The third level of behavior that may be encountered is that of true physical aggression and assertive behavior. The patient is totally out of control, and no amount of verbal intervention is effective. The physically aggressive patient must be confronted and controlled physically, not only for the safety of the emergency department personnel, but for the safety of the violent patient, other patients, and visitors in the department. Only when all other interventions have failed and once the decision has been made to restrain, no further negotiation is warranted. Physical control of a patient may require personnel skilled in overcoming a person without injury to self or others. Physical control should never be attempted single-handedly and should preferably be deferred to a trained individual. It is important to remember that a health care provider has a duty to evaluate a patient's needs. Restraint, in some situations, is only fulfilling that duty. Using appropriate and nonharmful restraint enables the physician to provide necessary care for a violent patient. Physical control is implemented, not for punitive reasons, but in the interest of patient care and safety for others.
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