Question about possible restraints on a psychiatric call.

[chadwick]

We were sent to the county jail for a middle aged white female who was having "apnea". Upon arrival on scene, pt found laying in bed holding her breath between random strings of gibberish. Vitals all normal, pt was rubbing and scratching her face wildly so I loosely immobilized her hands with a triangle bandage and the belly strap on the stretcher. Upon arrival @ the ER, the ER paramedic went in and started talking to her, she was healed instantly. She sat up in the bed and started talking and acting normally. The nurse said "She must have detected that she could get some sympathy out of you" and before I could say a word my partner said, "Nu uh, he was hollering at her to stop faking and doing sternal rubs on her". I provided adequate care and got her to the ER without her clawing her eye out.

I was a nurse aid before becoming an EMT so I have over 5 years expirience with restraints, most of the time, if they are coming peacefully I just use the three straps and the shoulder straps. I don't turn my back on them but I try to find calm things that we can talk about. I had a guy one night that scared the crap out of me but as long as we were talking he was fine. It was funny when we started comparing tattoos. If they really freak out enroute the straps should buy me enough time to either tuck and roll out the side door or be looking back at them through the plexiglass window in the door between the cab and the box. I decided a long time ago that I am not getting hurt if I can avoid it. Let me and my partner get our stuff and get out and you can have the ambulance, keys and all. If you prefer to walk I can't promise that I won't tell the police which way you were headed. I have seen hundreds of patients and restrained 1 so far.

 

[emtwacker710]

soft restraints, cravats are your friend...of if they come from the police always make sure you have an officer ride in the back, trust me, my crew told an officer he didn't need to ride but I wanted him to ride as I had transported this pt. before and they didn't listen to me, long story short we had to strap him down and call a patrol 10 minutes out from the hospital. I also switched crews so people wuld actually listen to me, lol

 

[bassman1490]

hey when did you change crews, didnt you use to ride with travis. when did you have this call, i didnt hear about that one

 

[emtwacker710]

I've ridden with all of our crews pat, and this call happened like 2 yrs ago too..but yea that call sucked, we mutual aided Moreau for a seizure pt. and he started getting combative, he used to live in a park in the west end, but he was at moreau family health that day and it happened, and Moreau was out on 2 calls so they called us as it was their 3rd call

 

[bassman1490]

ohhhhhh i understand now yeah that sounded like it sucked i would not want to deal with that

 

[griz1974]

restraints

when in doubt use local resources i.e. pd let them restrain the pt thats thier job

 

[emtwacker710]

I actually just found a new way to restrain a combative pt. the other night, take the reeves stretcher and put the pt. face down in it then secure it and flip it over and put the pt. facing up on the stretcher and secure the stretcher straps, a CO in my squad says this works great and does not affect the airway...sorry if someone else mentioned it, I didn't see it when I scanned through this thread

 

[JPINFV]

Is the patient sandwiched between the reeves and the gurney?

 

[Jon]

I actually just found a new way to restrain a combative pt. the other night, take the reeves stretcher and put the pt. face down in it then secure it and flip it over and put the pt. facing up on the stretcher and secure the stretcher straps, a CO in my squad says this works great and does not affect the airway...sorry if someone else mentioned it, I didn't see it when I scanned through this thread

This was already mentioned. It is a form of "sandwiching" a patient. Back in the "old days" that was a common way to restrain a combative patient. Now we know better.

What do you mean by CO? Chief Officer? Corrections Officer? Are they an EMT or a Medic? Are they your command doc? If they aren't your command doc, and it isn't a written policy.... I'd be careful and follow your state's policies on patient restraint... because a wrongful death suit isn't cheap. Additionally... how do they KNOW that the airway isn't affected? Are you monitoring SpO2 when you restrain someone? How about ETCO2?

The issue with sandwiching a patient is that you can impair the patient's breathing. In a normal person, it isn't necessary that much... but if someone is hypoxic from exertion, it could be life threatening - especially if the subject continues to fight.

Since we are talking about restraining a violent patient... Is everyone familiar with the term excited delirium? A decent look at excited delirum can be found here:
http://www.policeone.com/writers/columnists/ForceScience/articles/119828/ this is a police site, but the article disscusses EMS, as well as some of the causes of Excited Delirium. ED is a relitively new term for something that has been seen for years. Many cases that have been considered positional asphyxia actually seem to meet the criteria for ED. Many times, someone exhibiting ED will be restrained against their will, and in a relatively short time, the subject will stop breathing and die... This is still an evolving definition.

Here is that National Assn. of EMS Physician's Position Statement on Patient Restraint - it is a good discussion of the issue, including what services need to think about in advance. http://www.naemsp.org/pdf/restraint.pdf

 

[paramedix]

As Rid mentioned it depends on the situation at hand. If in doubt restrain. We dont have much space in our ambulances and if that patient start getting violent, there is no way to go or nothing much you can do besides getting involved.

For safety reasons I would restrain the patient, I would most probably find any reason to tell him that his back or neck might be injured and immobilize him so I could strap him down.

I had one too many patients assaulting me in the back of an ambulance and it could all be prevented.

As for suspects, they get the full monty... cuffs, spider and police restraints with an armed officer in the back with me.

 

[emtwacker710]

This was already mentioned. It is a form of "sandwiching" a patient. Back in the "old days" that was a common way to restrain a combative patient. Now we know better.

What do you mean by CO? Chief Officer? Corrections Officer? Are they an EMT or a Medic? Are they your command doc? If they aren't your command doc, and it isn't a written policy.... I'd be careful and follow your state's policies on patient restraint... because a wrongful death suit isn't cheap. Additionally... how do they KNOW that the airway isn't affected? Are you monitoring SpO2 when you restrain someone? How about ETCO2?

The issue with sandwiching a patient is that you can impair the patient's breathing. In a normal person, it isn't necessary that much... but if someone is hypoxic from exertion, it could be life threatening - especially if the subject continues to fight.

by CO i mean corrections officer, who also happens to be our squad captian and a critical care tech. (level 3) in NYS, as long as you keep the pt's head out of the reeves, you can attach the pusle ox to the ear and monitor SpO2, and I personally have not used this form of restraint myself, but I have heard of times when it was used and worked, I myself don't know if I will actually ever use this, 99.9% of the time we get a call that poses any danger to us the patrol is already on the scene or is en route and dispatch makes us stage in the area or if we need a patrol at anytime they are 5 minutes away 10 at the most..

 

[BossyCow]

by CO i mean corrections officer, who also happens to be our squad captian and a critical care tech. (level 3) in NYS, as long as you keep the pt's head out of the reeves, you can attach the pusle ox to the ear and monitor SpO2, and I personally have not used this form of restraint myself, but I have heard of times when it was used and worked, I myself don't know if I will actually ever use this, 99.9% of the time we get a call that poses any danger to us the patrol is already on the scene or is en route and dispatch makes us stage in the area or if we need a patrol at anytime they are 5 minutes away 10 at the most..

It's one of those situations where practice will change after the law suit. If there is a history of a practice causing a problem, and you follow the practice anyway, and something goes wrong, you or your insurer, will pay a large settlement. Now, there are those who will play the odds and continue to use a practice that 'so far ain't hurt nobody I know of' until their agency is sued. Some of us prefer to use risk managment.

 

[Ridryder911]

"....you keep the pt's head out of the reeves, you can attach the pusle ox to the ear and monitor SpO2" .

You do realize someone can not be breathing for up to 3 minutes before Sp02 will change?

I would not endorse any circumferential device as a restraint. There has been numerous wrongful death litigation by sandwich devices, and restraining per "wrap around". This is a very touchy legal subject, unless approved by studies and methods, I would not use.

R/r 911

 

[JPINFV]

Dr. Bledsoe has a good power point presentation on his website regarding restraints and the appropriate literature.

http://www.bryanbledsoe.com/handouts

Scroll down to the restraint one.

 

[evantheEMT]

In my state if the pt is already in restraints we can continue into our care.Protocols say we can only have someone restrained for only 30 minutes in the ambulance. If we need to restrain a pt halfway through transport then the pt had to be getting physical with us or hurting himself.In the new protocols this yr we have a certain way of postioning the pt so we can still maintain abc's and vitals.