PHYSICAL INTERVENTION

UNIT 1 - PHYSICAL INTERVENTIONS AND THE IMPLICATIONS OF THEIR USE

Legal implications of using physical intervention:

Physical intervention should only be considered as a last resort when all other de-escalation strategies have been exhausted. Using physical intervention as a last resort helps minimise the likelihood of harm and demonstrates a commitment to resolving conflicts through conflict management.

Use of force and the law:

• Criminal Law Act 1967, Sec. 3: This act gives everyone, including door supervisors, the authority to use ‘such force as is reasonable in the circumstances in the prevention of crime, or in effecting (or assisting in) the lawful arrest of offenders, suspected offenders or persons unlawfully at large’.
• Common Law, Self Defence: The rules of self-defence: ‘if any person has an honestly held belief that he/she or another is in imminent danger, then he/she may use such force as is reasonable and necessary to avert that danger’.
• Trespass: The law says ‘no more force is used than is necessary to remove the trespasser from the premises.
• Breach of the peace: “any disorder or disruption to the peace, in public or in private that results in violence, threat of violence or provokes violence from another”, ‘any person may use such force as is reasonable in the circumstances to prevent a breach of the peace or to save a life’.
• Health and Safety at Work Act 1974: You must take reasonable care of your own health and safety while ensuring that your actions or inactions do not negatively impact the health and safety of others.
• Employment Rights Act 1996: Section 44 of the Act protects employees from being disciplined or dismissed if they leave their place of work because they think they are under serious threat of attack. It also allows them to take appropriate measures to protect themselves and others from danger.

Duty of care:  When employing physical intervention, individuals have a duty of care to ensure the safety and well-being of all parties involved.

Principle of non-pain compliance and application: The principle of non-pain compliance emphasises the use of techniques that control individuals' behaviour without causing unnecessary pain or harm.

Professional implications of using physical intervention

• Sector-specific legislation: Healthcare, education and social care sectors may have regulations outlining when and how physical intervention can be used.
• Professional guidance and standards: Professionals working in various sectors are often guided by industry-specific standards and guidelines regarding the use of physical intervention. These standards may vary depending on the context but are typically based on common principles such as proportionality, necessity, and minimising harm.
• Ethical implications: Such as respect for dignity, and human rights.
• Financial implications: Related to training, equipment, insurance, and potential legal expenses.

Last resort: Physical intervention should always be considered as a last resort after all other de-escalation techniques have failed or are likely to fail.

Positive alternatives to physical intervention

 Primary controls:

·       Following employer safety and security policies, procedures, and working practices

·       Use of safety and security equipment and technology

 Secondary controls:

·       Positive and effective interpersonal communication

·       Knowledge and skills of conflict management

Defensive physical skills vs physical intervention skills

Defensive physical skills:

Defensive physical skills are techniques and strategies used to protect oneself from assault or physical harm. These skills are typically focused on self-defence and are intended to help individuals defend themselves from getting into problems in the first place

Defensive physical skills enable you to:

• Recognise danger
• Avoid it
• Manage it
• React to it safely

Usually involving no use of force.

Defensive physical skills include:

• Dynamic risk assessments
• Calling for support
• Your positioning
• Your stance
• Your communication skills

Physical interventions:

Physical interventions involve the use of direct or indirect force, through bodily, physical, or mechanical means, to limit another person's movement or behaviour. These interventions are typically used in situations where there is a risk of harm to oneself or others, or to maintain safety and order.

Physical intervention skills enable you to:

• Protect yourself
• Protect others
• Escort people away from incidents

Using low levels of force

Physical intervention skills include:

• Guides
• Blocks and deflections
• Escorting holds
• Restraints

UNIT 2 - RISKS ASSOCIATED WITH USING PHYSICAL INTERVENTION

Risk factors with using physical intervention:

The use of physical intervention carries inherent risks and requires careful consideration of various factors to minimise potential harm to all individuals involved.

Nature of the restraint:

• Method of restraint: Certain restrictive holds or techniques used in physical intervention may increase the risk of falls or injuries to the individual being restrained.
• Position held: The positioning of the individual during restraint can impact their breathing, circulation, and overall comfort.
• Duration of restraint: Prolonged periods of restraint can increase the risk of physical and psychological harm to the individual.

Situational factors:

• Setting and location constraints and risks
• Environmental hazards
• Staff numbers
• Availability of help
• Threats presented by others

Individual factors:

• Age
• Height
• Weight
• Physical state
• Mental health

Vulnerable groups:

• Children and young people
• Older adults
• Individuals with mental health issues

Staff working with vulnerable individuals should receive additional training in the use of physical intervention to ensure the safety and well-being of both themselves and the individuals they are supporting.

Acute Behavioural Disturbance (ABD) and Psychosis

ABD and psychosis are medical emergencies that can present significant challenges and risks, particularly in situations where individuals may exhibit unpredictable or dangerous behaviours.

Acute Behavioural Disturbance (ABD):  also previously called excited delirium

ABD is a combination of physical and psychological factors that can manifest to severe behavioural changes.

ABD can be caused by head injuries, tumours, high temperature or heat exhaustion and because of anti-psychotic drug abuse, if not treated quickly the subject can die of cardiac arrest.

Signs and symptoms of ABD may include: (H.I.V.E.)

• Hot to touch
• Insensitivity to pain
• Vomiting
• Excessive strength

Also: Bizarre or erratic behaviour, Sustained mental and physical exhaustion, Extreme agitation, Paranoia.

Psychosis:

Psychosis is a mental health condition that can result from underlying mental illness or drug-induced factors and should be treated as a medical emergency.

Signs and symptoms of psychosis may include: (H.E.P.)

• Hallucinations
• Extreme fear as part of delusional beliefs
• Paranoia

De-escalation techniques, such as verbal and non-verbal communication, distraction, and calming techniques, can be effective in managing individuals experiencing ABD or psychosis.

Positional asphyxia

Positional asphyxia is a serious and potentially fatal risk associated with restraint techniques that compromise an individual's ability to breathe, preventing the ribcage from being able to move in and out and therefore prevents the diaphragm from raising up and down.

Restraints involving forceful positions compromising breathing and circulation:

• Individuals held forcefully face down or face up on the ground or any other surface, such as a bed, may experience restricted breathing and circulation,
• Seated positions, where the individual is bent forward, can also impede breathing and circulation,
• Standing positions that compromise breathing and circulation, such as being forced to bend over or pressed against a wall or object,

Key risk factors:

• Method of restraint: Forceful restraints that involve pressure on the torso, especially during ground restraints, pose a significant risk of positional asphyxia. The techniques used during restraint can either increase or decrease the risk
• Position: Restraining individuals face up or face down on the ground or other surfaces, as well as seated or standing positions that compromise breathing and circulation, are particularly risky
• Duration: Prolonged periods of being held in positions that increase the risk of positional asphyxia can lead to oxygen deprivation and potential harm, including death

Risks of harm and fatality:

• Many individuals have died as a result of positional asphyxia during forceful restraint in the UK, while others have survived but suffered permanent brain damage due to oxygen deprivation.
• Positional asphyxia is a serious concern during forceful restraints, and restraints that carry a heightened risk of positional asphyxia should be avoided to prevent serious harm or fatalities.

Prolonged physical interventions

Prolonged physical interventions, especially those involving forceful restraint, pose specific risks and potential complications that increase with the duration of the intervention.

The longer the duration of the restraint, the greater risk of complications.

Risks of prolonged physical intervention:

• Increased risk of physical harm
• Risk of positional asphyxia
• Greater the chance of others getting involved
• Fatigue to both subject and staff

UNIT 3 - REDUCING THE RISKS ASSOCIATED WITH PHYSICAL INTERVENTION

Risks of physical interventions on the ground:

Dealing with physical intervention incidents on the ground presents specific risks that can have serious consequences for both individuals being restrained, and staff members involved. Going to ground should be avoided if at all possible and only used as a very last resort when all other options have been exhausted.

Risks:

• Restraint-related deaths
• Impact with the floor and/or objects
• Injury from glass or debris on the ground
• ·Vulnerable to assault from others

Dealing with physical interventions on the ground

• Avoid going to ground, only using it as a last resort
• Try to get the individual up or to a comfortable seated or recovery position as quickly as possible
• Monitor the individual and ensure they can breathe without difficulty
• Designate a team leader and maintain communication
• Position a colleague close to the subject's head for monitoring
• De-escalate force and respond to signs of concern or medical emergency

Reducing the risk of harm:

• Choose the least forceful intervention practicable
• Avoid high-risk positions, including ground restraints
• Avoid high-risk methods of restraint
• Maintain ongoing communication
• Monitor the well-being of the subject
• Work as a team and designate a team leader
• Follow established procedures
• De-escalate at the earliest opportunity
• Provide immediate assistance

Dynamic risk assessments with physical intervention:

“The continuous assessment of risk in the rapidly changing circumstances in the workplace or during an incident, in order to implement the control measures necessary to improve safety.”

• Assess threat and risks of assault
• Evaluate options and inform decision-making
• Identify when assistance is needed
• Continuously monitor for changes in risks
• Inform decision to de-escalate or withdraw

Managing and monitoring safety during physical intervention:

Observation and risk assessment:

• Fully observe and assess the situational and individual risk factors involved in the physical intervention.
• Ensure that nothing impedes the individual's ability to breathe or their circulation (ABC).

Actions to take:

• If the person is unconscious but breathing and does not have other life-threatening conditions, place them in the recovery position to maintain an open airway and prevent aspiration.
• Initiate CPR or use a defibrillator only when a person shows no signs of life, is unconscious, unresponsive, and not breathing normally. Respond promptly in cases of cardiac arrest.
• If the person is breathing and conscious, communicate with them, listen to their concerns, and take their statements seriously, especially if they mention struggling to breathe or experiencing distress.

Watch for 'red flags' indicating potential medical emergencies or distress:

• Effort or difficulty breathing
• Airway obstruction
• Passivity or reduced consciousness
• Non-responsiveness

De-escalation techniques:

• Employ de-escalation techniques, such as calming and distraction strategies, to defuse tense situations and reduce the risk of escalation during physical interventions.

Emergency response:

• If a medical emergency is suspected or if the individual's condition deteriorates, release them immediately from the restraint and call for first aid or emergency medical services.
• Provide emergency services with a detailed briefing that includes relevant information about the individual, any known medical conditions, and details of the restraint used, including the method and duration.

Responsibilities during physical intervention:

During a physical intervention, all staff members involved have specific responsibilities to ensure the safety and well-being of all individuals present these include:

• Duty of care to the subject at all times
• Duty of care to colleagues
• Respecting the dignity of the subject
• Providing appropriate care for injured or at-risk individuals
• Challenging unnecessary and excessive use of force

 Supporting colleagues:

• Switch roles within the team if needed
• Monitor the safety of staff members and the subject throughout
• Manage the immediate area, contain the situation, and handle bystanders
• Monitor the overall situation and communicate with other staff members or emergency services

Responsibilities after physical intervention:

After a physical intervention has taken place, there are critical responsibilities that must be fulfilled to ensure the safety, well-being, and proper documentation of the incident.

• Duty of care to the subject at all times
• Duty of care to colleagues and support services
• Providing appropriate care for anyone at risk or injured
• Briefing emergency services
• Preserving evidence and securing witness testimony
• Completing a full report

Importance of keeping PI skills up to date:

Maintaining knowledge and skills is important because:

• Legislation and best practice guidance can change
• Proficiency in physical skills will decrease over time, potentially reducing effectiveness of interventions and increasing risks