2 Letters are the Secret of Self-Defense for Healthcare Professionals.

The two letters are D and T.

De-escalation Tactics should be used ,when appropriate, prior to Defensive  Techniques
By: Kip Teitsort


In my research, I have found more often than not, solid de-escalation tactics could have prevented the need for use of Defensive Techniques. In our Escaping Violent Encounters courses, we teach several de-escalation tactics, all of which have, at the crux, outstanding customer service. The top three de-escalation tactics are: Distance, Assessment L and Verbal Skills. I will briefly explain distance and Assessment L, but will focus this article on the verbal skills portion.

* Distance (6-8 feet): Allows for perceived personal space on behalf of a true patient or potential aggressor. It also allows for critical moments in time allowing a provider to make a decision hence its common reference of reactionary gap. Distance is determined by the threat presented. Most intial patient encounters do not require the provider touch a person immediately upon arrival. Pausing at 6-8 feet allows for staff introductions as well as the visual cues behaviorally displayed by the person who may or may not be a patient.

*Assessment L: Used with verbal skills and distance initially. Providers move into the “L” configuration once consent has been obtained. Here is a video of the Assessment L

*VERbal Skills: Are more than merely the words we speak. We can use the words, with the way we say them, in an attempt to diffuse a potentially violent encounter. It is almost as if in this modern world of texting, many basic communication skills have been lost. DT4EMS’ VERbal skills formula is: Validate, Explain, Request help.

*Validate- Use a simple phrase such as “I get that” to let the person know you heard them. You are simply validating the fact they spoke to you.

*Explain- letting patients and their family know what you are doing every step of the way. It can also be explaining what NEEDS to be done.

Finally the *Request for help: Asking for someone’s help can empower them, redirect them and even diffuse their growing frustration about a particular problem. We are already masters at asking for bystander help, use it to your advantage.

I have had countless people telling me what great results they have experienced when using the VERbal skills formula on the job (Some have even been supervisors using it on employees). If you don’t practice, it will come out robotic and will likely have a negative effect.

Caveat: Training for one, but not the other.  Medical staff must have the spectrum of training to understand when to, and when not to, use de-escalation tactics or defensive techniques. Since some providers have been attacked by surprise, they must have a reasonable set of skills to escape a violent encounter occuring on the job. Likewise, some may be physically skilled and able to defend themselves, but could have de-escalated the situation with solid verbal skills and great customer service. DT4EMS training is what will afford staff essential critical thinking skills for dealing with the use of force or violent encounter. Sorry, but just a video of some physical skills won’t cut it either. That is like watching a video on how to perform an endotracheal  intubation and expecting staff to be able to do it on the job without ever practicing.

Ignoring the problem that is violence and the use of force does not make it go away. When faced with a violent encounter, staff will respond. How they respond will be based on training or lack of it. People with cell phone cameras can’t wait to make you famous. Make sure it is for the right reasons.