Assault Response Training for ER Staff

jojotoo, RN · Dec 1, 2006

Hello,
Does anyone here work in an ED that has provided professional training for managing assaultive behavior? What organizations or certification did they use for the training? Our ED has recently become the designated 5150 facility for our county, and our number of violent patients has increased, as has the number of violent incidents.
Thanks in advance!
-FX

We take a annual class in CPI - Crises Prevention Intervention. It was designed to control a combative psychiatric or intoxicated patient from harming himself or the caregiver.

This is a completely useless class and if you are 100% compliant with its guidelines, I'm 100% sure that you will eventually get hurt.

Hope you find something better than this.

S.T.A.C.E.Y, LPN · Dec 2, 2006

I'm actually curious about this too.

While in school one of my clinical terms was on a Medium security Forensic Psych unit with frequent violent patients. Finally on the last day of clinical our instructor had someone from the facility come to talk to us about what do with violent patients and how to properly avoid and handle situations. Good info, but too late to have been helpful should something have happened while we were there (luckily nothing did).

But, I am curious as to whether or not this info is provided to ER staff (as I hope to be one soon)...

Altra, BSN, RN · Dec 2, 2006

This is a completely useless class and if you are 100% compliant with its guidlines, I'm 100% sure that you will eventually get hurt.
Hope you find something better than this.

We are required to take this class also ... ours included some physical interventions and I thought it was very relevant. Just curious if the content of your class was different or what you found to be objectionable?

Having said that, however, I'm a firm believer in a show of force from 4 or more staff/security and in the use of restraints in the ER -- the ER doesn't have a safe place to put someone in seclusion as is done on psych units.

There is generally no talking down a coked up, violent pt. We employ restraints, Ativan & Haldol.

jojotoo, RN · Dec 2, 2006

We are required to take this class also ... ours included some physical interventions and I thought it was very relevant. Just curious if the content of your class was different or what you found to be objectionable?
Having said that, however, I'm a firm believer in a show of force from 4 or more staff/security and in the use of restraints in the ER -- the ER doesn't have a safe place to put someone in seclusion as is done on psych units.
There is generally no talking down a coked up, violent pt. We employ restraints, Ativan & Haldol.

I have now had the CPI class four times. Violence (or escalation) is almost a daily event in our ER. If a 24hr period passes and a patient has not been in hard restraints during that time - well, that's very unusual.

We have had staff (MD, RN, Tech, Security) slapped, punched, kicked, bitten, spit upon and the lives of ourselves AND our families threatened.

I have yet to see any of the info from CPI have a practical application. When we do a takedown, the patient isn't just standing there cooperating with the CPI stances and moves. He is a fighting / moving target.

hogan4736, BSN, RN · Dec 2, 2006

Took CPI 17 years ago working in psych...it sucked then too

augigi, CNS · Dec 2, 2006

Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers

http://www.icn.ch/guide_violence.pdf - "An organisation's formal policies and management attitudes greatly influence the climate in the workplace. The degree to which an individual's safety and dignity are considered important will greatly influence security within the work environment."

Have you notified your manager that you do not feel that the course provided adequate tools to deal with the issue and that you have ongoing concerns about workplace safety? I would suggest this should be your initial move - perhaps they can then investigate other courses or various measures shown in the literature to effectively decrease workplace violence. There are also multiple online CE courses related to violence prevention, workplace safety etc. If you understand the theory but have problems with the practical/physical application, you may need a change in security policies at the hospital.

augigi, CNS · Dec 2, 2006

Looks like Florida has a structured, 3 day program for nurses etc (from department of mental health): Aggression Management

(or an additional 5 days to become an instructor for your facility)

oso · Dec 2, 2006

The hospital I work at uses MOAB, we still restrain patients daily and staff still gets hurt.

Meerkat · Dec 2, 2006

We did CPI too, and I agree with the other posters---useless. For example, they teach that if someone bites you, you are supposed to 'feed' the bite. In other words, instead of pulling your arm or whatever back, push it more into the assailant's mouth. I don't know anyone whose instinct it is to give the patient more to bite on! Further more, striking a patient, even in defense, is automatic dismissal. I just took up karate after having my tooth knocked loose by a patient. Assaults are very common on our unit and I feel that I must know something better than CPI. Good Luck!

rjflyn, ASN, RN · Dec 2, 2006

We have to take CPI here as well, the facility basically will back you as long as you follow it other wise one is on their own.

As for violent/combative persons go in our ER at least on our team its not tolerated. Of course it helps that the charge nurse is an ex-police officer. So we set the rules from the start follow them and were ok. Break them and its restraints for you. Oh and by the way you assault staff and its to jail and possibly prison for you. Works 99% of the time unless someone is totally psychotic then as most know you cant reason with them.

Rj

jojotoo, RN · Dec 2, 2006

Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers
http://www.icn.ch/guide_violence.pdf - "An organisation's formal policies and management attitudes greatly influence the climate in the workplace. The degree to which an individual's safety and dignity are considered important will greatly influence security within the work environment."
Have you notified your manager that you do not feel that the course provided adequate tools to deal with the issue and that you have ongoing concerns about workplace safety? I would suggest this should be your initial move - perhaps they can then investigate other courses or various measures shown in the literature to effectively decrease workplace violence. There are also multiple online CE courses related to violence prevention, workplace safety etc. If you understand the theory but have problems with the practical/physical application, you may need a change in security policies at the hospital.

Augigi, you're giving good advice, and I appreciate your input, but you're preaching to the choir. Of course we've gone to management. And written numerous incident reports that go to that endless black hole known as risk management.

CPI just does not work on psychotic, intoxicated (alcohol or drugs), pi**ed off patients. It is unreasonable to think that if a patient has been brought in tazered or pepper sprayed by police - and in metal handcuffs - that I will be able to control his behavior by de-escalation verbally or with CPI.

In the past, we have even had a patient that was so violent that after he was physically subdued, we had to paralyze and intubate him for his and our safety because the leather restraints would not hold him.

At least at my hospital, the bottom line is $$$. They are not going to look for another class and pay staff to become instructors. It's always, "Do the best that you can". And we do, but not by using CPI.