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SafeClinch Training System Instructor Newsletter |
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January 4, 2010 |
Volume 1, Number 2 |
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In This Issue · Preventing Positional Asphyxiation · Positional Asphyxiation Defined · Prone Immobilization Considerations · SafeClinch Principles & Philosophy $500 per Instructor Master Instructor Certificate (Valid for three years) Training Manual Video Presentation CD’s and PowerPoint Official Safclinch T-Shirt www.safeclinch.com By going to the site and clicking on videos/photos; you can view a short demo video and click through pictures of the program.
· Preventing Positional Asphyxiation · Positional Asphyxiation Defined · Prone Immobilization Considerations · SafeClinch Principles & Philosophy
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· Preventing Positional Asphyxiation · Positional Asphyxiation Defined · Prone Immobilization Considerations · SafeClinch Principles & Philosophy
There Are Over 240 Photos in the SafeClinch Manual
· Preventing Positional Asphyxiation · Positional Asphyxiation Defined · Prone Immobilization Considerations · SafeClinch Principles & Philosophy $500 per Instructor Master Instructor Certificate (Valid for three years) Training Manual Video Presentation CD’s and PowerPoint Official Safclinch T-Shirt www.safeclinch.com By going to the site and clicking on videos/photos; you can view a short demo video and click through pictures of the program. |
We recommend that all staff authorized to use immobilization techniques be trained on the risks of positional asphyxiation and the relationship with prone restraint methods. Anytime you physically restrict a person’s movement there is a risk of injury. By seeking out the proper training you can minimize the injury risk to clients and staff involved in immobilization scenarios. For quite some time now there has been a small group of campaigners against the use of force of any kind, but in particular against the use of “prone restraints”. These campaigners do not want to allow prone restraints (restraining someone stomach/face down) by teachers, social workers, juvenile officers, mental health professionals, direct-care staff, or anyone dealing with special needs populations. An alternative to the prone restraint is the supine (face-up) position for immobilization. The supine position is not always as effective as the prone position and can require the use of more staff members to assist in the immobilization efforts. This can result in the need to hold the client for a longer period of time, which can result in staff and client injuries. Although, the SafeClinch Training System does authorize a prone hold for immediate containment purposes; staff are instructed on other physical alternatives as well. These alternatives include: escorts, body positioning, standing holds, seated holds, supine holds, and team immobilization. The SafeClinch program does not just rely on one hold to be effective. So, even if your organization does not allow for prone containment holds the SafeClinch program would continue to benefit your organization. Our goal is that staff and administrators have the ability to choose the best technique, hold, and position available to them for the situation, while using the least restrictive method possible. We must understand that the techniques we choose to use need to be reasonable and effective in order to provide a safe environment for everyone involved. Placing a “ban” on prone holding or restraint is every agency/organizations right, but there are several factors that must be looked at that have lead to the bad publicity of prone holds. Some of the cases where serious injury and/or fatalities have occurred can be directly linked to either poor program design or poor implementation of the techniques being utilized for prone holds. When a staff member feels the techniques they are authorized to use are not effective, the staff may modify the technique/hold. By modifying the techniques, because of a perceived ineffectiveness can cause a legitimate safe prone hold to become a deadly prone hold. Your training you receive should be effective and safe, so staff do not feel the need to “invent” their own unauthorized techniques. None of the holds or techniques in the SafeClinch Training System has ever been implicated in a life threatening injury and/or fatality, and this includes any use of prone holds taught in the program. POSITIONAL ASPHYXIATION DEFINED
The words “Positional Asphyxiation” often go hand and hand with the words “Prone Restraint”. According to advocacy groups against prone restraints the chances of positional asphyxiation increase dramatically when using prone holds. Positional Asphyxiation has been claimed in fatalities where prone restraint/holds have been utilized. The fatality is usually a result of a cardiac arrhythmia or respiratory arrest while being immobilized in a stomach down position. To explain what causes this without using a great deal of medical terminology; is that the body is receiving less oxygen at a time of increased oxygen needs. Cardiac arrest while being immobilized in a prone position can be the result of several factors that include the genetics of the individual. All factors have to be taken into consideration when closely reviewing case studies where a fatality or serious injury occurred from positional asphyxiation while attempting a prone hold or some variation: First, the techniques that were used in the prone restraints do not appear to be accomplished using a safe method, more than likely as a result of poor program design. In several of these studies there were too many staff involved in the restraint scenario. These staff were also applying extreme pressure and weight to the back of the clients. In addition to avoiding using extreme weight during the restraint; the staff should not use knees and/or hands to apply pressure to the middle of the clients back. So, poor holding procedures and/or training can be seen in several case studies. Second, the clients in many of the studies were considered obese by clinical terms, and when a person has extra fatty tissue it can make it harder for the lungs to expand. This is needed to produce oxygen during the restraint of any kind, but in particular a prone restraint where the person is immobilized “stomach first”, usually against a hard surface. Third, several of the clients had been injected with psychotropic medications during the restraint process. Persons with mental disorders can achieve an agitated delirious state and this can put the person at a greater risk if the body is not creating enough oxygen. Fourth, some of the individuals had enlarged hearts or other undiagnosed heart conditions. An enlarged heart can cause a cardiac arrhythmia due to the stress of the event and low oxygen levels. If these conditions existed the client could have had the same complications from everyday strenuous activity, like running. Lastly, there are other factors that can increase the chance of serious injury during a prone restraint or restraint of any kind. They range from drug/alcohol intoxication to medical conditions such as asthma. PRONE IMMOBILIZATION CONSIDERATIONS
Before considering a prone immobilization/hold we need to be aware of the dangers of such holds if done incorrectly. We suggest having medical staff present whenever possible before any restraint scenario. The medical staff are likely to have knowledge of the specific medical history of the client, and the average line staff may not have this information readily available. Furthermore, the medical staff can provide a medical expertise in the supervision of the restraint. The client can display great strength during the restraint and have a lot of endurance during the struggle. So, besides taking medical history into account before conducting a prone restraint, it is important to not apply an immense amount of pressure to the back of the client that is positioned stomach first and struggling. Selecting an effective crisis intervention program like the SafeClinch Training System is imperative. Your staff need to be properly trained in verbal de-escalation techniques, so they can intervene early on in the escalation process. Once the client reaches an escalated state of mind, it is harder to verbally de-escalate that person. We should spend more time training staff to notice precursors to aggressive behavior and offer alternatives to resolve the situation whenever possible. The SafeClinch Program emphasizes building a rapport with clients, while at the same time having staff understand and implement treatment plans created by professionals in your organization. If your current crisis intervention program does not offer a section on the dangers of prone restraints; your organization could be held liable for the injury of any clients. Even when using the prone containment methods in the SafeClinch Program you should have a staff member (preferably medical staff) present to watch for signs of distress. This staff will give instructions when a hold needs to be changed and/or the client be moved off their stomach as quickly as possible if needed. SAFECLINCH PRINCIPLES & PHILOSOPHY
The SafeClinch Program requires re-certification for refinement and safety reasons. Serious injuries during the restraint process should be the exception and not the norm. All verbal de-escalation; therapeutic holds; and crisis intervention programs are not created equal. In the SafeClinch Program we start with the least restrictive means possible and transition to more restrictive holds as needed, at no time allowing a immense amount of pressure to be applied to the clients back while the client is positioned stomach first on the ground. We also mandate that the staff member discontinues the use of any hold when the hold is no longer necessary. If the client is no longer resisting and/or struggling than the hold should be discontinued immediately.
The SafeClinch Program is designed in a way that is easy for staff to understand and retain for long periods of time. The physical techniques are practiced throughout the training sessions to ensure participants are confident in the use of the techniques, and able to transition easily between the techniques as needed. The techniques in the program do not rely on pain compliance; instead the techniques are effective by utilizing positioning and leverage to immobilize the client. All the techniques should be performed while keeping as much body weight off the client as possible. Prevention can be your greatest tool in your organizations to avoid the need for most physical restraints of any kind. When physical techniques/holds are required every effort should be made to transition and immobilize the client in a standing, seated, and/or supine position. However, it is our opinion that a healthy individual; that is not medically obese; has no illegal drugs in their body; and has no pre-existing medical conditions; can be safely immobilized in the prone position for short periods of time, when correctly using the SafeClinch Training System. Your time is important; Thanks for spending some of it with us! |
The SafeClinch newsletter is written by Alan T. Johnson, President of SafeClinch Training System; in an effort to keep our instructors and business partners updated on current events/trends in the industry. The newsletter also provides program announcements and contains information of particular newsworthy interest.
The below newsletter was devoted entirely to "Positional Asphyxiation".....In This Issue
1.) Preventing Positional Asphyxiation
2.) Positional Asphyxiation Defined
3.) Prone Immobilization Considerations
4.) SafeClinch Principles & Philosophy