Learn to anticipate a physical attack.

A high percentage of healthcare professionals report having experienced aggression at some point in their working lives. Every day, medical workers face numerous critical situations where stress is acutely present among both patients and family members. Disagreements over care or diagnosis, staffing shortages, waiting lists… these are just a few of the circumstances surrounding verbal or physical aggression.

Faced with this unfortunate reality, healthcare personnel can take steps to anticipate and prevent physical aggression. Certain behaviors warn us that an attack is imminent. As we teach students in our training courses, if we remain observant, we can anticipate the danger and escape the scene.

Verbal de-escalation is one of the primary mechanisms every healthcare professional should employ in an agitated scenario. Verbal management is an essential first-line tool when approaching an agitated patient, while simultaneously reading their non-verbal communication. If you observe closely in the initial phase, you will simply see a nervous person exhibiting pacifying gestures:

• Adjusting a jacket and/or tie.
• Puffing out cheeks followed by huffing/sighing.
• Rubbing thighs with the palms of their hands.
• Fiddling with necklaces or jewelry.
• Playing with their hair.

These are some of the most common movements made by a nervous individual, but these gestures do not necessarily signal direct aggression toward you. However, if you are dealing with an agitated patient, notice the aforementioned gestures, and realize that verbal de-escalation tools are failing, remain extremely vigilant—because if they display any of the following signs, we are facing an escalating climate of direct hostility toward us:

• Unblinking, fixed stare.
• Furrowed brow.
• Narrowed, squinting eyes.
• Flaring nostrils demanding increased oxygen.
• Slightly widening their stance and puffing out their chest.

There are more, but these are among the most common. If the hostile situation continues to escalate, cortisol levels will rise further, and the potential aggressor will make gestures such as:

• Bringing their hands toward their throat/neck area.
• Baring their teeth.
• Raising their voice tone or shouting.
• Drying lips, which the aggressor will repeatedly pull inward or lick to moisten.

At the end of this final sequence of movements—which lasts barely 15 seconds—the assault occurs. If as a healthcare professional you can detect these pre-assault indicators, you will be able to prevent the attack and escape the scene before it happens.