In 17 years as an ACT emergency room doctor, Sam Scanlan has been spat on, verbally abused, had "things thrown at me" and "vile threats" made to his personal safety.
"I've witnessed nurses being strangled, thrown to the ground, punched in the face, doctors being kicked in the face," Dr Scanlan tells The Canberra Times.
"In the last three to five years, we have seen that escalate quite significantly."
Dr Scanlan chairs the local branch of the Australasian College for Emergency Medicine and works at an ACT hospital.
He said ACEM wanted the ACT government to implement a "zero tolerance" approach to patients who chose to use violence when there was no medical reason for the behaviour, to prevent traumatising occupational violence that drove healthcare workers out of the profession.
"There's no way you can come back to this environment if you've had a physical assault. It's, you know, terrifying."
While some patients lacked control of their actions while experiencing an acute delirium or psychosis - and "we have a medical duty of care to make sure that they're safe" - others had "clear capacity but are choosing to act in a violent manner".
"Community standards are slipping," Dr Scanlan said, saying some Canberrans seemed to have lost respect for "people that are trying to help you on your bad day".
While he understood patient frustration if they had to wait longer than expected, ED staff were "trying to provide excellent healthcare within the limitations of a public system [and] what the emergency department is really designed there to do ... acute emergencies that need treatment within the hospital".
Dr Scanlan's observations are backed by new data from the Australian Institute of Health and Welfare, which shows the rate of healthcare workers being admitted to hospital due to assault almost doubled in the decade to 2024-25.
In 2024-25, there were 126 assault-related hospitalisations at a rate of 8.1 per 100,000 health care workers, an increase from 49 and a rate of 4.3 in 2015-16.
This was out of 819 injury hospitalisations, which occurred at a rate of 53 per 100,000 health care workers.
ACEM wants ED security to be strengthened, a centralised unit to deal with aggressive patients, an increased use of workplace protection orders and stronger criminal penalties for individuals who assault healthcare and other public sector workers.
The nurses' union is also advocating for stronger protections for members as part of enterprise agreement negotiations with the ACT government.
Australian Nursing and Midwifery Foundation ACT branch secretary Carlyn Fidow said healthcare employers "have a duty to keep our members safe, and that means proper security, safe staffing and support for workers after an incident".
Ms Fidow said the AIHW figures "confirm what our members have been telling us for years".
"Violence and aggression have become a routine part of the job, and that is not acceptable," Ms Fidow said.
"Nurses, midwives and assistants in nursing go to work to care for people, not to be assaulted."
The union wants occupational violence to be broadened to cover trauma incidents, arguing that psychological harm can be "just as damaging as physical injury".
The AIHW report, to be published on Wednesday, shows that 7416 healthcare workers were hospitalised nationally with injuries in the decade to 2024-25, with assaults accounting for 15 per cent of cases.
In that time, assault moved from the fourth to the second leading cause of injury hospitalisation among health care workers.
Among the general population in Australia, assault is only the seventh highest cause of injury hospitalisation.
Other leading causes of injury hospitalisation were falls (36 per cent and contact with objects such as knives, tools or machines (13 per cent), the AIHW found.
The types of injury that health care workers were most likely to experience were fractures (28 per cent), followed by soft-tissue injuries (15 per cent) and open wounds (10 per cent).
ACT Health Minister Rachel Stephen-Smith, who recently met with ACEM to discuss ways to address the problem, said the escalation of aggressive behaviour in healthcare was "extremely concerning" and reflected "what we're seeing in the broader community" - but that any violence towards these workers was unacceptable.
"We discussed specific changes we can make in the EDs, such as ensuring health care workers feel empowered to take a zero tolerance approach to violent or threatening behaviour," Ms Stephen-Smith said.
"There is further work to do."
A Canberra Health Services spokesperson said it took violent incidents "very seriously" and that "providing a safe working environment for our team is a key priority [with] proactive systems and frameworks in place to identify and manage occupational violence risks early."
"This includes structured processes for assessing risk factors, implementing controls, and supporting staff to ensure a safe and respectful environment," the spokesperson said.
"After an occupational violence incident, we carefully review what happened, look at any risks, and put measures in place to prevent it from happening again.
"This helps us learn and make improvements so we can keep everyone as safe as possible."
