The risks inherent in failing to train health care staff are examined, including negligent appointment, negligent assignment, negligent training, and negligent supervision; the implications of the risks, including civil and criminal liability, are explored. A case study of a physician's murderer is presented, and overviews of violence in various health care settings and among particular patient groups are provided. The increase in hostage taking in health care facilities is reported, and issues of hostage survival are addressed. Attention is focused on physical security, on basic security concepts and their applications, and on personal distress devices. Staff training that does not emphasize the physical management of the patient is detailed: when it becomes necessary for staff members to fall back on choke holds or throws to protect themselves, a basic flaw in the system exists. The risk that some systems take in training staff members to rely on physical management without adequate refresher training is highlighted, and basic training is suggested to help staff to develop adequate physical and body language deescalation techniques. Finally, staff as victims of violence are addressed. Approximately 100 references are included.