Aggression Management

Today I took part in an educational offering through work. Our entire emergency room staff is being trained in a program that teaches “management of disruptive and violent patient behavior.”

I was excited for this training for a few reasons.

The ER where I work sees a large amount of drunk,mentally unstable, and otherwise violent clientele. Many people are shocked to find out that legally, a patient can be restrained by all four limbs to the gurney when they have crossed a line and become a threat to others, or are trying to leave when they have been legally detained by the state. So, the job (some days) can be part care provider, part bouncer. It’s important to have staff trained to manage these situations for the safety of all parties involved.

Secondly, the program that we teach places an emphasis on recognizing levels of aggression. When staff can recognize the stage of escalation that the patient has risen to, they can have a response that is appropriate- and most likely to calm the patient to a manageable level. The levels that we teach progress in the following order: Calm, Verbally Agitated, Verbally Hostile, Verbally Threatening, Physically Threatening, and Physically Violent. Our number one goal in the emergency room is to de-escalate the patient to a calm and manageable level.

Thirdly, it’s always fun to put a mini whooping on your co-workers. The end of the training concludes with mock restraint scenarios where employees act out as patients who’ve gone off the deep end. This is fun because we all love to wrestle around and once someone’s tied to the bed… the ways to mess with them are endless. The most important thing (in my opinion) that comes out of the mock scenarios is the “team approach.”

We’ve had some scary situations at work and having everyone on the same page, knowing their responsibilities goes a long way in ensuring a smooth “operation.”

From spitting, to punching, scratching and biting- the staff of the emergency room have seen it all. What makes the ER  unique is that we regularly have “customers” who try to become violent towards us- the very people trying to improve their well-being. I love being a “grunt” in the ER, assisting the nurses and docs- I often get to be part of the restraint team. I have a certain “skill set” that allows me to be very effective in patient control. Wanna see my first cage fight? Click here.

Thanks to this seattle times article, I’m now acutely aware that I have the most violent job in washington state. Does this bother me? Not really… not because I enjoy violence… really it’s the opposite. I love challenge- when someone is ready to fight, engaging them in combat is easy. Taking someone who’s physically threatening and talking them down to a state of calm is much more satisfying and challenging than judo throwing them onto the gurney. There is a point in time where you’ve done all you can and there’s no way you can come to a state of calm -unless you put the smack down… that can be satisfying too…

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