- CPD accredited Conflict Resolution Training broken down in to areas for ‘breakaway techniques’, ‘proportionate response’ and ‘restrictive interventions’.
- Specifically tailored to meet the needs of each service allowing staff to feel confident in common situations that they may face when dealing with emergency calls or routine patient contact.
- Though hard to understand the rationale behind assaults on NHS staff they do often happen and this course allows trainers to cascade vital training, allowing others to be as prepared as possible for these occasions.
- The content of these courses allows best management of serious situations, whether this be an intentional assault, supporting a potentially violent patient due to a medical condition or ensuring best care of patient can be given through restrictive techniques.
CPD Accredited Emergency Services’ Training in De-escalation and Safe Holding of Patients
Following the guidance from the Association of Ambulance Chief Executives (AACE) the training will address the following guidance.
Ambulance clinicians are obliged under the Mental Health Capacity Act (2005) and its amendments Section 6(4a) of the Act states that someone is using a safe holding technique if they;
- Use force, or threaten to use force, to secure the doing of an act which the person resists.
or - To restrict a person’s liberty of movement, whether they are resisting or not.
Therefore, there is a need for a national approach and specific ambulance training on how to manage patients that are non-compliant with standard care though require medical assistance.
Key Statements
These statements have been developed by the Ambulance Lead Paramedic group and represent a consensus view from all UK Ambulance Services.
Ambulance Services have a responsibility to ensure that they are able to provide appropriate de-escalation and safe holding techniques to patients where this is clinically indicated providing this does not compromise crew safety.
Any form of safe holding, be it psychological, mechanical or physical must allow staff to discharge their duty of care under the mental Capacity Act, the Mental Health Act, the Human Rights Act, Common law and the Health and Safety at Work Act.
Standards
Staff must have attended training in preventative and primary strategies and secondary strategies before they are taught the use of Last Resort physical interventions.
HCEST will ensure any training on Last Resort physical interventions will adhere to the following.
Protecting peoples’ fundamental human rights and promote person centred, best interest and therapeutic approaches supporting people who are distressed.
Improve the quality of life of those being restrained or those supporting them.
Reduce reliance on restrictive practices by promoting positive culture and practice that focuses on prevention de-escalation and reflective practices.
Increase understanding of the root causes of behaviour and recognition that many behaviours are the result of distress due to unmet needs.
Where required, focus on the safest and most dignified use of restrictive interventions included physical restraint.
Emergency Services 1 day course
This CPD accredited Level 1 course will include
Conflict Resolution as set out in the UK Core Skills and Training Framework.
Key Learning outcomes the learning aims and associated outcomes are based on de-escalation techniques. The aims address the way one communicates, patterns of behaviour, recognition of warning signs, impact factors and preventative strategies, At the end of the training learners should be able to:
- Describe common causes of conflict and identify the different stages of conflict.
- Learn from their own experience of conflict situations to develop strategies to reduce the opportunity for conflict in the future.
- Describe two forms of communication.
- Indicate the level of emphasis that can be placed on verbal and non- verbal communications during a conflict situation.
- Understand the impact that cultural differences may have in relation to communication.
- Identify the causes of communication breakdown and the importance of creating conditions for communication to succeed.
- Utilise three communication models that would assist in dealing with different level of conflict.
- Recognise the behavioural pattern of individuals during conflict.
- Recognise the warning and danger signals displayed by individuals during a conflict situation including the signs that may indicate the possibility of physical attack.
- Identify the procedural and environmental factors affecting conflict situations and recognise the importance in decision making.
- Understand the importance of keeping a safe distance in conflict situations.
- Summarise the methods and actions appropriate for particular conflict situations bearing in mind that no two situations are same.
- Explain the use of reasonable force as described in law and its limitations.
- Identify the range of support to those directly affected by a violent incident.
- Understand the need to provide support to those directly affected by a violent incident and the wider organisational benefits of this.
NB: It is crucial that employing organisations deliver the appropriate level of CRT to meet the needs of staff at their organisation. For example, the clinical and environmental factors affecting conflict for Ambulance services or mental health services will be different to those experienced within the in-patient setting.
Even within each type of health organisation there may be different factors coming into play such as location demographics and geography. Therefore, in addition to delivering the core learning outcomes organisations will need to make a risk assessment of the CRT needs of their staff . In some cases this may result in training with additional learning outcomes to meet and mitigate the identified risks.
Training will include low level responses to the following
- Wrist grabs
- Clothing Grabs
- Hair Pulls
- Strangulation.
- Bear Hugs
- Inappropriate grabs
Safe Holding Techniques and Last Resort management
- These techniques are provided to assist with the management of medically ill patients, most of which will be lacking mental capacity, and a best interest decision has to be made.
Post incident Analysis
- Following an incident reflection is vital to learn from what went well and what could be improved further.
Staff/Patient support following incidents - Staff and patients are all individuals and may react in different ways, following these incidents. This course looks at support measures that can be put in place to ensure that all are looked after and receive the best care possible.
Reporting recording of incidents
- Incidents of Safe Holding techniques and Last Resort management need to be recorded whether they have gone well or lessons need to be learnt. This not only protects the patient but also the staff member that has conducted these practices. Best practice for reporting and recording is covered within this course.
Cost of course – £80 per person + VAT.
Course numbers – numbers 16 staff.
CPD accredited 3 day Train the Trainers CRT Level 1
This would enable organisations to cascade the above training down to their own staff.
Interventions are specific to Emergency Services this will include.
Safely escorting a patient to the Ambulance, using a proportionate response at all times.
There will be levels of escorting holds shown, taking into account if the patient is Elderly, fragile, or a child.
The course will also cover assisting colleagues who may be getting assaulted, in the back of the vehicle, and also in the home if on a visit.
Following the Proportionate response training, there will be a major emphasis on staff / patient support following any Incidents.
Do staff have access to counselling or TRIM practitioners will be discussed, and any advice given if this is not in place.
And the Importance of reporting and recording, and the terminology used when completing the incident forms.
Cost of course – £1500 per person
Course numbers – Minimum x10 participants.
CPD accredited 3 day Train the Trainers
Staff attending this course must have completed the level 1 CRT Train the Trainers.
Following data on increasing assaults on staff, this course has been developed following feedback from over 12 years, working with Emergency Services.
The dangers of positional / postural Asphyxia are covered in detail.
Feedback from staff highlighted the risks staff may face, when attempting to administer medication to a patient in a life-threatening situation.
For example, a combative head injury, a diabetic in hypoglycaemia, or Acute behavioural disorder.
Staff will be shown various levels of safe escorting techniques (proportionate response)
All techniques have been fully Risk Assessed, and are appropriate In the Care sector.
The techniques shown will be in varying positions
- Standing.
- Sitting.
- Kneeling.
And any risks if a patient should place themselves on the floor.
(It must be emphasised if it is a violent situation, and not a medical intervention, staff will retreat to safety at all times.)
Further techniques have been developed following an increase of incidents, of patients trying to exit a moving vehicle.
Staff will follow their DORA and if safe to do so, will attempt to safely isolate the patient till assistance arrives.
Cost of course – £1500 per person
Course numbers – Minimum x10 participants.