Something I want to share.

I moved to San Angelo, TX, in July 2010 to begin a job at the San Angelo State Supported Living Center (SSLC) in Carlsbad, TX. I arrived in San Angelo in late July of that year and began my new job at the beginning of August. Some of you reading this may work at the SSLC or may have worked there in the past. My first friends and adopted family in San Angelo were co-workers at the SSLC. I worked there for approximately 5 years, and I met many people. I’m writing about this now because I want to write about orientation training. It’s relevant. Just stick with me for a few paragraphs.

Please keep in mind that what I am writing about is my experience as an employee of the SSLC from August 2010 to April 2015. Policies change, and the processes at the SSLC may be different now. Also, processes and policies at different SSLCs may be different. I don’t want to point this out every few sentences. I am only writing about my own experience during the time period that I worked at this particular facility.

Orientation at the SSLC lasted for about a month. There was seated classroom training and some hands-on role-play-type training. What I will focus on here is Prevention and Management of Aggressive Behavior (PMAB). I learned PMAB during my initial orientation training and had to complete PMAB refresher every 11 months after my initial orientation. PMAB is hands-on training for various situations such as how to remove a dangerous object from another person, how to physically restrain another person, how to assist another staff member in the prevention or management of aggressive behavior, etc. Given what we have seen recently with the murder of George Floyd, I want to share – specifically – about physically restraining another person on the ground. Like I said, I received this training during my orientation in August 2010 and it was a part of refresher training every 11 months afterward.

This particular restraint requires 2 staff members. It begins with one staff member approaching the aggressive person from behind and placing the aggressive person in a bear hug restraint that transitions into a basket-hold restraint that further transitions into the restraint moving to the ground (I don’t remember the technical name for the restraint once it is occurring on the ground). When I planned to write this, I did not think about whether or not I should explain the beginning restraints. I may lose your attention, and I don’t know that this information is relevant to my main point. It’s important for you to know that training for appropriate and safe bear hug and basket-hold restraints involves the person performing the restraint to keep his//her head down and behind the person being restrained to prevent the person performing the restraint from being bitten, spit on, or head-butted. The person performing the restraint is required to hold the wrist of the restrained at the restrained’s waist to keep the restrained’s arms from impeding the restrained’s breathing. Restraints aren’t meant to harm a person or to put the person in further distress. If a person performing a restraint misses a mark, for example: doesn’t grab the restrained’s wrists, the person performing the restraint is supposed to release and begin again, if necessary. If a person being restrained complains of pain or not being able to breathe, the restraint is released. No questions. You can probably see where I’m going with this now.

Let’s fast forward to restraining a person on the ground. It requires 2 people to perform the restraint. Person 1 is the person who began the restraint by putting the person behaving aggressively into a bear hug and basket-hold restraint, then progressing to the ground. Person 1 is holding the restrained person’s wrists at that person’s waist to prevent the restrained person from striking self or others and still allowing the person to breathe without impediment. Person 1 is still keeping his/her head behind and away from the head of the restrained person for his/her own safety. On the ground, Person 1 would continue to hold the restrained person’s wrists at the waist so breathing is still unobstructed. On the ground, Person 1 will hold the restrained person on his/her side so the restrained person is not face down and is still able to breathe, as normal. Person 2 comes into the restraint on the ground to restrain the restrained person’s legs to prevent kicking and potential harm to self (person being restrained) or others. Person 2 has the job of maintaining visual of the restrained person’s face to monitor for signs of distress. It is also Person 2’s job to ask the restrained person, “Can you breathe?….Are you hurt?” If the person being restrained indicates s/he is hurt and/or that s/he is unable to breathe, the restraint is released. No question. If the person being restrained appears in distress (ex: doesn’t appear to be breathing, face/lips turning blue), the restraint is released. No question. If Person 1 or Person 2 notices that the person being restrained is not on his/her side and is actually face down or face up, the restraint is released. Restraint is not about harming a person or killing a person. Remember, PMAB is PREVENTION and MANAGEMENT of aggressive BEHAVIOR.

I successfully completed initial PMAB training and each subsequent refresher I had to take. I was fortunate that in my 5y of work at the SSLC I did not have to participate in any physical restraints. I have zero doubt that an actual, real life restraint is a vastly different experience from training. I know I am lucky that I never had to do it. The training I had, and the refresher training I completed is what applied to all employees: direct care staff, behavioral health specialists (my position), case workers, home managers, the folks who work at the gate, etc.

Education requirements are different for different positions at the SSLC. I do not remember what it was for direct care staff, but I know it did not require a college degree. It’s my understanding that the staff who were more likely to perform these restraints were the direct care staff. It’s safe to say that an advanced degree is not required for a person to comprehend that you let go of a person who tells you s/he is unable to breathe because of what you are doing to them or how you are holding them. Respect for humanity is not a complex concept.

If a staff member did not successfully complete PMAB training or the annual refresher, s/he was not permitted to work with the people who live at the SSLC. If I remember right, staff members who did not complete initial PMAB training would be let go and staff who did not complete refreshers would be placed on No Client Contact (NCC) status until they completed the refresher. I wasn’t allowed to walk by myself from the training building to the building where I had been hired to work until after I had complete initial PMAB training.

I have been thinking about this for days. At as State facility in Texas, staff are trained diligently about the importance of letting someone go when what you are doing to that person obstructs the person’s breathing. I vividly remember being told in every PMAB training, “If you ask the individual if they can breathe and they say, ‘No,’ you release the restraint.” Full stop.

What if they’re lying and they can breathe? Release the restraint.
What if you release the restraint and the individual continues to behave aggressively? Release the restraint. Start over, if necessary.
What if they don’t answer when you ask if they can breathe? Release the restraint.

What should a staff member do if they observe a restraint that is being performed incorrectly? Inform the staff performing the restraint. Direct them to correct if, if they can, or release the restraint. Even as a bystander-observer, staff had responsibilities during restraints. The same is true of a staff who observes a restrained person who appears to be in distress, harmed or unable to breathe – inform the staff performing the restraint and direct them to correct it, if they can, or release the restraint.

There are no excuses. As a person restraining another person, it was never up to me to decide that the person I was holding was safe and was able to breathe normally. I was not a law enforcement officer or a corrections officer. I was not a public servant of any kind. The training I received was for safety and protection of myself, residents of the facility and the other staff. I cannot accept that this is not also a component of training for law enforcement officers, correction officers and other public servants – folks who are much more likely to encounter situations what call for restraint of another person. Even in states other than Texas. Is there a state that is so lacking in their training of law enforcement officers, corrections officers and other public servants that they do not understand how to respond to a person who says, “I can’t breathe?”

There may be situations in which the person performing the restraint feels afraid of what the person may do if the restraint is released. That is fair. It may be scary. I cannot get on board with suffocating to death another person who is telling me that s/he cannot breathe because I feel afraid of what that person may do if I stop suffocating him/her. If that person is in handcuffs, it is even more atrocious that the person doing the suffocating may say s/he felt afraid of what the person would do once released. The person who is released may run. Okay, but that person will likely struggle to even stand up because of the handcuffs and especially if the person was being suffocated. The person may kick. Okay. Stay away from the person’s legs. If the person was unable to breathe just seconds before, you may be best served by staying near the person’s head and face to find out if the person is okay. In any case, when you release a restraint, you can back up and give the previously restrained person a little bit of space. You can take a beat to reassess the situation. There may still be a need to restrain that person, but you can begin again and be safer.

This is all I have for you. My PMAB training is well out of date because I left my job at the SSLC 5 years ago. As I wrote at the beginning of this post, I don’t know what PMAB training is now. Did I need PMAB training to know that I need to get up off of a person who is saying s/he can’t breathe because of what I am doing to that person? No. Can the phrase, “I can’t breathe,” be used as a manipulation for a person to get out of a restraint? Yes. Does that mean a person should second guess another person’s claim of, “I can’t breathe,” and exercise their own judgment about whether or not that other human being can or cannot breathe? No. I think, “I can’t breathe” is too strong of an indication that a person is near death to be ignored.