“Code Black..Code Black” – This is the call to the security team that has been made over 20 times during Bob’s three stays at the Royal Adelaide Hospital (RAH). The restraint team consists of a team of 7 security guards that respond very quickly to any emergency within the hospital and are a vital part of the system. Both men and women are on the individual teams that work 12 hour shifts each day. One person is in the control room and the others team up to wherever the next restraint is required. Two guards are normally stationed in the Emergency Department (ED) as this is a ‘hotspot’ for trouble. This is due to alcohol and drug related violence often occurring on friday and saturday nights.
Another area the restrain teams are required regularly is in the three locked wards on Level 8 of the hospital . These wards include patients that may have dementia, schizophrenia or mental health problems.Patients can have unacceptable behaviours which may include aggression, hitting, kicking, biting, spitting, fighting, abuse, nudity and verbal outbursts. Gloves are worn by the guard as they attend each incident and some wear safety glasses and surgical masks when required. It is very re-assuring when you have a code black situation happening that at least 4 guards will be arriving within a couple of minutes.
The first time they were called when we were in the Emergency Department I will never forget the ‘whoosh’ and power of the group as they all grabbed an arm or a leg each and helped me restrain Bob. It seemed barbaric and cruel at the time but there simply is no other option when violence is involved with a patient. The team is trained to restrain and there does not appear to be any difference in how they handle each incident. I assume this is because they often do not have time to reason with people or know what the patient is capable of. If they have a show of force quickly then the chance of escalation is reduced. The guards usually have no medical background and ultimately their role is to protect the person, the hospital staff and other patients.
I have worked with many members of the restraint teams as they have been called to help us many times. I will often talk to the first two guards and quickly explain that we are dealing with a dementia patient and a ‘softly, softly’ approach is to be attempted first if possible. The reason why dementia is different is that usually the person is older and more frail, but also the patient is scared or delusional and extremely traumatized by the sight of up to 6 guards in a small space trying to grab them. I am a big believer that ‘dementia training’ is a must for the restraint teams. As I have been involved so many times I have witnessed many occasions where we have avoided even touching the patient by not crowding the person with dementia, talking with them in soft,calm tones and re-directing them. The guards get to know the patient often and use his or her name and get a much better result because of this.
I have actually seen some of the guards adjust to this calmer method and it is really pleasing to see. Of course situations often escalate and force is required. If we can train the restraint teams to adapt to the conditions of the patient it will allow them alternative methods to try which will have the patient’s well being considered. I believe we need to provide dignity and respect wherever we can in our hospitals and the restraint teams is probably the most logical place to start.
I must say the more I get to know the guards and have them watch me deal with Bob, the more I understand how they work and the more tips they pick up on dementia from me. There are some terrific people on the restraint teams and we all try and have some lighter moments when we are standing together for up to an hour at a time. Thank you to all the guards in the hospital who keep everyone safe – you are doing a great job!
**Funny Story – In the middle of a tense situation whilst the restraint team were holding Bob, one of the male guards points at Mum and says to me “So who is is that lady over there? Is she your sister?” I responded with ” She’s my Mum and you have just made the Christmas List Buddy!” 🙂