Law Enforcement in EDs: Impacts on Survivors of Violence, Marginalized Communities

Identifying and addressing points of contention between emergency department (ED) staff and law enforcement could improve experiences for survivors of violence (SOV), according to a new study published in JAMA Network Open.¹

Law enforcement officers (LEOs) are commonly present in the ED, particularly in urban, safety-net hospitals. Despite regulations defining their authority, many ED staff and LEOs remain unclear on the rules, creating tension and potential harm for SOV, particularly Black patients.¹ Hospital-based violence intervention program (HVIP) representatives serve to mediate interactions between LEOs and ED staff. While their presence is growing across level 1 trauma centers, there are still continuous reports of tension and unintended harm associated with law enforcement interactions in the ED.¹

Even routine law enforcement presence can compound stress for survivors of violence, influencing whether individuals seek care or fully engage with treatment.²

While the study specified SOVs’ outcomes, its findings are also relevant to immigrants, who may encounter Immigration and Customs Enforcement (ICE) in or around the ED. Hospitals were once considered “sensitive” areas, protected from routine ICE and Customs and Border Protection (CBP) actions. Alongside schools and churches—legally recognized as “sanctuary jurisdictions”—ICE officers were discouraged from detaining or requesting information on immigrants in these places. Those protections were rescinded under the Trump administration, giving ICE broader access to and potentially deterring vulnerable populations from seeking care.^3,4

Voices from the ED: Staff, Survivors, and Law Enforcement

The JAMA Network Open study aimed to collect the anecdotes of those most directly involved in the ED.¹ They include SOVs, HVIP representatives, and LEOs. The study was conducted between September 2020 and September 2023 at an urban level 1 trauma center. Sixty individuals were interviewed by trained law students and medical students. PhD-trained researchers conducted focus groups for LEOs. Of the patients interviewed, 23 were HVIP representatives, and 21 were SOVs. There were 3 focus groups conducted with a total of 16 LEOs.

Researchers identified 3 main themes amongst SOVs, HVIP representatives, and LEOs:

1. Limiting interactions with law enforcement, especially during SOV treatment and recovery.
2. Formalizing hospital staff and law enforcement training on their role in protecting SOC rights in the ED and trauma-informed training for LEOs.
3. Integrating SOV advocates in the ED to relieve SOVs of the “full burden of self-advocacy” and help protect their rights.

Many SOV and HVIP representatives agreed that LEOs should not be allowed to question patients while they are in the acute phases of resuscitation. Often, patients are not of sound mind and “can’t provide or be able to share necessary information most accurately,” an HVIP representative said in the study.

Although LEOs agreed that there should be alternative methods to obtaining patient statements related to the injury, SOVs and HVIPs emphasized that their timing was “inappropriate.”

“I think they should give family members their moment and their space,” an SOV family member stated. “We are already hurting. You keep asking all these questions, and it’s hard for us to be there.”

All stakeholders agreed there should be formal training for both ED staff and HVIP to protect patients’ rights and sensitivity, or trauma-informed training for LEOs. There is a lack of understanding of what HVIPs can and cannot share with law enforcement if the patient is involved in an active investigation.

For instance, an HVIP representative addressed LEOs obtaining patients’ personal belongings and not knowing how to intervene or if they should.¹ Under the Plain View Doctrine, LEOs can legally seek patient belongings if the officer is lawfully present where the evidence can be plainly viewed; they then have the lawful right to access said belongings. However, the incriminating character of the object must be immediately apparent.⁵

“There is no training. There is no point in the academy where you’re role-playing, ‘This is how you conduct yourself in the hospital with this kind of scene.’… You go approach this shot-up kid, who’s probably not in the mood to talk.… There’s no training for it,” a patrol officer stated during the study.¹

Lastly, stakeholders agreed that having a lawyer present for SOVs would help mediate contention between SOVs, HVIP representatives, and LEOs. SOVs emphasized that having legal support would help hold LEOs accountable. LEOs in the focus groups also agreed and explained that SOV advocates can also serve as a buffer by protecting patient rights but also helping with their investigations.

“That [advocate] is there for [the survivor’s] level of comfort and to help them through it, because [the advocate’s] role is totally just to take care of the [survivor], versus our role, which is to extract patient information so we can try to get the perpetrator,” a detective stated in the focus group.

These insights underscore how law enforcement interactions intersect with patient safety, trauma-informed care, and health equity, particularly for SOVs from marginalized communities. Overall, the study findings suggest that SOV advocates not only mediate law enforcement interactions but also help prioritize patient recovery.

Implications, Challenges, and Limitations

This study discusses how unregulated law enforcement presence in EDs can have negative health, legal, and privacy consequences for SOVs. Addressing knowledge gaps pertaining to the responsibilities of HVIP representatives and LEOs is a small step toward improved collaboration between ED staff and law enforcement.

The study was limited because it only included 1 urban, level 1 trauma center, and therefore, the findings are not generalizable to other hospital settings. Qualitative data were collected in many different variations, which may have introduced variation in responses, making comparisons across groups complicated.

“Optimizing hospital environments in emergency medical settings through formal policies and training on managing law enforcement presence in the ED has the potential to prioritize SOV recovery, limit interactions between SOV and law enforcement, and improve information sharing and job effectiveness for different stakeholders,” the study authors concluded.

References

1. Bhatnagar P, Ramdath C, Pinto D, Hall E. Navigating law enforcement presence in emergency departments. JAMA Netw Open. 2026;9(1):e2551804. doi:10.1001/jamanetworkopen.2025.51804

2. Pearson LD. Factsheet: Trump’s rescission of protected areas policies undermines safety for all - NILC. National Immigration Law Center. February 26, 2025. Accessed January 13, 2026. https://www.nilc.org/resources/factsheet-trumps-rescission-of-protected-areas-policies-undermines-safety-for-all/

3. Statement from a DHS spokesperson on directives expanding law enforcement and ending the abuse of humanitarian parole | Homeland Security. Department of Homeland Security. January 21, 2025. Accessed January 13, 2026. https://www.dhs.gov/news/2025/01/21/statement-dhs-spokesperson-directives-expanding-law-enforcement-and-ending-abuse

4. McAmis NE. Responding to ICE in emergency departments: Protecting patients and navigating legal obligations. EMRA. February 11, 2025. Accessed January 13, 2026. https://www.emra.org/emresident/article/ice-in-the-ed

5. Law enforcement presence in the emergency department: A toolkit by the State Legislative & Regulatory Committee developed in collaboration with the diversity, equity, & inclusion committee. ACEP. October 3, 2024. Accessed January 13, 2026. https://www.acep.org/state-advocacy/state-advocacy-overview/law-enforcement-toolkit