By Shawn Paul & Joe Anderson
If the nation has learned anything from the Covid-19 crisis, it’s that advance planning in safety preparedness is vital to our ability to respond to emergencies, whether they’re viral, violent, or otherwise. Healthcare organizations in particular need procedures and sufficient up-to-date equipment to quickly respond to potentially confusing and fluid circumstances.
The coronavirus crisis has also illuminated the dangerous problem of workplace violence against medical caregivers, an issue that healthcare organizations now have a unique opportunity to address.
Of all professions, healthcare workers are the number one victims of workplace violence across the country. OSHA reports that 70% of claims for injuries from violence occur in a healthcare setting. Until relatively recently, many nursing veterans (and the administrators responsible for their health and well-being) considered the occasional injury caused by an act of violence in a hospital “a part of the job.” Because all medical professionals want their facilities to be seen as safe places of healing, these disturbing stories often stayed unknown.
There is movement to change this. Across the country new legislation is making battery of a caregiver a felony regardless if any injury occurred. This is similar to how assaults on law enforcement and the judiciary are treated.
Although laudable for bringing the problem into the light, we don’t need more felonies so much as we need fewer batteries. Preparations designed to deter, prevent, or stop an assault before it ever becomes a potentially injury-causing battery truly is the goal.
Healthcare workers receive little and often zero training on how to recognize and respond to violence in their workplace, but they should. Imagine instead if this training was part of their licensing curriculum prior to working in acute/hospital settings and mental health treatment locations. Discussions about planning and preparation could begin well before and segue into training in other facility policies and procedures.
For those who believe anti-violence safety preparedness should be left to “security personnel,” there are two very important reasons not to:
1) The response gap between the time when potential violence erupts and help arrives is often filled with terror and injury. Trained security cannot simply be everywhere instantly.
2) Many smaller or rural facilities have no onsite security at all. Local law enforcement is the closest help.
The April 2018 Sentinel Alert, published by the Joint Commission healthcare accreditation organization, declared that healthcare facilities must provide adequate training in response codes and anti-violence safety preparation to all healthcare workers, including but not limited to security. Few hospitals or healthcare organizations have yet taken this admonition fully to heart by establishing and integrating well thought out anti-violence safety preparedness policies, procedures, tools, and training.
Post-Covid implementation of new and better pandemic response procedures, as well as newfound public appreciation for the role caregivers play (and the risks they take), provides a perfect opportunity for healthcare organizations to address workplace violence safety preparedness head-on.
While healthcare workers should understand that suffering injury due to violence is absolutely not “part of the job,” equally important is training to understand another simple truth: “You are your own first responder.” Not security, not your panic alarm, not law enforcement – you. And every second counts. Seconds count in the case of an active shooter, for example, because one person is shot every 15 seconds on average in such an incident (more in any given burst). Medical workers need to know how to react immediately to the threat of violence, regardless of its source.
Healthcare workers should receive at least annual training in verbal and non-verbal de-escalation techniques, reasonable physical intervention methods, and the basics of “Run/Hide/Fight” and how it may or may not apply to a caregiver with a duty of care to her patients. Because of this special duty, however, caregivers (and security alike) should also have access to and training in defensive tools that offer compassionate controlling force.
In the past, this was called planned improvisation and you were taught using improvised weapons. This type of instruction, ironically, itself often led to unnecessary trauma or injury. The best practice today is “low impact, no scare tactics” training using modern defensive chemical formulations specially designed for use inside sensitive environments (i.e. not pepper sprays), accompanied by fast-acting decontamination solutions.
Training in the use of and access to such tools is also not just for security, but should support registration clerks, orderlies, and bedside caregivers alike. Everyone should be trained to act as his or her own first responder – the “response gap” allows no time to wait for help.
Another simple thing is training to protect ones’ personal space and reactionary distance. According to industry-standard MOAB training, the brain takes 1.5 seconds to recognize a threat, form a response, and physically respond. That’s why caregivers need to step back a minimum of four feet so an aggressive person can’t touch them and they have the ability to deflect and move if the assailant throws something or advances in a threatening manner.
Interestingly, this last point ties in directly to lessons learned from Covid-19. Healthcare workers are trained to move toward emergency situations. Over the past weeks, many nurses have had to relearn this training, remaining mindful to stop and first put on PPE before entering a Covid-19 patient’s room to protect themselves and their colleagues from infection. Likewise, in case of potential violence, caregivers require training in the counter-intuitive need to stop, back up, and create space so they can physically respond to the situation, including accessing and deploying a compassionate and controlling tool if necessary.
While so many communities are on lockdown, healthcare facilities have a unique opportunity to start implementing much needed policies, procedures, and training in the use of modern best practice anti-violence safety preparedness solutions, alongside the newly apparent need for focused pandemic response solutions. Post-Covid attention to physical design or redesign of spaces, including barriers, escape routes, and visitor management systems should be on the agenda to protect caregivers as well.
Safety preparedness is always something easily left for another time. The lessons of Covid-19, however, make clear that the only good time to prepare for an emergency in the future is today.
Shawn Paul is the Director of Enterprise Physical Security,
Safety & Emergency Mgmt. Risk & Integrity Services at
Providence St. Joseph’s Healthcare
Joe Anderson is the CEO of Reflex Protect®,
maker of America’s only “hospital safe”
compassionate active defense solution
As described in heartbreaking detail in Pulitzer Prize-winning journalist Raquel Rutledge recently issued exposé in the Milwaukee Journal Sentinel, the direct cost to a healthcare organization when responding to the death or injury of an employee from violence is often substantial. In addition to payment of workers’ compensation claims, liability claims for failure to provide a safe workplace for employees or even the general public frequently present (at least pre-Covid-19) in a medical facility are..