment. A relevant factor on the list included working in a community setting, as all emergency departments in Canada are accessible to the public. Working at night or early in the morning is another applicable factor as most hospitals are open 24 hours a day. Other relevant factors... half of the document... the hospital has zero tolerance for violence and potential consequences are clear. This can be done through signage positioned in the Emergency Department waiting area, and in other areas of the Emergency Department. Additionally, if a patient begins to act in an intimidating manner, he or she should be immediately reminded of this zero-tolerance policy towards violence. To minimize patient, family and visitor stress and agitation which can potentially escalate into violence, emergency department staff should aim to communicate with them every half hour. If despite these measures, a patient, visitor or family member becomes violent or verbally abusive, they should be immediately reported to appropriately trained security or the police if necessary. Additionally, the patient's name must be recorded for emergency room personnel to view. In this way, if the patient goes to the emergency room again, the staff can be on maximum alert for any violence on his part.