California Cares! Workplace Violence Prevention in Health Care
Finally! After years of trying to raise awareness by speaking at conferences, teaching courses, creating videos and blog posts, some literally begging OSHA to dig into (the dirty little secret) violence in healthcare… CalOSHA stepped up.
While I like to think DT4EMS played some part in it, I am sure professionals like those in the Emergency Nurses Association (ENA), the National EMS Management Association (NEMSMA), and research by Dr. Brian Maguire and Drexel’s Jen Taylor, were major driving forces behind the new regulatory requirements. Having been the victim of violence personally, and hearing the horrific stories shared with me, this was a change long overdue. Regardless of the level of involvment, to each and every person involved with making this happen, from the bottom of my heart, I truly thank you.
So, check this out…
For more than 20 years, DT4EMS has provided unparalleled, reality-based self-defense programs, designed specifically for healthcare professionals, by healthcare professionals. DT4EMS’ EVE is not some form of police, military, or martial arts training relying on pain-compliance for custody and control. Its creation was for the sole purpose of providing critical thinking skills for the singularly-unique environment of professional health care organizations. DT4EMS’ network of current instructors, that are also active within the medical community, as staff and/or administrators, ensures our methods and material remain current. DT4EMS’ Escaping Violent Encounters (EVE) training program(s) meet the expectations outlined in CA OSHA §3342. Additionally, DT4EMS offers discipline specific train-the-trainer programs for in-hospital and pre-hospital providers.
While most attacks on staff are not life-threatening, the risk of serious injury is evident and unpredictable. Healthcare professionals require an effective and reasonable plan on how to de-escalate when possible, and defend if necessary once attacked with a focus on escaping the encounter, not physically winning a fight. All too often healthcare organizations and agencies have been led to believe some offerings of de-escalation courses were in fact sufficient. This idea does not prove true in reality, as providers are routinely attacked both prior to any possible attempt at de-escalation as well as while escalation is attempting to be employed.
De-escalation techniques assume that the person interacting with the provider has the mental capacity to understand and make appropriate choices of their behavior. In the healthcare setting, whether it is in emergency or more controlled environments, such as a ward or ICU, patients, family, and bystanders are often stressed, their normal physiologic response is “fight or flight”. When denied the ability or even perception to flee, “fight” is the instinctual response in all animals, including people. This natural stress response may even be exacerbated by synergistic medical conditions such as drug/medication reactions as well as blood loss, or underlying psychological or psychiatric impairment. Similar to being appropriately capable to consent to or refuse medical treatment, a potential patient must be mentally able enough to choose de-escalation options.
Successful completion of the Escaping Violent Encounters program(s) affords staff the critical skills to recognize the difference between a patient and a criminal aggressor. That critical recognition allows for professional patient care, safety for staff, patients, and the healthcare organization.
As with any skill or knowledge, proficiency requires maintenance. EVE is not a “one and done “process. After successful completion of an EVE course, participants have online access to ongoing research, safety tips, relevant articles, and instructional videos. All provided by recognized experts on the various subjects.
The following pages and hyperlinks will assist you in identifying ways in which DT4EMS’ Escaping Violent Encounters training program(s) can help EMS agencies, health care organizations, and fire services, in the state of California comply with CalOSHA’s Workplace Violence Prevention in Health Care rule.
Cal/OSHA’s Workplace Violence Prevention in Health Care standard went into effect on April 1, 2017. The standard is found in the California Code of Regulations, Title 8, Section 3342
California Code § 3342. Violence Prevention in Health Care defines four workplace violence types:
“Type 1 violence” means workplace violence committed by a person who has no legitimate business at the work site, and includes violent acts by anyone who enters the workplace with the intent to commit a crime.
“Type 2 violence” means workplace violence directed at employees by customers, clients, patients, students, inmates, or visitors or other individuals accompanying a patient.
“Type 3 violence” means workplace violence against an employee by a present or former employee, supervisor, or manager.
“Type 4 violence” means workplace violence committed in the workplace by someone who does not work there, but has or is known to have had a personal relationship with an employee. (image on left)
Those who have trained with DT4EMS should immediately recognize how our EVE courses address the four different workplace violence types. Our blend of material, instruction style and resources provide the end-user with vital critical-thinking skills for on-the-job use.
Per the scope and application, Health care facilities, service categories, and operations affected include:
Health facilities, Home health care and home-based hospice, Emergency medical services and medical transport, including these services when provided by firefighters and other emergency responders, and several others. (Click image to enlarge)
One of the major battles in raising awareness of criminal acts of violence in healthcare, was the lack of “proof” via published research. For years, as I continue to do, I would reach out to agencies named in a news report of an assault. Nearly all would refuse to take my call, or answer an email. Those who did respond, would refuse my requests for an interview. The best I could do was create my own assault on staff logs. So, from 2004-2017, I kept records of assaults that would make the news. I kept “Assault on Staff Logs” in order to show the nay-sayers:
- Proof of incidents of criminal assault
- Types of Assaults
- Locations of Assualts
- “Patients” were actually being arrested and/or convicted for the crime of assault
- The types of “patients” most likely to commit assault
California, as part of this new code, has a Violent Incident Log . Employers had to implement by April 1, 2017. Interestingly enough, an integral part of EVE, is proper reporting and documentation procedures. For over 20 years, we have been training staff on proper documentation of the violent encounter. Like de-escalation training, our reporting and documentation modules are not separate training. They are inter-woven into every aspect of our training. Understanding the stressful nature of documenting the violent encounter, at DT4EMS, we simplified the documentation process. We created, and make the DT4EMS Assault Response Form (ARF) available to clients. Our clients will immediately recognize how similar our long standing ARF (sample below) is to the information requested in California’s new Violent Incident Log.
The log, while important in the long term (for research), short term employer requirements such as having to review their Workplace Violence Prevention Plan, have a Workplace Violence Prevention Toolkit, and provide training for their staff, will have an almost instant result. Employers must implement those short-term changes by April 1, 2018.
What makes us at DT4EMS so excited about what CalOSHA has done? To put it simply… The domino effect. What one state does, many follow suit. The actions taken by California may very well be THE most important piece of changing the culture in medicine for the better. In addition, for the better part of 20 years, we have been set up for this. DT4EMS and our EVE courses have the requirements covered. We have been providing real-world training, specifically designed for healthcare. Being seasoned providers ourselves, we understand, at a cellular level, the unique environment healthcare providers face for the use-of-force in self-defense and patient restraints.
The links provided will allow you to see what administrators, risk managers, nurses, medics, EMTs, firefighters, and educators alike have to say about DT4EMS’ EVE. The links will also provide resources for you to make an informed decision about CA OSHA §3342 and how DT4EMS meets the requirements of the rule.
- California Code of Regulations: CA OSHA §3342
- About DT4EMS
- Media Coverage of EVE courses
- Sample articles by others regarding EVE:
- Montgomery County Hospital District (TX)
- Twin City Ambulance (NY)
- Detroit’s Medical Director JEMS Article
- Indianapolis EMS
- Testimonials regarding DT4EMS’ EVE
- Interviews and Hangouts (Youtube)
- CPI vs. DT4EMS Comparison
If you haven’t noticed already, and if we didn’t know any better, it looks as if CalOSHA took our EVE courses and wrote regulations based on our courses. It is like they took our objectives and resources and went, “Yup, this it it!”. I for one couldn’t be happier. It is vindication in the purest of form. Having faced ridicule for the standards we set for our courses. The steadfast refusal to bastardize those standards to make a buck, to see a state write into regulatory code, almost our exact program… I mean, you can see why I am beside myself with joy.
While I would be honored to have certified DT4EMS Instructors share our culture changing message with every healthcare provider in California, choice of training will be at the discretion of the employer. In closing, for the first time in my over two-decades of researching and teaching about the subject of violence in healthcare, it really looks like true change is taking place. Much of my optimism is because of what CalOSHA has accomplished. Like I’ve said for years, practicing Saving Yours While You Save Others (SYWYSO) is more than a tag-line, its a culture change.
