The AACE Violence Prevention and Reduction Hub and Dr Tony Bleetman, who are leading on the development of a bespoke national restrictive intervention training programme to increase both staff and patient safety, discuss why staff engagement and feedback is crucial to its effectiveness and success.
Providing care and treatment in a diverse range of incidents for people who are often at their most vulnerable and in crisis shouldn’t evoke concerns for personal safety in staff.
However, data gathered for the AACE #WorkWithoutFear campaign shows a concerning 58% increase in violence and aggression directed towards operational staff in English trusts from patients and members of the public in the past five years. Some of these behaviours are undoubtedly caused or exacerbated by a person’s clinical presentation or situation, although some could be categorised as unwarranted or criminal.
In addition to verbal abuse and being spat at, physical injuries received by staff include facial fractures, stab wounds, bruising and soft tissue damage, with the AACE #WorkWithoutFear campaign also highlighting the profound personal and emotional impact this has on the staff members concerned.
The AACE National Ambulance Violence Prevention and Reduction Hub is committed to equipping staff with the skillset required to deal with the rising tide of violence they face.
Adam Hopper, Operational Lead for the AACE Violence Prevention and Reduction Hub explains:
The sector needs a completely unique training programme that provides the right skills at the right level to reduce the risks faced by our operational staff. This needs to be based on evidence and best practice to extensively meet the needs and increase the safety of both our staff and patients.
Having secured funding from NHS England, we are working collaboratively with subject matter experts ‘Maybo’ in developing this to equip our staff with a suite of skills and strategies to respond to the dynamic, wide ranging and unpredictable risks of distressed, aggressive and violent behaviours, which they face on a daily basis. This will enable staff to safely facilitate immediate and necessary clinical interventions and safeguard patients who lack capacity.
In developing a sector-specific training programme for the ambulance service, work commenced in January 2023 following wide stakeholder engagement. A review of the existing training provision throughout the entire UK and a national training risks and needs analysis is currently underway. However, what will truly make this training programme relevant and valuable is understanding the perspectives and needs of operational staff who are often already working in challenging environments. Says Adam:
We would encourage all staff to complete the forthcoming online survey and if able, join the planned focus groups facilitated by our subject matter experts. We want to understand staff experiences to inform the development of the programme and ensure its effectiveness.
Steering groups with wide sector representation are working to develop the training programme which will see the creation of national policy and guidance. This will promote and reinforce the rights of staff when faced with potentially risky or challenging situations and will be supported by a range of easily accessible resources and aide memoires.
There will be an in-depth clinical focus to explore necessary and proportionate skills and strategies to ensure staff can safely manage reversible and clinical causes of agitation and aggression. An underpinning human rights approach will safeguard patients and others who may be potentially vulnerable.
Working on the initiative as part of the Maybo team is Dr Tony Bleetman, who has extensive experience as a consultant in emergency medicine, a pre-hospital and former HEMS Doctor and expert in the use of force in healthcare. He explains:
Aggression and violence has always been a part of pre-hospital work. As a young pre-hospital doctor, experienced ambulance staff showed me how to restrain a patient on a trolley with a sheet and securing straps, explaining to me that they weren’t allowed to formally restrain patients but had learned to improvise in a worryingly common situation.
From his experience, he reflects many patients can pose a risk to staff and others, not because they are bad people but because they are ill, frightened or in pain and there are many medical or clinical conditions which can cause a patient to lash out or pull out a line. Says Tony:
An integral part of developing this welcomed national initiative will be to encourage ambulance staff to consider and look for reversible causes of behaviour that can be challenging. It is very exciting to support the ambulance service in compiling this programme of interventions which is truly driven by what staff need. How do we know that? Because the content of the training for staff will be driven by staff reporting and experience of the risks they face, not what a trainer thinks they face.
Once the sector’s requirements are better known and understood, Maybo will create a programme including practical skills and scenarios which, when combined with current conflict resolution training provided in trusts, will provide safe and effective strategies for the situations that staff encounter.
If you would like to learn more about this initiative, please contact Adam Hopper (adam.hopper@aace.org.uk) or Clare Barnham (clare.barnham@aace.org.uk) from the National Ambulance Violence Prevention and Reduction Hub.
