Workplace violence and safety perception in emergency medicine system: The Emergency Medicine Day International Survey across 81 countries.

BACKGROUND AND IMPORTANCE: Workplace violence is a major occupational hazard in emergency care, yet most evidence derives from single-country studies. International data on workplace safety climate and organizational preparedness remain limited. OBJECTIVES: To assess workplace safety perception by describing the epidemiology and characteristics of workplace violence among emergency department (ED) and emergency medical services (EMS) professionals, and to identify factors associated with safety perceptions, organizational preparedness, reporting practices, and violence prevention measures. DESIGN, SETTINGS, AND PARTICIPANTS: International cross-sectional online survey conducted from May to June 2026 among ED and EMS professionals. The questionnaire was distributed through the European Society for Emergency Medicine and partner organizations. Of 2199 consenting respondents, 1306 complete questionnaires from 81 countries were included in the analysis. OUTCOMES MEASURE AND ANALYSIS: The primary outcome was overall safety estimation, measured on a 7-point Likert scale (0 = very safe; 6 = very unsafe). Secondary outcomes included workplace violence exposure, organizational preparedness, prevention strategies, and reporting practices. Descriptive statistics and comparative analyses were performed using complete-case analysis. MAIN RESULTS: The mean overall safety estimation score was 3.26, indicating moderate concern regarding workplace safety. Overall, 75.04% of respondents witnessed workplace violence in the previous year; 68.8% experienced psychological harm, and 40.3% physical harm. Verbal aggression (87.8%) was the most common form of violence, with patients as the principal perpetrators (67.6%). Alcohol/drug intoxication and ED crowding were identified as the leading contributors. Only 51.1% had received formal violence-prevention training, and 57.3% had access to psychosocial support following violent incidents. CONCLUSION: Workplace violence is highly prevalent across emergency care systems worldwide and reflects broader organizational safety challenges. Comprehensive prevention strategies, including staff training, improved organizational measures, effective reporting systems, and psychological support, are needed to strengthen workplace safety and emergency care resilience.