Assault Response Training for ER Staff

Altra, BSN, RN · Dec 2, 2006

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.

I agree w/you there ... and as I said I'm a firm believer in a show of force and in the use of restraints.

For a patient who "starts from zero" and then escalates, I think there is a window of time for effective use of CPI. And that is what the class teaches. For those lovely coked up individuals brought in with 2 or more LEO ... obviously that window has long since come & gone.

Do we work at the same place ...lol? It would be a rare 24 hrs. here that someone isn't in restraints, and not too long ago we also had the intubation-as-only-means-to-keep-everyone-safe scenario. After assaulting a nurse, pt. ripped the skin from their arms getting out of leather restraints and used body weight to "hop" the several hundred pound stretcher across the room.

Fiesta Red · Feb 5, 2007

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.

Hey, these links are great stuff. Thanks for them.

Having been involved in several high-risk incidents in the past couple of years because I am the go-to guy for psych patients (I worked in a psych hospital for several years), I have started a project involving research on how to get everyone trained in handling psych patients in general and managing violent behavior.

There does not seem to be much research on it, though.

TazziRN, RN · Feb 5, 2007

We are also required to take CPI. I can see how some of the manuevers taught can get us out of being grabbed, but I don't see the restraint techniques working at all.

Email4KH · Feb 6, 2007

CPI here, too.

As with others, our facility only approves reacting to assaultive behavior with CPI-designed techniques.

My children, on the other hand, have no interest in seeing Daddy get hurt.

I vote with them.

Sure, I'll try the goofy CPI.

But if it's necessary, it's any means necessary. I'm not getting paid enough to get hurt for a policy.

kat911 · Feb 6, 2007

Several years ago a hospital I worked for did Mandt training. It was pretty good, especially the restraint holds. Don't know if it is still being taught.

TazziRN, RN · Feb 6, 2007

Sure, I'll try the goofy CPI.
But if it's necessary, it's any means necessary. I'm not getting paid enough to get hurt for a policy.

The thing that makes my eyebrow go up is that so many of us are hurt in CPI training!!

nurse_nan · Feb 6, 2007

When management failed to respond to our requests for training, we put a class together ourselves. Did it through credentialling. Had a man come in who was associated with the police department who was also a martial arts expert. He showed us ways to break holds and restrain people while making it all look very passive. He taught us places to aim for that would disable while making us look very nonagressive. His was the most thorough training I ever received and we practiced it in class until we could all hold him down by one thumb (placed correctly below the clavicle). It looks good to the general public but is very effective.

About 3 weeks after the class, a participant had a patient jump up on a stretcher and launch themselves on her. Thanks to his training, she neatly sidestepped and rolled the patient to the floor. No one got hurt and she felt empowered!

S.T.A.C.E.Y, LPN · Feb 10, 2007

When management failed to respond to our requests for training, we put a class together ourselves. Did it through credentialling. Had a man come in who was associated with the police department who was also a martial arts expert. He showed us ways to break holds and restrain people while making it all look very passive. He taught us places to aim for that would disable while making us look very nonagressive. His was the most thorough training I ever received and we practiced it in class until we could all hold him down by one thumb (placed correctly below the clavicle). It looks good to the general public but is very effective.
About 3 weeks after the class, a participant had a patient jump up on a stretcher and launch themselves on her. Thanks to his training, she neatly sidestepped and rolled the patient to the floor. No one got hurt and she felt empowered!

So my first day in the ER for my final clinical placement we get a psych patient in who had stabbed herself. All was fine and good, she was totally cool and co-operative, until the cops showed up to inform her she was being arrested. 5'10" 240lb lady dives out of bed and runs for the door. Two cops are on the floor fighting with her trying to hold her still, while the other nurse with me is trying to stop her from assaulting the cops too, me--i'm just watching cluless about what to do. I get shouted at to grab the restraints, which of course no one has shown me where they are located. So I'm running around like a mad person trying to find the supplies, while security shows up to jump into the struggle and hold her down too. So with a cops/security/nurses sitting on her legs/arms/chest to hold her down, I get handed a set of restraints from someone and am told to start securing them to the pt. But somehow applying 4 pt leather restraints to a violent, screaming & aggresive pt was never covered in nursing school........but I can make a bed with the best of 'em! All of the topics the poster above listed should be covered in nursing school. It wouldn't take long. Even if you only may ever need it once at work or in a dark parking lot, at least it'll be somewhere in your head for you to use.

paradisemakai · Feb 10, 2007

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.

I completely agree. In fact, when I worked at an adolescent unit, we were all taught CPI, and it was useless and people did get hurt.

When I worked ER we had a local guy who has worked psych forever and he developed his own deescalation training. It was good. Sorry to not be of more help. Putting prozac in the drinking water at the hospital should be the second line of defense :smilecoffeecup:

lauralassie · Feb 11, 2007

No we don't have such training. Wish we did though. We had a nurse tech who was beat bad enough that he had to go home. He now needs HIV etc. testing due to a scratch he obtained during the insident. The illegal allian was arrested by the police dept. But, was released by the detective after he reviewed the dvd. The detective said the nurse tech actually could be sued for illeagl restreint of a pt. All he did was put his hands on her shoulders and ask her to calm down, when she grabbed and twisted his sctrotum , hit him in the neck and left a nice mark on his chest. We asked the detective what we should do in the next event, he said wait for the police. We were soooo upset. That detective was wrong, medical personel are allowed to restrain to protect and defend. We couldn't belive it. I've posted this incident before on a thread. Couldn't imagine how many people were worried about the rights of the illegal over the nursing personel. It was upsetting.

GIRN · Feb 11, 2007

CPI was required in our ER and I felt like I was in a scene from The Emperor's New Clothes". I kept looking around at the other participants thinking, "Do you guys really think this will work? Where's the REAL course that will give us helpful information?!?" The instructors laughed patronizingly at me when I asked "Once I disengage from his hold, how can I disable the person to give me time to escape?" Seems we have to passively let them attack and then try to figure out how to break their hold without hurting them. Forget that! If I feel I'm being physically threatened, I'll risk termination or a lawsuit to stay safe. (We're trying to give aid to someone and not only do we have to worry about them hurting us but we have to worry about them suing us for it, too! There's something wrong in this country!)

epg_pei · Feb 13, 2007

We have Non Violent Crisis Intervention, which often becomes Violent Crisis Intervention. This is an area of psych I hate. I'm not a big guy, but I am tasked to deal with aggressive patients without adequate backup. I heard a rumor that our hospital is losing orderlies. No, I have no idea what they are thinking....