Personal Safety &

Aggression Management
Course
PSAM Provider Course 2013

PSAM Instructor Course 2014

 Break away & Blocking Technique
Course Objectives:

1. Explain the importance of Breakaway and

Blocking technique as a personal safety
measures.
2. Explain the importance of Personal Safety in
managing violence and aggression.
3. Simulate practical exercises in breakaway &
Blocking technique as part of personal safety.
Goal

► The main goal in executing the

techniques toward an aggressive
patient is to provide safety to
self, patient and others.
 Ethical & Safety Considerations

► Be aware of your environment at all times.

eg. Location and opening of doors should
always be considered, presence of safety
hazards, other patients etc.

► Control and Restraints should be

conducted after communicating with the
patient (De-escalation technique).
Ethical & Safety Considerations Cont’d
► While de-escalating a patient, you must be in a
non-threatening, non-challenging posture.

► Safe distance from patient: Position your self

“one leg-length” away, on an angle and off to
the side of the other patient.

► Stay far enough so that the other patient cannot

hit, kick or grab you.

► Never approach an aggressive patient alone

for the purpose of restraint and seclusion.
Ethical & Safety Considerations Cont’d

► All physical interventions carry a level

of risk and hence should be a last
resort.

► Never place pressure on or around

the back, chest, stomach, face,
neck, shoulder and major joints or
the fingers.
Ethical & Safety Considerations Cont’d

► Prone restraint (Face down) if possible

should be avoided, and when someone
is in prone, He should be moved to a
sitting, kneeling or supine (face up)
within 3 minutes or let go.
To prevent Positional Asphyxia
Ethical & Safety Considerations Cont’d

► Use the element of surprise in the

execution of the breakaway techniques.

► Change your breakaway techniques from

time to time and according to the
situation to prevent familiarity of the
techniques by the patient.
Ethical & Safety Considerations Cont’d
► Avoid covering patient’s face with any
materials such as blanket, pillow, etc.
which could hinder breathing.

► After the restraint has taken place, staff must

make a judgment whether a medical
examination, or action may be required.

► A doctor/licensed practitioner must conduct

an in-person evaluation within 1 hour of the
beginning of restraint/seclusion
Ethical & Safety Considerations Cont’d

► All episodes of restraint and Seclusion must be for the

shortest possible time and applied in a humane and
therapeutic manner.

► All orders for Seclusion & Restraints must be time

limited and should not exceed:
► 4 hours for Adult (18 years & older)
► 2 hours for Children & Adolescent (9 to 17 yrs. old)
► 1 hour for children younger than age 9
(The Joint Commission, 2015)
Ethical & Safety Considerations Cont’d

► Restraint & Seclusion should never

be applied as a means of :
► Coercion
► Discipline
► Convenience
► Retaliation by staff
 Workplace Violence Guideline
Al Masarra Hospiatl

Work place Violence

Guideline
Workplace Violence (WPV): is the behavior of a person toward an
employee accompanied by threats, insults, or the risk of physical
abuse or injury.

Procedure to deal with WPV:

1. The assaulted staff informs the Public Relations and Patient Services
Department immediately after the attack.
2. The Public Relations and Patient Services Department Immediately go to
the site of the attack accompanied by security (if necessary).
3. The Public Relations and Patient Services staff will notify the parties of the
dispute to attend The Public Relations and Patient Services Department.
4. The Public Relations and Patient Services Department will inform Oman
Royal Police if there is physical injury.
5. The Public Relations and Patient Services staff tries reconciliation between
the parties if possible.
6. The Public Relations and Patient Services staff will notify the assaulted
staff to fill the Processing Staff Complaints.
7. The Complaints will be taken to the Hospital Director for his comment.
8. Then The Complaints will be taken to Public Persecution according to
article No. (171, 172, 173) of Oman Revised Penal Code
9. The Public Relations and Patient Services Department will follow the case
at Public Persecution.
10. If the case taken to the concerned court the hospital will contact
Directorate General of legal affairs.
11. If the staff waiver of his right to complain he/she need to inform the Public
Relations and Patient Services Department and submit a copy of his
statement.
Workplace Violence Guideline
Al Masarra Hospiatl
 Open Palm Posture

Keep palms open and widen your stance.

Keeping palms open would indicate a non-threatening

behaviour and wider stance keeps balance.
 Cup the Chin Protective Posture
Cup the Chin – Keep one foot
forward while cupping the chin Protective posture – keep both
with one hand. arm in front with palms open.
This would indicate that you are
ready to listen to the patient as you This posture indicates a
are doing your de-escalation non-threatening gesture.
technique. If de-escalation does not
work, you can easily position to
protective posture.
Breakaway
Techniques
 SCOOPING HANDS INWARD
ROTATION
Once the patient grabs both of you
hand, Position yourself one foot
forward or back. Cup both hands
facing you, and scoop quickly
towards you. Then proceed to
protective posture or
UP THROUGH THE MIDDLE
Note: this is applicable if you are
grabbed on a/both wrists and upper
arm.
Position your self one foot forward, and
turn both hands creating a circle
towards the middle. Push both/the
hand away and proceed to protective
posture.
 PEEL AWAY INWARD ROTATION
TWO HANDED STRANGLE, PEEL
AWAY
Note: This is applicable if you are grabbed with one hand or two,
upper hand grab and choked
Position yourself, and grab the patient’s side of the palm and wrist
with one hand. Twist the hand forcing the patient to turn his/her
back. Push the patient a little and proceed to protective posture.
INWARD ROTATION, PUSH AWAY (One/two Hand)
SINGLE /TWO HAND STRANGLE UNDERNEATH THE ARM INWARD
UNDERNEATH THE ARM INWARD ROTATION
ROTATION
RELEASE FROM HANDSHAKE
Note: This is applicable if you
are grabbed on hand, during
handshake
SINGLE HAND STRUNGLE
THUMB RELEASE METHOD
Note: Can Cause discomfort and/
or pain
Thumb Release Method

Note: This is applicable if you are grabbed on the wrist, cloth, hair, lahaf,
or during handshake
Position yourself one foot forward, locate the thumb and push the thumb
towards the patient. (Pushing towards will be according to the anatomical
position of the thumb thus preventing fracture of the patient.
SINGLE HAND STRUNGLE THUMB RELEASE METHOD
THUMB RELEASE METHOD
Note: Can Cause discomfort and/
or pain
STRANGLE HOLDS

SINGLE HAND TWO HANDED STRANGLE

STRANGLE IN CIRCLE CIRCLE
STRANGLE FROM BEHIND, TWO HANDED STRANGLE
TURN IN AND CIRCLE FROM BEHIND, TURN AND
CIRCLE
Release from Choke Hold

CHOKE HOLD 1 CHOKE HOLD 2

TWO HANDED
STRANGLE X
 DIP THE ELBOW DIP THE ELBOW, TWO HANDS
Note: This is applicable if your patient grabbed your arm with both of his/her hand.
*Dip the elbow, two hands are used if the patient is stronger and bigger than you.
Position yourself one foot forward, dip the elbow and remove the arm away from
the patient.
* Position yourself one foot forward, dip the elbow, grab your hand and remove the
arm away from the patient. Proceed to protective posture.
 KNUCKLE IN THE BACK OF THE HAND

Note: this is applicable if you are grabbed from behind, cloth, hair, lahaf
and of patient is grabbing on something.
Position yourself one foot forward, make a fist and rub knuckles on the
patient’s back of the palm focusing on the bony prominence. Once you have
freed yourself, proceed to protective posture.
* If patient continues to grab, push your fist further through your free hand.
 SIDE HEAD CHANCERY HOLD

Note: This is applicable if you are on choke hold.

On choke hold position, hold and push down the patient hand, creating a
space for breathing. Position the leg that is nearest to the patient on this
back. Bend down and turn your head facing the patient, locate the elbow and
push yourself out. Proceed to protective posture.
SIDE HEAD CHANCERY HOLD NIP TO INNER
THIGH *Causes discomfort &/ pain

Note: This is applicable if you are on choke hold.

On choke hold position, hold and push down the patient hand, creating a
space for breathing. Position the leg that is nearest to the patient on this
back. Bend down and turn your head facing the patient. With your other hand
grab the side of the patient and locate the inner thigh. Nip the inner thigh,
once there is an opening on the choke hold locate the elbow and push yourself
away from the patient and proceed on protective posture.
 Release from Bite
BITE THUMB AND FORE FINGER TOGETHER TWIST
*Causes discomfort &/ Pain
Once you are bitten, don’t pull
your hand. Push the hand towards
the patient creating an opening and
twist the lower lip with thumb and
forefinger.
BITE FINGER THUMB EITHER SIDE OF MOUTH PUSH
IN *Causes discomfort &/ pain
Once you are bitten, don’t pull your
hand. Push the hand towards the
patient creating an opening and press
with thumb and forefinger the
maxillary area.
BLOCKING

PUNCH TO FACE DOUBLE FOREARM BLOCK

LINKING HANDS BLOCK LINKING HANDS BLOCK

BLOCKING HEAD BUTT BLOCKING KNEE STRIKE

BLOCKING KICK BEING KICKED ON THE FLOOR

SAFE HOLDING
Thanks and Have a Nice Day!