What does changing our culture have to do with protecting our future?

What does changing our culture have to do with protecting our future?


This subject is so deep, I will point out the topics and hyperlink the greater discussion on each point.

1) There is a lack of true understanding of patient vs aggressor. This is a problem because people lable a person as a “combative patient”. When the term “patient” is used when a person is actually a criminal aggressor/attacker:

  1. No criminal charges get pressed
  2. Attitude of “just part of the job” is present
  3. Ridiculing/mocking by fellow or senior staff when victim wishes to pursue charges
  4. Staff member will remain connected, physically, and won’t flee the violent encounter because they subconsciously keep thinking they want to help a “patient”
  5. When a person is called combative patient- police, courts, media and provider’s administration do not treat the violent encounter for what it was, a criminal act.

Removing the label “combative patient” from medical lingo is the first and most important step in changing our culture and protecting our future.

2) With no formal training in the use of force, the pendulum has swung way in the other direction. When staff are not taught what is “reasonable” in the use-of-force, many have resorted to caveman style techniques and have actually become aggressors themselves. Simply look at how JADED many in medicine have become.

3) Soft Restraints equal hard times for medical staff. My unofficial research reveals the leading incidents where criminal assaults occur, either to staff, or staff toward a patient is during a restraint situation.

  1. Medical staff are not police. When I travel the country and ask about restraint training, the average answer is 0-4 hours total. Police officers entire training and experience is essentially about custody/control and handcuffs- a temporary means of restraint
  2. Train on #1 (what is or what is not a patient) and medical restraints become an easy task for healthcare

4) Tactics of prevention then techniques of escape. All too often providers are given a band-aid to stop an exsanguinating hemorrhage, meaning offered a class on techniques and not addressing the underlying issue of the actual problem.

  1. No technique is 100% for self-defense or to control someone. If such a technique existed, why do police officers have tools on their belt for when empty hand control techniques fail?
  2. Martial arts style techniques of finishing, destroying or submitting my opponent have no place in medicine.
  3. The Win. Must be defined differently for medical staff. A win is never using force or escaping a violent encounter with little or no injury.
  4. The techniques used in emergency medicine should be reserved for when tactics of prevention were not an option (i.e. spontaneous attack)

5) Loss of neutrality. With little or no formal training on how to deal with human conflict, healthcare providers are left to learn on their own.  Much of this visual type or unofficial training comes from watching police officers and how they control someone (verbally and physically).

  1. Provider begins to  order people instead of asking or consent
  2. Has a false sense of security of the uniform causing people to follow their orders
  3. Provider uses visually learned technique (usually pain compliance style joint lock) – officers see provider use police style technique and mistakenly assumes provider is trained similarly in the use of force. The person the force is being used on, the public, the officer and the provider begin to believe the provider is an extension of law enforcement. That causes us to lose neutrality.
  4. This leads to the “You can go to the hospital with them or jail with me”

6) Custody or Care? What is the role of emergency medicine? This is a dangerous line that has become very blurred. Although providers learn in school that touching a person without their consent much less taking them somewhere against their will… providers have actually taken custody of people without knowing it.

7) The dirty little secret in medicine. Violence against healthcare providers is a subject that many refuse to talk about much less train for.

  1. Hospitals not wanting to have the public aware of how dangerous the emergency department really is
  2. Administrators not wanting to train their staff for self-defense yet many front line staff are asking to carry guns on the job
  3. The media only covers lethal or potentially lethal encounters on staff so some believe that is the only kind that exist
  4. No support to the victim of a violent on the job encounter leads to JADED attitudes, PTSD etc.


So you see, in a 16 hours class, we shove 40 hours of material into a program trying to help change a culture. A culture change that will protect not only the future or our current providers, but the future of those who follow us into emergency medicine.

It is truly about Saving Yours, While You Save Others! Train and be prepared for each of the 4 battles of every encounter: