An investigation was made of the occurrences of occupational injury deaths and workplace related homicides among health care workers (HCWs) in the United States from 1980 through 1990 as part of an effort to develop a better understanding of this phenomenon, and possible strategies for its prevention. Occupational injury death data were collected from the NIOSH National Traumatic Occupational Fatalities surveillance system. Homicides were identified from codes E960 through E969 of the International Classification of Diseases, Ninth Revision. A total of 522 HCW on the job injury deaths were recorded from 1980 through 1990, with that total encompassing 128 physicians, 117 registered nurses, 68 nurse's aides, orderlies and attendants and 167 HCWs in other occupational categories. Motor vehicle accidents, homicide and suicide accounted for 23.4%, 20.3% and 16.9% of this total, respectively. HCW homicides occurred most frequently among pharmacists and physicians, and a majority involved firearms. The authors conclude that strengthened surveillance for HCW workplace related homicide must be initiated to gain better understanding of the circumstances surrounding this phenomenon and, consequently, to develop effective prevention strategies.