Recent reports point to the emergency room as the area in the hospital where violence is most likely to occur. It is unlocked 7 days a week, 24 hours a day, and is easily accessible. Many emergency rooms lack security and are in the middle of crime-based neighborhoods. Generally, emergency rooms are full of tension, with stressed patients, family members, and staff quite frequently interacting in a disruptive manner. These pressures, combined with the increased random violence in society, has resulted in multiple aggressive outbursts in emergency rooms throughout the country. Most emergency rooms only deal with aggression once it actually occurs, but preventing violent outbursts should be a major goal in emergency rooms. Suggestions for handling the occurrence of violence are provided. Staff reactions to violence are considered, and the physical design of the emergency area is shown to increase or decrease the potential for violence, help prepare staff for a violent outburst, and help control a violent patient. A total of 36 references are included.