Health Care
Violent Patient Management

In the health care field, violent patient management and the application of medical restraints differs greatly from other professional use of force applications.

Issues of subject control, take downs, and mechanical restraint applications must all be considered within the framework of the health care provider being a "care giver". This is not just a matter of public perception, it is also a real dilemma for the professionals who became involved with this field to "help" other people.

The psychology of a care giver can differ greatly from that of a more "enforcement" inclined professional. Thus, many things that can be taught and utilized successfully in other professions are simply considered unacceptable by the health care profession and/or by the public whom expect a different type of interaction with medical staff than they would receive from enforcement personnel.

Most types of striking would be frowned upon in a purely care giver setting. A possible exception would be security officers tasked with working Emergency Admissions areas. Here, especially in more metropolitan centers, street violence, including gangs, can spill over into the Emergency Room.

In such centers security personnel are often issued batons and handcuffs and expected to be capable of and prepared to use both. However, once a patient has completed the intake process the use of a baton would be considered unthinkable in most settings.

Confinement areas for the criminally insane would be run more along the lines of a prison than a health care facility. Officer safety would be the primary consideration. Thus the application of both batons and/or chemical restraints would be more acceptable in these settings.

Indeed even the terminologies mean different things in the medical community than in security or enforcement settings. In security and enforcement environs 'chemical restraints' would almost always mean some form of pepper spray. For medical settings 'chemical restraints' would almost always mean an injection.

Different Environments, Different Requirements

Often times on the street the application of pepper spray or an impact tool will quickly settle the altercation in favor of the enforcement officer. The exception are those persons high on drugs, emotionally disturbed, or mentally disturbed.

Most of the instances where I personally, and others I have spoken with, have gotten negligible results either with sprays or batons have been dealing with these types of persons. Now let's switch to a health care setting.

What are you dealing with there? Oh yeah. Persons high on drugs (or coming down off them) and emotionally or mentally disturbed persons. So knowing that pepper derivatives and baton work doesn't work on these people would also preclude their use in a medical setting.

So let's talk about pressure points. When are they most prone to fail? Oh yeah. With the same types of individuals. So let's not get confused here. Pressure points are fantastic when they work, but if you can strike a pressure point in the legs, for example, with a steel baton, and get no effect, what makes you think that digital manipulation on a different pressure point is going to produce any better results? Great when they work, don't bet your life on them.

Now let's talk about take downs. In an enforcement setting you want to put the person face down to neutralize their fighting options. In a medical setting, you're often times trying to lay them on their back on a gurney. This requires a different type of take down and a very different type of follow up when the subject ends up face up, three feet in the air, as opposed to face down on the ground.

My finding has always been that the medical professionals are very well aware of their unique needs. The problem is that most trainers want to teach them the same stuff they teach everybody else! That just won't work in the medical setting.

In the health care industry violent patient management up to and including the application of medical restraints requires an understanding of the psychology of the care giver as well as their unique needs with regards to their subject.

Thus, physical interventions should focus more on off balancing the subject, limb isolation as opposed to joint articulation, and a team approach involving at least two, possibly four persons who will be hands on and a team leader who's only purpose will be to direct and report, thus ensuring patient care as well as staff safety.

Training should also be done on site or by simulating the environment as closely as possible. Hospital staff, including medical staff, all of whom can be at risk from a violent patient should also be taught at least disengagement tactics so that they can get themselves out of trouble and activate a team response.

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