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Thread: Anyone hear had to deal with MANDT training

  1. #1
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    Default Anyone hear had to deal with MANDT training

    Here's a little background first: I work as a security officer in a hospital that treats Psychological and addiction problems in people from as young as 5 on up to elderly adults. We at times have patients both adolescents and adults who can be very aggressive and dangerous, or just dangerous to themselves. At points the staff are required to put hands on and restrain someone. The old system we used was called Management Of Aggressive Behavior (MOAB). Not great but it worked ok you pinned the person to the floor using essentially what’s almost an Ikkyu principal with arm bar technique and you place your knee right up to the juncture of their arm and arm pit to limit movement. Now however we have officially switched over to the Mandt system. Mandt prohibits the use of prone restraints and uses a vertical restraint. Now I wouldn't object but the vertical restraint used is actually called a side body hug. You come up beside the person at 45 deg. behind them. Put your pelvis against there hip and reach around them pinning the arm near you to there body but leaving the other arm free. Now a second person is supposed to do about the same thing on the other side. To me this just seems dangerous and like your putting staff in unnecessary risk. Our training instructors kept saying that a person can't get out of the hold, however when I and another large staff member put him in it all he did to fight it was lightly jump up and down, when we didn't but his "resisting" and he actually resisted harder not only did he get out but elbowed me in the temple in the process. Has anyone here had experience with this system, if so what’s your take on it? They say that it's taught to law enforcement and correctional officers but I have a hard time picturing either using this.
    ___________________
    Ray Bellville

  2. #2
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    Default MANDT madness!

    Hi Ray,

    About 8 years ago I used to work in group homes and had to use the MANDT system on a weekly/daily basis. The population we dealt with were 9 to 17 year old males who weighed up to 185lbs. Staff members consisted of 109 lb females to 250 lb males.

    During my initial training I didn't have much to say to the instructors. I just learned all of the techniques. We spent 80% of the time on the theory and the rest on practice. However during the yearly recerts I had lots of comments.

    From what I remember there are no "takedowns" in the system. Therapuetic holds are meant to "stabilize" and help the person calm down. There are floor restraints, but they need to be done if the client "lowers" themself to the floor (yeah right!) No pain compliance is allowed due to the escalation factor (DPW regs for PA allow for only one use of pressure point and that is the point where the mandible meets the skull for bite release. MANDT technique for that was to feed the flesh into the mouth and then "roll" the appendage against the bottom teeth). You are also not allowed to take the person "off balance" in MANDT. No application of your bodyweight either from what I can recall.

    In essence, I really disliked the physical part of the system. We had numerous injuries from this method to staff while executing the techniques. The ladies would get tossed around and often thrown into walls or onto the floor while trying to stabilize the client. One day a female staff member almost got choked unconscious because she couldn't do the choke escape. Everybody got black eyes, bruises, bites, and of course, were easy targets for being spit upon. After that during weekly staff meetings, we devoted one hour to drilling and practicing the mandt holds. after about a month and a half, our injuries went down.

    I think this method of restraint takes the risk of injury from the client and transfers it to the worker. MANDT really makes it "safe" for the person who is getting restrained. But that fact also makes it easier for the holds to be broken. When you take a person with no skill or training in wrestling/grappling/ma and try to teach these techniques, the techniques really break down. There are alot of other methods out there that have better restraints that are safer for the worker and the client. I liked the theory on de-escalation from MANDT, but not the physical techniques.

    Just some thoughts!

    Ben
    Benjamin Delich

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    Since you're doing this at work, this means that all your injuries are covered by workers' comp. So, if you're really annoyed with this system, just make sure all users are properly briefed on how to file a claim. (The union should be more than happy to provide the training.) Then, encourage them to file the claims whenever appropriate. Rising claim costs will get the attention of management much faster than any complaints you'll ever make.

  4. #4
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    Ben,
    Yeah that sounds about like the MANDT we're being trained in. Everyone at work is skeptical of it and no one really wants to use it. They started out with fourteen volunteers to be instructors and are now down to four all but three quit because of the system itself. The use of pain compliance is pretty much the reason they stopped using MOAB, which I found kind of funny do to the fact I never really used MOAB as pain compliance. Sure I put them in a hold on the floor but the only pain they ever experienced was caused by them, because I always used the minimal force necessary. I agree that the first part of MANDT dealing with de-escalation and what not is good training but the technical end is a nightmare. Also in most cases I wouldn't need the de-escalation part because at the point they need to call security to the floor the nurses and mhws should have tried those techniques and should be the ones doing it even when we are there. It's also bad because the training we had in MANDT was three days, first two were book work and the last was physical techniques and we wont train in it again untill like next year and they expect us to be able to do it all year. Lastly one other thing I found funny was MANDT always says to not teach what your not qualified in and yet they have a section on avoiding lawsuits and medical risks involved in restraint but put up big disclaimers before teaching it that no one on there staff is a doctor or a lawyer. Anyway the good news is I found out that with all the staff resistance to the program, my place of work has decided to teach a suplementary training to handle situations that MANDT can't handle.
    ___________________
    Ray Bellville

  5. #5
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    Ray,

    Sounds like what the same training we went through... There have been about 8-12 deaths from restraints just in PA alone. There is one on tape where the staff are just sitting on the kid until there is no movement and then they kept sitting on the kid. Then the kid died due to chest compression and not being able to breath. Probably a reason why MANDT doesn't have floor restraints anymore. That fact probably looks great to lawyers!

    I am glad to hear that you are getting another better method to use. Safety for all involved in crisis situations is important. I never got more than a bruise here or there but I saw others get pretty messed up. That is a reason why I got out of that field. Too much risk for not enough money. Having personal liability in those situations is pretty risky to have.

    Good Luck with the new method!

    Ben
    Benjamin Delich

  6. #6
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    This stuff goes through cycles and it will be awhile before it swings back to more realistic defensive tactics policy and procedure. The next step will be to start documenting "residents" who are combative, at risk, passively challanged, whatever the PC label of the week is. They'll be observed, their behavior documented then they'll be dosed up on thorzine, till that gets out of hand or draws protest. Of course the next cycle of approaved physical tactics will have to have a brand new name, a new vocabulary and a feel good mission statement.
    joe yang, the three edged sword of truth

    "Not going to be fooled by you again Joe Yang's right you are evil and self-serving." Haiyomi

    "Give my regards to joe yang. very intelligent man." Sojobow

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