b. Medial Care Image. If verbal control is successful (the violent patient has
calmed down), continue to reassure the patient and provide orienting information.
Reinforce the "medical care image." For example, the patient on the rifle range in the
first paragraph of this lesson could be told, "Good. You are looking calmer. I should
check your pulse and blood pressure now." If the patient accepts this, he is agreeing to
sit still and talk while you prepare for the next step.
c. Restrain the Patient. If you cannot control the patient verbally, he must be
brought to a horizontal position on the floor or ground to ensure his safety and the
safety of any other people in the area. To do this, you should have a minimum of four to
five people. If you do not have this number of people to help, wait until you do have the
number unless the patient is so dangerous that something must be done at once.
When you have decided to take action, do so quickly and decisively. When the patient
is on the floor, place a stretcher under him. Use sheets or cuff restraints to maintain
secure control. If necessary, give medication to help the patient maintain his own
control. It is best to give no medication until the cause of the violent behavior can be
determined because some drugs interact badly with some illnesses. If you must
administer medication, a careful follow-up is necessary. Convey the attitude that you
believe the patient is a decent human being who is struggling to control difficult thoughts
and feelings. Assure the patient that no harm will come to him nor will he be allowed to
harm anyone. An expeditious transfer should be arranged for the patient to a medical
treatment facility for evaluation.
MANAGEMENT OF THE ARMED, VIOLENT PATIENT
An armed, violent patient can be managed if certain measures are taken. Follow
a. Leave the area quickly, if possible.
b. Warn all personnel to clear the area and notify the authorities.
c. If you are unable to leave, keep talking and allow no long silences to develop.
Try saying things such as, "You can do a lot of harm if you want to, even without a gun."
or "You look frightened, and I feel frightened." You can also say, "I'd like to help you,
but I'm concerned that you might do something with that gun you can't take back. Could
you please put it down, or let me hold it for you until we can finish talking about what is
troubling you?" Make no abrupt movements. If the subject will not give up his weapon,
he may at least be willing to put it into his pocket or into a nearby desk drawer. It is
important to offer him free access to the exit. This could be achieved by asking if he
would feel better leaving the room or staying. Stand away from doors to keep the
patient from feeling trapped and cornered. The patient's behavior may depend on your
position and your reaction. If the patient leaves the room, alert all personnel and the