Assaults against NHS staff in the News

Dynamis proudly provides Conflict Resolution training to NHS staff accross the country and we stay current with many of the emerging issues in this area, such as the introduction of Lone Worker Alert Device technology and services.

In April 2004, the NHS SMS developed a national syllabus for conflict resolution training designed for frontline NHS staff. This training gives staff the skills to recognise and defuse potentially violent situations. More than 428,000 staff have been trained so far and we are delighted to have contributed to this effort.

The Security Management Service recently published the result of its annual report on violence to staff. There were 54,758 assaults against NHS staff in 2008-2009, with the vast, vast majority of those cases occurring in the Mental Health and Learning Disability settings. These figures represent a decrease in assaults overall, which is something we are encouraged about.

The Department of Health is subsidising the roll out of 30,000 subscriptions to lone worker alarm services for NHS staff. Roll out started in May 2009 and many frontline workers are now actually being trained to use the devices.

The system is designed for staff who work in isolation from colleagues and may need the ability to call for assistance when their personal security is threatened. If a lone worker indicates they need help then a trained individual is able to listen to events, call for assistance if necessary and record events in a way that is legally admissible making it easier for workers to bring cases to prosecution where appropriate.

Of course, we have written on this blog in the past about some of the issues which need to be addressed when rolling out lone worker devices, especially in regard to training and awareness and we have begun to incorporate many of these key points in our Conflict Management training when it is appropriate to Lone Workers.

Interestingly, we focus a lot of our training on making staff aware of the risk management implications of their work and the obligations their managers have to create safe systems of work.

Over at Nursing Times, there have been some comments on this:

“Royal College of Nursing chief executive Peter Carter said: “The very slight decline may be a step in the right direction but too many employers are failing to invest in measures to prevent attacks on staff in the first place. In particular, lone workers continue to be put at risk despite the government scheme to provide assistance with the funding of lone worker alarm devices and training.”

One of our training maxims is that organisations should be “training the person, not the kit”. An ounce of awareness which keeps the trouble from starting is worth a ton of equipment to deal with the trouble once it starts. However, we do advocate the deployment of these alert devices and we anticipate their use will become ubiquitous in the field of lone worker management and supervision, to great effect when coupled with good training and risk management.

Indeed, our colleagues over at "G4S Vulnerable Worker Protection" have even secured their first conviction with the help of their technology and monitoring services.

Of course, the decision to give an alert device to staff must be carefully made and in-line with robust risk-assessment protocols. As RCN Senior Employment Relations adviser has said, again in Nursing Times:

“‘The devices that are being rolled out must be getting to the staff that need them”

and added

“What I would like to see is more information sharing about dangerous clients and relatives of patients out there in the community. It comes down to good risk assessment.”

To find out more about our NHS Conflict Management or Lone Worker Training, please visit our website by clicking those links or contact us to ask a question.

Use of Force Conference :: Part 2 :: Decision Making

Decision-making, at both a strategic and tactical level, is a critical issue in reducing the overall risk of harm in a given service or incident.

For example: at the recent use of force conference we attended, we examined a very interesting case whereby a police organisation in the USA made key decisions regarding use of force when confronted with a planned protest.

In this example, the protest organisers had informed the police that this would be a serious “sit-in” and went as far as to suggest that to reduce the risk of injury to individual protestors, the police should provide hospital gurneys, and should lift and carry each protestor on to a gurney to be wheeled away from the area ‘safely’. There was no question that the police would be forced to remove protestors from the area they were occupying, because of the risk to public safety and order. For the purpose of this blog entry, we are not going to consider the rather contentious issues around policing of public order, such as those raised by the recent Channel 4 Dispatches documentary.

However, in the incident we looked at, the police examined their use-of-force options with a risk-management mindset and prior to the protest and made a strategic decision regarding use-of-force: the officers would be advised to use physical intervention and pain-compliance methods to move the protestors from the area.

During the protest, when police intervened, injuries were caused when the protestors resisted removal, and a case alleging “excessive force” was put to the courts.

Now why would a chief of police release his officers to use pain-compliance holds when the alternative of ‘lifting and carrying’ was an apparent option?

Well, the primary factor in the decision to use pain-compliance holds rather than the ‘lift and carry’ method was in fact to avoid back injuries which are often sustained by officers in those situations! Certainly, ‘lifting and carrying’ the protestors (all 100 of them) to a place of safety under conditions of non-resistance or ‘passive-resistance’ sounds like a far more humane and non-aggressive strategic option, however we know that the reality of confrontation can rest far from the sterile laboratory of theory.

The key realisation in this story was that by forcing officers to use a ‘minimum’ approach to use of force, the chief may in fact have been putting his staff, and the protestors, at far more risk of injury.

Imagine for a moment the physical challenge of ‘lifting and carrying’ 100 protestors off the ground and onto gurneys for transport, in high-stress and constantly unfolding circumstances… The scenario is one that would make any competent manual-handling trainer wince with the potential for injuries amongst the staff involved.

Consider in fact that by taking this ultimately controversial ‘pain-compliance’ approach to use-of-force, the overall risk of injury (to both the Chief’s staff and to the protestors) was probably reduced, compared to the potential list of back strains and injuries, days off work and reduced control of the situation that the alternative option presented.

The ‘big-picture’ can often provide greater clarity for ‘in-the-weeds’ decisions.

We find this decision-making example - one which considers the risks to staff as well as the risks to the subjects of the use-of-force, very significant. For starters, it follows with the principles laid down in the UK Management of Health and Safety At Work Regulations 1999 regarding risk-assessment. You see, assessments should be made of the risks to staff AND the risks to others! All too often, in the pursuit of causing no harm to clients/service users or other subjects, managers will instead prefer to put staff at risk!

So, we are pleased to find that even our US cousins show an awareness of the balancing of risks necessary to make sensible decisions about use of force. When this balancing is purposely done, it gives staff the right tools and the permission to use levels of force which will ultimately reduce overall risk to everyone involved in an incident.

All of our courses help managers to understand the relevance of risk management to their training, safe systems of work and risk assessment obligations to reduce risk along these same lines!

Next up on the blog: positional asphyxia controversy.

Use of Force Conference, Part 1

Dynamis Insight Director and Lead Trainer Gerard O’Dea recently travelled to the USA to attend a number of training and educational events related to use-of-force options and their physiological, psychological and legal implications.

The first of these was the AELE Workshop on the Legal, Psychological and Biomechanical Aspects of the Use of Force.

Over 3 packed days of presentations and discussions, specialists in a number of fields took the podium in a schedule which attempted to cover the entire breadth of use-of-force decision-making and their consequences.

Presentations followed a logical flow and were presented by an experienced panel:

- Legal aspects of Use-of-Force. Judge Emory Plitt

- Investigation of Use-of-Force incidents. Kris Pitcher (LAPD)

- Psychological dynamics of combative encounters Dr. Audrey Honig

- Use of Alternative Methods of Control (ECD / Spray) Greg Meyer

- Use-of-Force and Sudden Deaths Dr. John Peters (IPICD)

- Decision-Making and the Dynamics of Body Movement Josh Lego (Force Science)
- Contemporary issues in Use-of-Force investigations Ken Katsaris (Expert Witness)
- TASER “Smart Use” Michael Brave (National Litigation Counsel)

Gerard recounts some of the highlights of the 3-day AELE Workshop as follows:

“There were many interesting topics covered, however the ones that stand out include:

• 
  
• Use of force decision-making which is based firmly on legal standards is possibly a rather under-utilised approach in the USA. This should not be so surprising as we have noted on this blog before how in our own industry, far too many systems of physical intervention which deal ultimately with the use of force do not, in fact, use a legal standard to base their decision-making on. Furthermore, we see this fragile approach to decision-making in US-based systems of physical intervention more than in others.
• 
  
• Legal Liability and Negligence claims are almost a certainty in US instances of Use of Force. In the case where training needs can be reasonably identified but are not put into operation, then the term “Deliberate Indifference” is used to describe the organisation’s failure to train its officers in correct procedure or care for an individual’s needs. This again mirrors our approach here in the UK, where a risk assessment and training needs analysis approach seeks to minimise the potential for adverse incidents. Evem so, we still see deliberate indifference....
• 
  
• Research into the emotional-psychological experience of the realities of use-of-force incidents is reaching an advanced level, as the presentations from Lego and Honig underlined. Honig gave an encompassing talk about the broad topic of perceptual distortion and its relationship to critical stress, caused by the physiological relationships between cortical and sub-cortical regions of the brain. I noted how much of Honig’s talk about knowledge recall during investigations referred to ideas such as memory plasticity which reflect some of the work of Mark Dawes of the National Federation for Personal Safety.
• 
  
• Body dynamics research, such as that carried out by the Force Science Research Centre, is also reaching a prominence and usefulness which is exciting to observe. Josh Lego gave numerous demonstrations of how objective scientific measurement of body dynamics could illuminate use-of-force training (pre-incident) and litigation issues (post-incident). This FSRC presentation seemed to focus on the relationship between reaction-time and perception-speed. It therefore underlined the importance of Emotional Climate Training and LARD Scenario-Replication as advocated by the PDR/S.P.E.A.R. System we teach for personal protection. Scenario-based training was mentioned by many of the speakers as the best way to teach and practice critical decision-making for use-of-force.
• 
  
• The issues of sudden death associated with use-of-force were discussed a number of times by the speakers, however Dr. John Peters of the Institute for the Prevention of In-custody deaths (IPICD) took this subject as a focus. This very controversial subject covers positional asphyxia, Excited Delirium, training issues, medical crises, behavioural cues and procedural requirements - many of which are critical to the successful care of persons who may be vulnerable during a confrontation with operators in a medical care or police custody setting. The IPICD are funding research in the area of asphyxia, obesity, hog-tying, compression and restraint which we will be looking forward to hearing more about in due course.

This was a very thought-provoking and broad-based conference, resulting in greater awareness of numerous issues which will doubtless influence our training approach, so that we can deliver competent advice with greater clarity to our clients in the UK and beyond.”

Following this excellent AELE course was the Institute for the Prevention of In-custody deaths (IPICD) Use of Force Train-the-Trainer course which Gerard also attended and will comment on in a future blog entry. Stand by!

Clarity and Enablement

Our training team just returned from a programme of training delivered in a psychiatric environment. The staff team was one of the most mature and professional medical teams we have had the great pleasure of working with and between them, had a great deal of experience with a number of different restraint methods being taught in the UK.

These included a variety of well-known methods of physical restraint which either:

• adhered to the BILD code of practice
• precluded staff from using pain during restraint
• used the prone position as the primary method of control

This course in particular turned into a “Masterclass” due to the high level of experience in the room - and indeed, while we expected each session to provoke and challenge beliefs held by the participants, we found the opposite. The staff were passionate professional carers, and their intuition about much questionable training they had received proved to be accurate time and again.

Our training system, designed and developed by the highly competent team at the National Federation for Personal Safety, is in every respect firmly based on clarity around UK legisative and regulatory obligations. It therefore offers staff a potentially unique level of clarity - and therefore of enablement - to act appropriately.

The physical elements of the system offer what appears to be an unparallelled flexibility to circumstances, while allowing the staff to apppropriately administer control in high-stress scenarios.

The staff team we met this week had up to now been struggling with systems of training where in particular the legal direction on restraint was erroneous, arguable or simply (although unbelievably) absent. Here are a selection of comments about the course dynamis insight delivered for them, in their own words.

“I felt that Gerard was an excellent teacher and trainer. Clearly an expert in his own field, he explained everything very well. Everything he taught was backed up with legislation - supporting evidence-based learning throughout the entire course. The most beneficial course in control and restraint I have attended in 12 years”

“I have never done a course that equalled this level - I thought the training was broken down into very easy to learn steps and the movements could be made to work in fluid scenarios. Absolutely fabulous - already recommended to other colleagues”

“Having completed numerous courses over the past 14 years I have never attended one which gave me so much factual information.”

“The trainer was fantastic at expaining everything and was extremely professional. The best course I have ever been on”

“I have been on many courses and this one gives us the legislative information as well as the techniques, so we understand the context in which we use the techniques. In turn, we feel more confident in using restraint interventions correctly”

“Very good provider whose attitude and teaching methods improved my self confidence”

We continue to offer training to a broad variety of teams, with content fitting their requirements, to help them effectively manage aggression, violence and fear in their workplace. Clarity comes as standard.