Smashed windows, broken teeth, makeshift weapons: Our emergency department nightmare exposed

Long waits in emergency departments and a breakdown in public mental health services have led to a rise in physical assaults on the state’s health workers, say NSW hospital staff – who have shared horrifying accounts of being kicked, spat on, bitten and slashed with scissors.

Attacks on hospital staff have risen most sharply in the Illawarra Shoalhaven Local Health District, which covers Wollongong Hospital and six other hospitals on the South Coast. There has been a 62 per cent increase in incidents of physical aggression towards its workers in the past four years.

The statistics, obtained by the Herald under freedom of information requests, also revealed 30 per cent increases in aggression incidents in the southwest Sydney, Nepean Blue Mountains and Murrumbidgee health districts.

“It happens almost every day,” said Emma Gassman, of Wollongong hospital’s emergency department. A member of the NSW Nurses and Midwives’ Association, she described a noticeable increase in violence, aggression and verbal abuse in the nine years she has worked there.

Gassman has been assaulted three times in the past three years. After one spitting incident, she had to undergo six months of testing to ensure she hadn’t contracted an infectious disease.

The rigorous and restrictive testing caused “massive issues” for her mental health and personal life, which were compounded when she was spat on again less than a week after receiving the all-clear.

“I love my job, I turn up every day because I love what I do,” she said. “But it is frustrating when ... you’re faced with this regularly. You feel like you’re doing everything that you can, but you’re still not meeting the needs of the community.”

Gassman said more patients are coming to the emergency department with mental health or substance use issues because of a lack of services in the community. Longer waiting times were fuelling a “boiling pot” of frustration, violence and aggression, she said.

“They’re frustrated, they’ve spent hours waiting in the emergency department on what could be one of the worst days of their lives,” she said. “Nobody enjoys going to the emergency department, and then you add a long wait to access services and the help that they’ve come for.”

A NSW Health spokesperson said mental health presentations had remained stable in the Illawarra region since 2018. “While aggressive episodes in our hospitals are rare, they can happen across every hospital setting,” they said.

Jessica Comish, a registered nurse from the Illawarra region, has also been involuntarily admitted to Shellharbour hospital during acute mental health episodes. She said patients and health workers alike had been let down by underinvestment in affordable community health services and hospital staffing.

“People are forced to wait until they reach such a critical point in the deterioration of their mental health and their wellbeing, that the only option that they have is to get that emergency intervention,” she said. “This could be the worst medical emergency that you’ve ever had ... and then you’re told to sit in the waiting room [for] several hours.”

Comish said many people, including mental health cases brought in by police, were already in a heightened state of anxiety or frustration before they arrive at hospital.

“When we’re in a crisis situation, as mental health consumers, we really just need somebody to sit with us and give us some advice and reassurance,” she said. “What we’re met with is people with bulletproof vests, guns, tasers and pepper spray in our face.”

Health Minister Ryan Park, whose electorate of Keira falls within the health district, said the increased use of the drug ice in the past 15 to 20 years has brought greater challenges for clinical and security staff.

“I’m not saying that every person who has harmed a health worker is under the influence of ice … but what we do know is that that drug has a particular impact on people’s behaviour, and when they do present to an ambulance, a police officer, a healthcare worker in a hospital, that behaviour can be very challenging,” he said.

There were 713 incidents involving physical aggression against health staff in the Illawarra Shoalhaven health district last year, a 62 per cent increase from 440 in 2021.

Episodes of care, a metric used by NSW Health to assess the business or activity of hospitals, increased by 3.3 per cent in the same period.

Jayden Watson, a Health Services Union delegate and security guard at Shellharbour Hospital, said there had been a sharp increase in “code black” calls in one of the hospital’s mental units.

A code black is called when there is an immediate threat to patient or staff safety. The alert was called 56 times in the 20-bed unit in 2024, more than double the 25 calls the previous year. There were 40 from January to July this year, Watson said.

Watson said a patient headbutted him in March 2023, breaking two of his teeth. In another assault last year, he was spat on and repeatedly punched while attempting to shield a nurse from an abusive patient.

“We were trying to activate our [duress] alarms … they worked, but I was hit over five times in the head to achieve that,” he said.

Colleagues have suffered broken cheekbones, torn tendons, broken wrists and burn injuries from hot coffee thrown at them, Watson said.

“People come [to work] in this department, and they just leave within a week,” he said. “We are getting assaulted non-stop.”

The NSW Health spokesperson said patients in the high-acuity unit frequently have many other health issues and this “increases the potential for code black situations, particularly in the early stages of admission”.

When patient-related incidents are logged in a hospital’s system, they are given a “harm score” based on the severity of injuries and the level of treatment, care and review needed afterwards.

The majority of incidents attract a harm score of four, where there was “no harm” suffered by the worker. There were no incidents leading to deaths of a NSW hospital employee in the past four years.

South West Sydney Local Health District had the highest rate of aggression incidents per hospital admission, with more than 200 incidents per 10,000 episodes of care.

Covering Liverpool, Bankstown-Lidcombe, Campbelltown, Fairfield and Bowral Hospitals, the district had the highest number of “major harm” incidents last year – seven episodes with a harm score of two involving staff. The previous year, there were none.

The state government last year announced a 12-month trial of up to 300 cameras worn by security guards in nine hospital emergency departments, to test whether they were an effective tool for deterring and de-escalating violent incidents.

The trial has expanded to Westmead, Port Macquarie and Lismore hospitals.

In responses to a NSW Health email requesting feedback on the trial, seen by the Herald, security guards said the trial had been a “mixed bag”.

“At Westmead in June of last year, we had a guard whose throat was cut, another got several lacerations alongside another [registered nurse] and guard injured in the same incident,” said one security guard. “We were told within days that it wouldn’t be classed as a stabbing.”

Another, from Newcastle’s John Hunter Hospital, described encountering weapons including knives, batons and garden shears while on the job.

NSW Nurses and Midwives’ Association general secretary Shaye Candish said the physical and psychological toll on members was profound.

“Just this week, a member lost several teeth after being punched in the face, while earlier this year a nurse was strangled, rendering her unconscious,” she said. “No one should fear for their safety at work, least of all those who dedicate their careers to providing healthcare.”