If it looks like a duck, swims like a duck, and quacks like a duck?

Delivering training & consultancy to hospitals, children's homes and in educational establishments, I meet a wealth of lovely people from a variety of backgrounds and with different fields of expertise. Many of these people have often had some form of physical intervention or handling training previously to my organisation coming in. Some of these people, are entirely happy with the training they have received and assume that what they have been shown is correct and is "best practice" because their local authority says that the provider they chose is who they should go with for example. However, there are many people I meet who are despondent to their existing training or procedures and I hear in their voices, see in their feedback and read from the expressions on their faces the frustration and confusion they face daily. This display of negative emotions is a direct consequence of them attempting to implement strategies, perform techniques or use approaches which are ultimately putting staff and service users at risk. 

Risk reduction

If a risk assessment made by a competent person identifies that physical restraint training is necessary, a clear understanding of "when" to apply such techniques is of massive importance. There has been a lot of focus in recent years placed on "Managing challenging behaviour" and across NHS trusts we have seen "Violence Reduction" posts set up where people look at implementing proven ways of reducing the number of restraints and interventions that are actually taking place. Another really important aspect of any restraint programme which addresses the minimisation of risk, must be making sure that the techniques staff are being shown, aside from being necessary in the first place are appropriate and effective for not just the service users but for the staff that are attempting to implement them.

Justifying instinctive interventions

Part of being a trainer or consultant on the use of force is getting across to people that in emergencies, physical interventions can (and in some circumstances MUST) absolutely be used as a first resort. Certain emergencies do call for unannounced or unplanned interventions which by their very nature are often instinctive. Evidence shows us that they are often based on a person's honestly held belief that at that moment in time, what they did was right in relation to that certain set of circumstances.This instinct can be primitive for example flinching or reactive movements such as pushing someone away from danger, grasping the arm of someone lunging or thrusting an arm out as a barrier to catch or stop someone. In any instance where there is time for people to contemplate alternatives, rationalise or make a choice before intervening though, the implementation of a taught structured physical intervention that a staff member has been shown in training will directly influence how they manage a situation as it escalates.

The importance here is that people understand along with holds they are taught the law in relation to their duties and to their powers.

Powers; you CHOOSE to use - for example the power to search (consensually or non consensually), the power to remove a child from a classroom or, the power to physically intervene between say two residents who are fighting or with someone self harming. Duties (your duty of care to yourself and others) are things that in law you MUST do.  

So, in some circumstances, a member of staff may not have access to immediate, adequate assistance or may feel that due to the strength or size of the service user that their chances of safely, successfully intervening without causing a greater injury to those concerned was highly unlikely. Would it be then in this scenario a more preferable option for them NOT to intervene immediately and instead look at ways to win time to call for help perhaps? After all, the duty of care to oneself always comes first, that of your "neighbour" as was specified by Lord Donoghue to mean "those directly affected by your acts or omissions" comes second. If we don't ensure our duty of care and we fail exercising a power, then by default, we fail in our duty of care to oneself and if the situation isn't quelled to the service use also. 

Look at a First-Aid primary survey, the first thing we check for before considering the wellbeing of the potential casualty is for Danger. If the danger is too great then we don't move onto further assessments, the same should be true for planned physical interventions.  

Basket holds

So let's look at what people are being shown as suggested primary methods of intervention which some trainers say are appropriate to use independently with children, vulnerable adults and those with learning disabilities you would think they would be consistent with what the law states. You would think.

A quick google search for "Basket hold" takes you to a world of worrying images,

Which takes you to a video of what appears to resemble a basket hold is applied by a member of staff to a child who is seated. The hold is shown at 1 minute 25 seconds.

Aside from the obvious risk of positional asphyxia, there worryingly seems to be little concern for good manual handling procedures and the form being used by the applicant. Musco-skeletal disorders are a concern resulting from movements that aren't consistent with good manual handling practice. Many supermarkets you will notice are now avoiding unnecessary packing assistance and upper body rotations to combat claims arising from staff injuries.

Aldi and Lidl are the best I find for the up and coming sport of "sprint packing".

A basket hold is a single person restraint technique where a person stands behind the subject, reaches round them, crosses their arms and then holds the wrists. One description made by a government department defines a basket hold as being:

"...where the person's arms are drawn tight across their chest by a person standing behind them"

Such definitions have been manipulated by members of staff and training providers who still wish to teach such holds despite the known risks, here are a few I have heard and my response to such claims:

We hold the wrists on the hips

(Provided the person doesn't struggle or drop their weight that is)

If they struggle we just release

(If you are to immediately release them then, why take hold in the first place?)

Where there's a blame

If we look at the Management of Health and Safety at Work Regulations 1999 and specifically at the advice given on manual handling, it steers us away from any form of single person restrictive hold as safety factors other than necessity, such as core stability and guidelines for recommended maximum weights we can lift must also be considered.

Those of you who have read my previous post or watched the video entitled "procuring a contractor for restraint or positive handling" from the NFPS annual restraint refresher course: https://www.dhirubhai.net/pulse/procuring-contractor-restraint-positive-handling-training-doug-melia?trk=mp-author-card) will understand, liability-wise that it is the organisation procuring the training provider that would be liable should a claim or prosecution arise from using such a technique. It is they who have a non delegable duty of care and therefore, the Head-teacher, Director or owner who should be selecting a training provider by adequately performing their due diligence and ensuring that the company who they are selecting is qualified as a contractor in their field of operations.

These holds are still being used

Training providers and their trainers, despite the known risks and despite there being far less intrusive methods available, are still promoting basket holds under a different guise.

For example we have seen "Basket holds" rebranded with fluffy and politically expedient names such as "Wraps", "Embraces" and even "Hugs".

The reality of it is we have a hold, notorious as a contributing factor in incidents of serious injury and which represents a concerning percentage in studies of restraint related positional asphyxiation fatalities. Despite this, the very same practice has been dusted down, given a metaphorical shower, haircut, had its teeth brushed, its hair slicked and squeezed into a suit and is being pushed back out there into our schools, hospitals and children's services to carry on with its good work?

Sounds to me like Ian Huntley in a suit, and Ian Huntley in a suit?

Well it's Ian Huntley. In a suit.