Crisis Intervention

 
Crisis intervention is the appropriate response to a 
situation in which a THREAT OF PHYSICAL INJURY is present, 
but actual physical contact does not seem likely for some 
time, giving an opportunity for reversal or de-escalation of 
the threat.  
 
Intervention is best practiced by those who are trained and 
experienced in its use, but a brief outline is presented here 
for safety purposes.
 
General Principles of Crisis Intervention
 
1.  Self Control:  If you are not in control, it would be 
    difficult to convince someone who is being impulsive and 
    explosive to regain control.
 
2.  Identification:  Ability to identify visual and auditory 
    signals is absolutely essential. Failure to identify 
    virtually insures failure of a crisis intervention 
    attempt.
 
3.  Communication:  Minimize the use of words (rule of five 
    words/five letters per sentence) and maximize non-verbal 
    communication.
 
4.  Timing:  Crisis intervention techniques are appropriate 
    shortly  before, during, and shortly after the crisis 
    phase of the stress cycle.
 
5.  Patience:  The crisis will pass, even if crisis 
    intervention techniques are not successful.
 
6.  Spontaneity:  Although there are basic identifiable 
   causes for assault, each incident is unique and requires 
    some elaboration or modification of the basic response 
    guidelines.
 
Types of Crisis Intervention Techniques for Assaultive 
Incidents
 
1.  THREAT REDUCTION:  Useful when the probable cause of the 
    assault is fear.  The basic assumption is that 
    communication patterns that tend to reduce the perceived 
    threat will also reduce the probability that the assault 
    will escalate to battery.
 
2.  CONTROL:  Useful when the probable cause of assault is 
    frustration.  The basic assumption is that patterns of 
    communication that demonstrate control will contribute to 
    the restoration of the internal control in the frustrated 
    person.
 
3.  DETACHMENT:  Useful when the probable motive of assault 
    is manipulation.  The basic assumption is that 
    communication patterns which tend to indicate a refusal
    to become involved in being manipulated.  This will
    decrease the likelihood that the manipulative person will
    attempt to gain something through complete loss of 
    control, resulting in battery or assault and battery.
 
4.  CONSEQUATION:  Useful when the probable motive of the 
    assault is intimidation.  The basic assumption is that 
    clear communication of the consequences (or cost) of an 
    assaultive act is likely to reduce its probability.  An 
    intimidating person will escalate to battery to have 
    demands met.

 
 
General Management During the Incident
 
Violence in a patient has been identified both as an 
expression of the patient's feeling of helplessness and as a 
response to loss of control over personal territory.  Illness 
contributes to a sense of helplessness and loss of control.
 
Other conditions which may contribute to such episodes 
include: the effect of drug and alcohol abuse; the confused, 
frightened, paranoid state of the patient with organic brain 
syndrome; acute psychotic states in which the individual is 
responding to delusions and hallucinations; and, poor impulse 
control.
 
1.  BE CALM:  Anxious or angry patients can often be calmed 
    by using common courtesy and simple, friendly 
    conversation or by answering questions in a professional 
    manner.  Ignoring or avoiding the angry patient is 
    counter-productive, that is, the patient may experience 
    rejection and thus increased helplessness and a further 
    decrease in self-esteem, and become more angry.  Often 
    this anger will escalate into a state of physical 
    aggression.
 
    Never stand within reach of an angry or upset patient who 
    is unknown to you.  If there is no positive communication 
    within a few moments, it is wise to get someone who can 
    help.
 
2.  WHY PATIENTS RESORT TO VIOLENCE?  Whatever the primary 
    cause, there are four basic reasons why patients threaten 
    and injure others:
 FEAR: an irrational need to escape, defend against, or 
    eliminate a perceived threat of personal injury (the 
    patient is tense and prepared to defend, hide or run 
    away; 'fight or flight' response).
 
    FRUSTRATION: an irrational need to express frustration in 
    a physically destructive manner (the patient is tense and 
    prepared to attack).
 
 
 
    MANIPULATION: an impulsive attempt to obtain something in 
    exchange for not losing emotional control and doing 
    something dangerous (patient whines, then accuses, then 
    threatens, then assaults).
 
    INTIMIDATION: a calculated attempt to obtain something in 
    exchange for physical safety or freedom from the threat 
    of injury (patient looks neutral but speaks in a menacing 
    voice or uses threatening words).
 
3.  RESOURCES FOR DEALING WITH ASSAULTIVE BEHAVIOR: 
    Employees are reminded to use their training to protect
    themselves from blood borne diseases; the following
    information is included as a reminder:
 
    A.  Do not take unnecessary risks.
    B.  Shut off machinery.
    C.  Sound the alarm.
    D.  Do what must be done to save a life.  DO NOT touch
        blood or body fluids; DO NOT give unprotected 
        mouth-to-mouth resuscitation.

 
    E.  Wait for emergency professionals to arrive on the 
        scene.
 
After the Incident
 
Any employee who gets blood or body fluids on gloves, clothes 
or shoes, should remove clothing items as soon as possible 
and place them in a sealed bag.  Next, wash up with 
non-abrasive soap and water.  Supervisory personnel can 
explain the company policy for decontamination or disposing 
of contaminated items.
 
1.  Only employees who have received proper training should 
    clean up blood or body fluids.
 
 
 
2.  Guidelines for employees who may have been exposed to 
    blood or other potentially infectious material:
    A.  Do not panic.
    B.  Report the incident immediately to your supervisor
    C.  Try to determine the source of the blood or body 
        fluid contacted.
    D.  Follow the plan outlined in this manual regarding HBV 
        vaccination, testing, counseling and follow-up steps, 
        as appropriate.
 
Approved By Governing Board    
SP.6
Control #180.0
GUPTA GASTRO ASSOCIATES, INC.