Violence in our emergency departments is an ever growing problem and healthcare workers are at increased risk as the violence moves from the streets into the medical settings. Quality patient care can only occur when patients, doctors, nurses, and visitors feel safe in medical environments and will likely result in improved staff morale and productive work environments.

“Detect, defer, protect” refers to the fact that healthcare professionals need to be able to develop strategies for creating healthcare environments that minimize environmental factors that may trigger potentially dangerous behavior from people coming into the work environment. Nurses and other healthcare professionals suffer violent attacks at four times the rate of other industry. The Mandt System refers to this as RADAR – recognize, assess, decide, act, and review the results. We spend significant time discussing the importance of being proactive, which allows us to de-escalate situations before they become dangerous. In hospital and other healthcare settings this requires evaluation by calm and prepared professionals with knowledge of a graded system of interactions – including verbal and psychological intervention, accessing security personnel, and the potential use of physical or chemical restraints (American College of Emergency Physicians, May 2011). has identified several risk factors that may contribute to increased violence in healthcare facilities. They include:

• Prevalence of handguns among patients and their family and friends;
• Lack of follow-up care for patients who have acute mental illness or chronic mental illness;
• Long waits in emergency departments that may cause increased levels of stress for patients and/or family members;
• Unrestricted movement of the public through many healthcare settings; and,
• Lack of staff training in identifying and de-escalating potentially hostile and dangerous situations.

Some things healthcare professionals might employ to de-escalate the situation include involving a family member to stay with the patient to help lower stress; use reflective listening and acknowledge the emotional responses of patients; stay calm and don’t over-react; and finally, no heroics…know your limitations. Strict policies regarding violence in healthcare organizations as well as a supported debriefing for workers may empower employees to make changes that will increase safety and decrease risks.

Here at Mandt we have developed a specific 3 hour program called ‘Emergency in the ER’, this is a class that Mandt Certified trainers are feely able to download and deliver. For more information on this please contact Kevin Mandt at [email protected]

Nikki Wince – Mandt Faculty Supervisor