t staring was used to intimidate them into prompter action when they responded to this cue violence tended to be avoided.
Lack of eye contact was also an issue and was associated with anger and passive resistance. However, it was noted that there can be cultural reasons for avoiding eye contact and it was important to differentiate these from other cases.
Tone and volume of voice was associated with 13 of the 16 violent episodes. Most of the cases involved raised voices and yelling but two involved sarcastic and caustic replies.
Many of the people who attended the emergency department were anxious and nurses were acutely aware of how stressful a visit to casualty could be. They normally intervened before anxiety reached dangerous levels, but one patients anxiety did escalate into violence.
However when anxiety levels were raised by the disorientation associated with conditions such as mental illness, substance misuse, dementia, epilepsy, diabetes and head injuries, this became a real issue. Nine violent episodes involved disorientated people with raised anxiety levels.
Eleven of the 16 patients who became violent were observed mumbling, using slurred or incoherent speech or repeatedly asking the same question or making the same statements. Mumbling was perceived to be a sign of mounting frustration and a cue for violence.
Pacing was seen as an indication of mounting agitation and was observed in nine of the 16 episodes analysed in detail. Other physical indicators included staggering, waving arms around or pulling away from healthcare staff trying to treat them.

Violence towards healthcare staff and other professionals such as police officers and social security staff are an increasing part of daily life says Luck.

We feel that the STAMP system provides an easy to remember checklist that can be used in a wide range of potentially stressful situations to provide an initial
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