123 | Josh with Crisis Prevention | Code Grey | Safety in the ER | The unmet want or need

Josh has 20 years in Public Safety

Currently doing crisis prevention instruction

We often don’t get any education in med school or PA school in how to communicate well with patients or how to de-escalate their behavior

Code greys are the behavior health emergency response; someone has some concern that a patient is escalating to potentially violent behavior and a team will respond

Staff safety is priority

We are there to provide excellent medical care, if it’s safe to do so

We recommend calling code greys earlier to avoid worsening scenarios 

Code grey assures staff safety then de-escalation of the patient

Recognizing when you need help with patient interaction from some other staff member is important

Typically, negative behavior is a result of an unmet need or want

Rationally detach

Give people options, this helps give them a measure of control when they feel out of control

Get consent to do a physical exam, taking that extra few seconds to explain what you’re doing and getting that quick permission goes a long way

We forget that we ignore many social norms in the ED, patients may not be used to this

Always introduce yourself

A huge component to de-escalation of patients with negative and violent behaviors is that, if not done properly, they are a primary source of burnout. They become a huge negative experience that it sticks with you, not to even speak of the potential for an injury. Avoiding these negative experiences at all costs will be key to thriving in emergency medicine

Josh talks about a severe ankle injury he sustained and how he found a way to keep helping people anyway. He talks about how he strived to get the struggling people back connected to community. He helped them re-establish trust in others so that they could accept help

We talk about the resources available for financially struggling patients