DT4EMS’ 4 T’s for dealing with Workplace Violence, a violent encounter, you know, self-defense in Emergency Medicine.
Emergency nurses assaulted, medic headbutted and a Detroit medic describes assaults are common. Reports of assaults on staff in the field of emergency medicine occur almost daily. Regardless of their uniform, staff need suitable preparation for a reasonable response to these types of attacks. (1)
Preparation for an on the job violent encounter should include the 4 T’s (Train, Tactics, Talk, and Technique).
Staff must have training before the event occurs that includes proven safety tactics, how to talk to patients, family members and bystanders as well as have sound/reasonable techniques for when talking/tactics were not an option.
Train– Self-Defense in emergency medicine is unique. Unlike any other profession, medical staff must recognize in a split second if they are dealing with a patient suffering from an injury or a medical 
condition forcing them to act erratically or dealing with an intoxicated (drunk/drugged) person attempting to criminally assault them. Training must cover 4 areas (Mental Preparation, Street skills, Media and Courtroom Preparation)
Tactics- In-Hospital and Pre-Hospital staff need tactics of safety for prevention of the violent encounter. Training includes aspects of entrance and egress, body positions, hazard identification and mitigation, how personal appearance can reduce potential attacks, how to avoid conflict while on the job just to name a few.
Talk– is an important PART of the training, but it can’t be THE training. While the term talk is mainly associated with communication, most of our communication is via body language. If the choice of words does not match demeanor, the words themselves may serve more as an ignition source for someone considering the violent attack. However, having a firm foundation of verbal skills to diffuse a potentially violent encounter is considered an industry best practice. Great 
verbal skills also turns bystanders into witnesses should the need present itself. If staff is captured on video using sound verbal skills in an attempt to diffuse a situation, but are forced to actually use a physical skill to defend themselves, that use of verbal skills on film can provide protection administratively and in court. The Talk training would also contain ways for the provider to be able to tell not only administration but law enforcement about any use-of-force either in self-defense or patient restraint. An often overlooked portion of “Talk” is that training on the use-of-force in medicine will allow peers to discuss reasonably the problems we face in dealing with- not only the occurrence of- but the aftermath, in dealing with the violent encounter. Beware of the “talk-only” course that is supposed to be THE answer for staff.
Technique– Thanks to action movies and clever marketing, some staff may believe “technique” is all that is required for the day to day operations for any use-of-force situation. On the contrary, use of a technique proves there was a breakdown in the use of tactics or talking. An overlooked problem proving detrimental to the healthcare profession is that recognition of patient or attacker(2)…the whole custody 
versus care.(3) Ensure staff are training in ESCAPE techniques that work more often than not. Review the material to see if the techniques taught are martial arts style “fight-finishing” moves or police style pain-compliance techniques that have no place in medicine. If only trained in technique, what happens when a provider uses a throat punch, body slam on a confused patient? What happens to the provider when trying to apply soft restraints to a person who is criminally assaulting them?
Staff must have training before the event occurs that includes proven safety tactics, how to talk to patients, family members and bystanders as well as have sound/reasonable techniques for when talking/tactics were not an option.
(1) Visit this Collection to view actual news reports of attacks on staff
(3) Custody or Care
Share our BLOG with others by clicking the icons below.