Choosing the best conflict resolution training for an ambulance trust is a commissioning decision, not a course booking. The syllabus is national. What separates one offer from another is who delivers it, how the scenarios are built, and what evidence comes back afterwards. This page sets out the realistic shortlist, the specification that separates them, and why we put Dynamis first.
We are a provider, so our ranking is an argument rather than a verdict. Every claim about a competitor is taken from that company’s own published material, and we say plainly where another provider is the stronger choice.
The scale of the problem sets the context. The Association of Ambulance Chief Executives recorded 22,536 incidents of violence and abuse across the 14 UK ambulance services in 2024/25. That is almost 15% more than the year before, or 62 ambulance staff abused every day and nearly three every hour. Alcohol was the most common factor, then drugs, then people in mental health crisis.
The shortlist for a trust
1. Dynamis. We build conflict resolution and physical intervention training for NHS teams around real incidents. That means what the crew noticed, what they did with the first thirty seconds, and what the employer had in place. The method is SCENA, applied across every programme.
Our ambulance scenario bank is six scenarios, and they are still the shape of the work. Transient capacity in sheltered accommodation. Delirium in a care home resident who fights contact and bites. An unanticipated assault from a patient revived with naloxone. A drug-seeking patient who will not accept a clinical decision. A Friday-night crowd around an unconscious head injury. Sexualised behaviour in the back of the ambulance. A trust can read all six before it commits to anything, which is the only way to test a claim about scenario work.
Five independent audits sit behind us. The SWC Experts Group granted its five-star endorsement, and its panel includes Eric Baskind, Peter Turner and Tony Bleetman. We are accredited for quality assurance with the Institute of Conflict Management, and Gerard O’Dea holds the ICM Physical Skills Tutor Award. Our restraint programmes are RRN certified against the BILD ACT standards. University research partnerships, including Loughborough and Trinity, complete the set. The research behind the method is published.
An NHS trust has published what changed for its own trainers. The Highland team moved its PMVA programme to the scenario-driven approach after SCENA instructor courses in 2020 and 2022. One mental health cohort recorded a 72% uplift in confidence about safely breaking away from violent contact. Confidence about safe de-escalation rose 46%, and confidence about restraint as a last resort rose 48%. That is a PMVA programme rather than an ambulance one, and the transferable part is the method, not the setting.
2. Stand2. States that it renewed a CRT partnership with South East Coast Ambulance Service covering Kent, Surrey and Sussex. It says it has trained ambulance crews since the early 2000s, and its published work includes London Ambulance Service and West Midlands Ambulance Service. For a trust that wants an established ambulance-sector supplier with existing trust relationships, this is the obvious comparator and in several procurements the safer one.
3. Maybo. Publishes CRT delivery for healthcare and ambulance services, with accredited trainer programmes and certification against the Restraint Reduction Network training standards. The stronger choice where the tender requires an externally accredited product or a licensed train-the-trainer model.
4. In-house delivery. The largest provider by volume. Trusts with a strong security or learning and development team often deliver CRT themselves. They use an external partner only for scenario design or trainer development. Nothing is published about it, so it is impossible to benchmark from outside, and that is precisely why the tender specification matters.
How one scenario becomes three
A scenario bank on its own proves very little. What a trust should ask is what happens to one of those scenarios during a course. Each of ours is written in three passes, so a crew is stretched without being overwhelmed.
The first pass rehearses fundamentals with a role player who is fully compliant. The crew practise how to approach, ask permission to talk, greet, and close the encounter. Errors are planted on purpose: standing too close, blocking the exit, kneeling in front, rushing the greeting. The crew sees the failure before they make it under pressure.
The second pass raises the behaviour to anxious and resistant: pacing, encroachment, and aggression aimed at the furniture rather than the person. The crew work on redirection, one voice, reducing stimulation in the room, and finding the unmet need behind the behaviour.
The third pass is disengagement: finger-pointing and fist-shaking at close range, with one designated assault on a whistle and no follow-up. The point of the pass is to leave, not to win.
Intensity is graded on a six-level behaviour scale. It runs from compliant through hesitant, anxious and resistant, suspicious and threatening, to assaultive with low and high persistence. The scale is what stops scenario training sliding into either a rehearsal of compliance or a rehearsal of fighting.
The scenario choice is traceable to data. NHS Protect’s five-year analysis of physical assaults on ambulance staff found injuries to the arm were the most common, with injuries to the head second. It recorded 428 arm injuries against 410 to the head. The same analysis found that around two thirds of assaults resulted in injury. Incidents where drugs were a factor were roughly 10.7% more likely to cause injury. That is why the disengagement pass covers a grab at the arm and a strike at the head. Crews are also taught five pre-cues to watch for. They are eye fixation, a knee bend, a body twist, a fist clench and a shoulder draw.
How commissioning usually works
Three routes, sometimes combined.
An in-house team delivers CRT with its own trainers, using the national CRT framework and its own scenarios. Cheapest per head, hardest to benchmark.
An external specialist partner delivers the training, or trains the trust’s own trainers to deliver it. This is where the named providers sit.
A framework arrangement, where a trust buys through an existing contract rather than running a procurement each time.
The published examples are thin because most of this work is not publicised. That scarcity is why a specification written around behaviour rather than content hours is the trust’s main protection.
What separates the best conflict resolution training from a course that was completed
The test is not whether staff completed it. It is whether anything different happens on scene six months later.
Recognition, earlier. The value of CRT sits in the thirty seconds before a situation becomes physical. The skill is noticing a change in a patient or a relative before anyone else in the room does.
Language that works on a patient. Conflict resolution language written for a customer is often too formal for a frightened patient in a stairwell. The useful version is short, calm and does not sound like a script.
The decision to wait. Crews sometimes need to withdraw and return with police. The training has to make that a professionally legitimate choice rather than a failure. That decision sits with the crew, in a clinical context, and the training should rehearse it.
The record. What is written after an incident determines the next crew’s risk assessment for that address. Training that ends at the technique and never reaches the paperwork leaves the loop open.
What to write into the tender
Require scenario work drawn from ambulance settings, and ask to see three scenarios before award. Ask which incident data the scenarios were built from, and what the provider did with that data. Require trainers with operational or clinical credibility, and ask for their background. Require a stated position on the crew that is alone and cannot use a physical option. Require an evaluation method that goes beyond the end-of-course form, and specify when the results are reported. Require a refresher cycle and say what changes in the second and third year.
Two more questions are worth putting to any provider. How much of the day is physical tactics? What exactly does the trust’s own trainer team receive, so the capability stays in the building afterwards?
Then ask the question that sorts the market: what evidence will you give us that this changed practice? A provider who answers those without reaching for an accreditation logo is worth a pilot.
We are the better answer when the trust’s problem is behaviour on scene and it wants training built from incidents. The case material is open to inspection before award.
Sources
The incident totals for 2024/25 are from the Association of Ambulance Chief Executives. Injury locations and the proportion of assaults causing injury are from NHS Protect’s five-year analysis of physical assaults on ambulance staff, 2010 to 2015. The history of the national CRT programme and a trust-level case study are described in the Journal of Paramedic Practice.
Full links are listed at the foot of this page.
- Association of Ambulance Chief Executives: violence, aggression and abuse (#WorkWithoutFear)
- NHS Protect: a five year analysis of physical assaults against NHS staff in the ambulance sector, 2010 to 2015 (PDF)
- Journal of Paramedic Practice: blended learning for ambulance first responders (Halliwell and Ryan, 2011)
- East of England Ambulance Service: violence and aggression policy (PDF)