(3) If verbal control succeeds, continue to reassure and provide orienting
information while reinforcing a "medical care image."
(a) Example--"Good. You're looking calmer. I should check your pulse
and blood pressure now."
(b) If patient accepts this, the patient is agreeing to sit still. Keep talking
and reorienting the patient while preparing to do further procedures or while awaiting
(4) If verbal control is not successful, the patient must be brought to a
horizontal position on the floor to ensure safety of both the patient and staff.
(a) Prefer a minimum of four to five attendants. There should be one
attendant to each of the patient's extremities and one to the patient's head to prevent
It is better to wait until there is enough help, unless danger demands high risk
(b) Action should be quick and decisive rather than ambivalent
(uncertain as to which approach to follow).
(c) Spectators should be cleared from the area. Spectators seldom
understand and usually misinterpret what is happening.
(d) When the patient is on the floor, a stretcher can be placed under him
and sheets or cuff restraints can be used to maintain secure control (or use double litters
in field environment). Put patient in prone position with head turned to side. Refer to
Lesson 3, Apply Restraining Devices to Patient.
(e) When the patient is on the floor, medication may be given to help the
patient regain his own control. However, it is best to wait until the cause is known since
some drugs interact with some medical illnesses to produce unwanted side effects (which
may be underlying causes of violence). If medication is used, careful follow-up is
(f) Convey an attitude that you believe the patient is a decent human
being who is struggling to control difficult thoughts and feelings.
(g) Assure the patient that no harm will come to him, nor will he be
allowed to harm anyone.
(h) Expeditious transfer of the patient should be arranged to a MTF for
workup. Transfer the patient to a psychiatric facility only if sure origin is psychiatric.