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
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
3. Communication: Minimize the use of words (rule of five
words/five letters per sentence) and maximize non-verbal
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
Types of Crisis Intervention Techniques for Assaultive
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
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
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
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
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
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
E. Wait for emergency professionals to arrive on the
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
D. Follow the plan outlined in this manual regarding HBV
vaccination, testing, counseling and follow-up steps,
Approved By Governing Board
GUPTA GASTRO ASSOCIATES, INC.