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Alex.M's picture
Self Protection in a Care/Professional environment

Hi! Longtime reader and listener of podcasts, first-time poster. I was wondering, is there any good advice or methods for self protection in an environment that does not allow harming ones "opponent"? I work in an environment where things can get quite troublesome (ie physically aggressive) but because it is in the workplace and the aggressive parties are my clients or patients (not sure what the proper english term is).

I don't want to use harmful methods such as strikes and cranks and similar (and whatever else is available under the sun that might cause serious injury), what I need is to be in control of a situation - or control it such that I can get away to a safe place.

As I understand it, many of the topics are geared towards civilian self protection, but I was wondering if there is any advice that can be given in regards to protection in a care environment? Keep in mind that the parties that I may have to subdue or control are the very same that are in my care and they need to be able to trust me even after an incident has occurred.

Since I do need, for the privacy of the involved parties, to be circumspect I can't really describe my workplace any closer than "Imagine a personal assistance-like job but with clients that may or may not have violent tendencies sporadically". Thanks in advance for any and all advice and thoughts!

Wastelander's picture
I used to train with a woman who worked in a care facility for patients with dementia, and had to use her training exactly as you describe. The problem is that you can't really use pain compliance, which takes away a lot of the techniques for immobilization that are present in karate. She used her cross-training in judo to her benefit--blocking strikes and controlling her patients limbs to prevent them from harming her came from karate, and from there she would move in to sweep them (gently) and then pin them until her team could arrive. A good, solid pin will keep an untrained person on the ground pretty effectively without hurting them for a good while.
Alex.M's picture

Combining her judo experience with Karate sounds very reasonable to my mind. I used to train judo and found it's excellent even in it's non-direct applications like staying on your feet, understanding what it takes to keep balance and unbalance others, balance through movement and so forth. I think the single most important aspect I've gotten from Judo is to stay balanced and comfortable within a short range. Unfortunately I don't practice Judo atm (though I plan on starting it up this coming fall) and it really got me wondering if Karate in particular had methods that do not require pain compliance.

This certainly reaffirms my conviction to add Judo to my Karate training, so thank you for that.

Tau's picture

I suspect that I'm the most qualified person on this board to answer this specific question which with the expertise and years of training available is saying something. For those that don't know me and for the person asking this question, my simple credantials are

- Martial Arts Instructor

- Emergency Nurse Practitioner. In this capacity I am "front-line" NHS staff and am the senior Nurse on duty every time I work a night shift

Aside from various Martial Arts that I've studied I've also invested quite a bit of time and money into NFPS who provide courses in conflict management, restraint, breakaway and so on to professional bodies including the NHS. My grand plan for some point in the future is to combine my roles and teach these subjects to my trust.

There isn't an easy answer. The way that I personally look at it is a hierarchy to whom I, as a registered health professional, am anwerable to. It looks like this

Top - The Law of the Land

Middle - The registering professional body

Bottom - The organisation that employs me

I'll revisit this hierarchy later. First you must cut through the rubbish out there and this is where the BCA (via Iain here) and NFPS are excellent resources. I appologise if I'm giving you information that you're already well versed in but you might find it helpful or if not you then someone else. I will add that I've been intending to put this on paper for a long time so I'm gaining from typing this out too, especially on a forum where I can be endorsed or challenged.

Be familiar with the law. Not only things like the 1967 Criminal Law Act but also the Human Rights Act. This is important as there are a LOT of myths out there are often employers seem to either deliberately or accidently promote those myths. There is no LAW anywhere that says you can't hit a client should such an act be reasonable and necessary. Indeed, should you fail to prevent a client from seriously harming another person by not being willing to use the necessary level of force then you may find yourself in breach of the law! It's not easy.

With this in mind let's return to my hierarchy. Bear in mind that I do work with clients that may be drunk, on drugs (meow meow is horrible substance that makes it's users highly unpredictable,) agitated, innocent victims of assault, delerious, hypergycaemic, learning disabled and so on. I don't have the choice about entering their home or not, they come to me! Now, I may act in accordance with the law of the land BUT my employer or registering body may feel that I haven't acted in accordance with my contract of employment or code of professional conduct. There's a reason that I pay to be a member of a union! Let's create a hypothetical situation where someone becomes highly aggressive without any medical reason behind it and they then attempt (or succeed) in assaulting me. I can have colleagues call 999 but until the police arrive it's down to me to sort. Really. I act using a level of force that is necessary and appropriate in defence myself or other patients but in doing so, I am forced to render my assailant unconcious. To use a colloquialism, I "knock the fucker out." The local newspaper headlines the following day: "Nurse knocks out patient." I strongly suspect that whatever my legal standing I'll find myself suspended pending investigation.

I'll try to get back to answering your question directly. First and foremost I feel that it is actually impossible to teach a comprehensive and safe system of self defence / breakaway that doesn't at some point involve some degree of harm being bestowed upon your attacker. I would hastily add you should remove the term "opponent." I completely understand that there's a massive realm of difference between an elderly person who's dementia manifests in physical violnece and a drunk geezer that wants a fight.

Your employer has a legal duty to risk assess the environment, the staff and the clients and act upon the results of the risk assessment to minimise risk. Someone feel free to correct me, but 1978 Health and Safety at Work Act? This may involve ensuring you have adequate staffing levels, approrpriate training e.g. conflict management and other appropriate security measures e.g. panic alarms. Any training that you are given must be "fit for purpose." Your organisation must have policies in place and must acknowledge various aspect of law as part of this.

For you, the techniques that you are seeking are primarily (although I must emphasise not exclusively) "breakaway." You need to understand how to preceive and prevent a problem arrising, how to maximise your chances of diffusing that problem and then the appropriate techniques which will initially focus on disengagement such as releasing hair grabs, clothing grabs and so on. I'm not sure that there's any one best art to give you this but training certainly is out there.

I hope all of this help and that I haven't been at all condescending. Please jump in with any questions and indeed anyone else please speak up with any inaccuracies here.

Tau's picture

Addendum, re-reading your initial post, you used the word "fall" rather than "Autumn" so I suspect you're not from England? In that case, all the law that I've stated doesn't apply and you need to get familiar with your own nation and state equivalent laws.

Alex.M's picture

Thank you for the good advice. You're right in suspecting I'm not from England, but I feel you raise valid and important points about hierarchy and safety policies. Part of the problem in my workplace is that while we have policies in place (such as staff levels, "escape plans", and such) they are not always carried out to the letter (in some situations barely to the spirit of the letter). I've started to re-read the laws on self-protection in my country, and I intend to re-read them a couple of more times so I can better understand my responsiblities and rights. Also, I do regret using the term opponent in my original post because that is not the case. I was, very inaccurately trying to convey the fact that I'm in a workplace where the people I care for can indeed lose control to such a degree that it sometimes is appropriate to call what has taken place a "psychosis" - I do not use this term lightly at all, and I've been "there" often enough to know such terms should never be used lightly. Also, for what it's worth, the people I care for are usually in a "non-senior" age range, which affects the levels of physical force some people dish out (that is, young people are very strong).

When it comes to training in the workplace (ie having a professional demonstrating and teaching proper break away techniques and defense to the staff) it is actively discouraged. It's the "unwritten law" and opinion from higher up that staff that can defend itself will behave violently against their patients. I personally disagree of course, and the effect this has on escape and defense policies and plans (and the discussions thereof in particular) is that they're limited to something along the lines of "If something happens, just run away to safety". True, you have to get away, but how?

jimlukelkc's picture

I work with people of all age groups who have severe learning disabilities in the UK . Uk law states you cannot consent to be assaulted, however employers will often put you in situations where assault is likely with the expectation that you will divert, distract or in some other way deal with challenging behaviors without recourse to any degree of force. This is not always possible and restraint techniques are necessary for many reasons.  Sef-protection, protection of the subject, prevention of environmental damage and harm to colleagues and other services users. 

Overtly aggressive responses can ruin rapport and breach trust. It is a minefield.  Disengagement should be top of your list of techniques,  then takedowns and pins, although restraints really should be employed as part of a team strategy as they are very tiring attempted solo.

I agree that judo/jujitsu is probably a good starti g point however they need adaptation as it is not acceptable to apply pressure to the neck, or compress the chest.

Good luck, it is a subject fraught with difficulty. 

Andrew Carr-Locke
Andrew Carr-Locke's picture

Hello, I'm from Canada and specifically Ontario so my knowledge is based on law there. I am a long time karate practitioner, and have had experience in BJJ as well. I work in Physical Security, and as such we are constantly in a position where we must take care of our 'opponents'. I have had experience with the kind of techniques you are looking for, simple and effective non-harmful control tactics for use in a care facility or hospital environment. We are using the Care-Welfare-Safety-Security model, and the Canadian Use of Force wheel ending with non-lethal responses. The techniques you use must be effective in control (not pain-compliance), and ethical is application. Pay particular attention to positional asphyxia and excited delirium as these are the 2 most common areas overlooked by some physical systems I have seen in place. The system I use is called "Assess Plan Act" and it comes easily from a karate background, as the techniques are not that dissimilar to some concepts in the Heain Kata series.

Feel free to PM me for further info.