Code Grey Protocol: Kerala takes bold steps towards violence-free healthcare

Kerala has rolled out a protocol to establish a violence-free healthcare system in the state, making it the first state to do so.

ByDileep V Kumar

Published Mar 17, 2024 | 8:00 AMUpdatedMar 17, 2024 | 8:00 AM

Kerala officials launching the Code Grey Protocol. (Supplied)

The next time you visit a healthcare setting in the state, don’t be surprised if you see doctors, nurses, and healthcare staff practising blocks, kicks, and techniques to temporarily incapacitate attackers. This is all part of “Code Grey Protocol — Kerala”, a framework released on Saturday, 16 March, aimed at establishing a violence-free healthcare system in the state.

The Kerala Health Department claims that the protocol safeguards the rights and well-being of healthcare professionals, patients, and others who visit healthcare facilities for various services. With the launch of this initiative, Kerala has become the first state to introduce a Code Grey Protocol.

Breakaway and self-defence training

Among the many recommendations in the protocol are breakaway training and self-defence training for health workers.

The protocol, which South First examined, states, “It (breakaway training) is a set of techniques and strategies designed to help individuals safely and effectively disengage from physical confrontations by acquiring skills like non-violent communication, de-escalation techniques, and physical interventions. Breakaway training can help improve communication skills, reduce stress and anxiety, and improve decision-making skills.”

“All health staff shall be trained in identifying early signs and causes of aggression/violence, using methods of distraction/relaxation, and responding to the situation appropriately to avoid provocation,” it states.

In the case of self-defence, an excerpt from the protocol highlights that “all health staff and support staff shall receive periodic training in self-defence.”

It further recommends “physical defence techniques like blocks, kicks, and strikes, techniques to temporarily incapacitate attackers, and techniques for escape and breakaways to break free from physical restraints” for healthcare workers.

Also Read: Dr Vandana death: Doctors’ protest paralyses Kerala’s health system

A centralised command centre

Instructions to hospitals to implement the Code. (Health Department)

Instructions to hospitals to implement the Code. (Health Department)

Another major proposal in the Code Grey Protocol is to set up a 24×7 centralised command centre with adequate security personnel. The centre should ensure video surveillance of the entire healthcare institution, including the campus. A hotline should also have to be established for wards and the casualty/emergency department.

Other recommendations include:

  • A clear policy on reporting and processing cases of hospital violence
  • A committee at the hospital level responsible for overseeing the institutional mechanism for prevention and response to occupational violence and aggression
  • Visitor entry and bystander restrictions
  • Bystanders and visitors to be allowed only to visit those wards where their patients are treated
  • A designated nodal officer in charge of the Code Grey Protocol at all departments/units in healthcare facilities
  • Conducting mock drills to review the preparedness for managing Code Grey incidents
  • Training on Code Grey to become part of the induction training curriculum
  • A lone worker policy that ensures at least one senior staff member during all shifts
  • All healthcare institutions to develop their own Code Grey management plan based on the broad guidelines given in “Code Grey Protocol-Kerala”
  • Victims of hospital violence to be provided with psychosocial support

Also Read: Kerala’s Health University Students’ Union urges govt to roll out security measures

The origin of the Code

It was in June 2023 that the state Health Minister Veena George announced that the Code Grey Protocol would be implemented across all hospitals in the state.

Code Grey Protocol. (Health Department)

Code Grey Protocol. (Health Department)

A protocol in effect at various hospitals abroad, Code Grey is meant to address occupational violence and aggression against healthcare workers.

According to a Government of Australia document, “Code Grey” is an organisation-level response to actual or potential violent, aggressive, abusive or threatening behaviour, exhibited by patients or visitors towards others or themselves, which creates a risk to health and safety.

In the case of Code Grey Protocol-Kerala, a total of 66 experts had contributed towards its draft. This includes bureaucrats, health and police officials, health experts working in the United States and the United Kingdom, medical professionals working in Bengaluru, and others.

Commenting on the initiative, Dr Sulphi Noohu, a member of the Indian Medical Association-Kerala (IMA) tells South First that it was one of the demands that the IMA raised when an assailant stabbed Dr Vandana Das to death.

“A code of this kind is the need of the hour. We are happy that the government has rolled it out. Now, it must be implemented in letter and spirit,” Dr Noohu asserts.

The murder of house surgeon Vandana in May 2023 raised some serious questions about the safety of healthcare workers in the state.

It was following this tragic incident that the government amended the Kerala Healthcare Service Persons and Healthcare Institutions (Prevention of Violence and Damage to Property) Act 2012. The Act, which expanded the scope of protection, also increased the punishments for acts of violence against healthcare service persons.

Also Read: Kerala Governor signs ordinance for protecting healthcare professionals

(Edited by Kamna Revanoor)