When a patient at Williamsport's Divine Providence Hospital hit a doctor in the head last month, hospital security guards weren't the only ones to respond to the scene. Williamsport police arrested the patient, who was sent to another facility to continue treatment, police Capt. Raymond Kontz said.

When it comes to workplace violence, doctors are in a unique position, Valley self-defense instructor Jeffrey Miller said. While physicians work to help people, they sometimes need to defend themselves from a patient's violent behavior and keep the patient safe at the same time. And it happens more often than people think, said Miller, owner of Warrior Concepts International, Sunbury.

Miller, a former federal police officer, bodyguard and undercover investigator, said the medical field has one of the highest rates of workplace violence of any industry. He is going to Amsterdam next week for the International Conference on Workplace Violence in the Health Sector. He will be speaking on the lack of defensive tactics training -- what he calls "the missing element" in most workplace violence plans -- including those in health-care facilities.

Hospitals like Divine Providence are taking action to ensure both patients and employees are protected.

"People highly trained tend to respond much more calmly when under pressure," Miller said.

Divine Providence, Evangelical Community Hospital in Lewisburg and Sunbury Community Hospital require employees to attend annual training sessions in psychological and physical techniques used to handle violent patients or even family members.

Employees learn what triggers attacks, such as interactions with medications, an electrolyte imbalance, excessive pain, disorientation and alcohol abuse, and how IV poles, utensils and food trays can be used as weapons.

"We actually identify all those potential weapons during training," said Joanne Hostrander, a Susquehanna Health clinical education specialist and registered nurse who's trained Evangelical hospital employees.

Employees at Evangelical and Divine Providence are led through hands-on sessions requiring them to practice what Hostrander called "safe holds" on each other. Staff at Divine Providence used training methods last month after the behavioral health patient hit the doctor, said Terry Austin, manager of safety and security for Susquehanna Health.

"The staff is used to dealing with clientele there and jump into action. It's part of their training and protocol," Austin said.

Sunbury Community Hospital provides training for new hires and annual online courses for the entire staff.

Hands-on sessions are "more specifically in our behavioral health unit because we might see an increased risk in combative patients," said Talia Beatty, human resources director at Sunbury Community Hospital. "If there is a combative patient in our ER, for example, the behavioral staff would assist in a situation like that."

Often, patients lash out because they're not getting what they want and find someone to "punish," Miller said. Family members may become violent after being told a relative admitted to the hospital has died.

Though procedures and guidelines have changed, unruly patients are not new. The average nurse is assaulted one to three times a year, Miller said, but as medical employees are trained, they'll learn to focus in a crisis situation, no matter why it erupts.

"There are lots of reasons why it happens, but it doesn't make a difference what the reason is," Hostrander said. "We have to be educated to respond and protect the person who has the issue."