Explorer127
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Is it difficult to restrain patients? Usually, how many people are needed to restrain someon?
Patient restraints
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JPINFV
Gadfly
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There is no answer to this question. Every situation is unique to the skills of the provider, the equipment available, the scene, and the patient. I've restrained patients who weren't combative at the time of restraint with only two people (my ONLY hard and fast rule with psychiatric patients and restraints is if the patient is restrained when I arrive (i.e. handcuffed and in a cop car), then the patient shall be restrained on my gurney) all the way up to 7 or so people (person for each limb plus two people to apply restraints, plus nurse to administer haldol. This was in an ED, so help was readibly available).
In general, more is better. You want at least one person for each limb. Ideally speaking, a few more people to apply the restraints so that the people restraining the limbs do not have to try to fiddle about with the restraints while holding a limb. When restraining, each person should be assigned a role/limb prior to even approaching a patient as well as having the gurney set up to accept the patient. In addition to restraints, it is helpful to have a surgical mask available in case the patient begins to spit.
Finally, verbal deescalation is much more important that restraints. I've never gotten the entire fetish thing that the majority of EMS has with restraining psychiatric patients. That's not to say that I have a problem with restraints. They do have their uses. It's just that generally restraints are near the bottom of my list of things to use when dealing with patients.
In general, more is better. You want at least one person for each limb. Ideally speaking, a few more people to apply the restraints so that the people restraining the limbs do not have to try to fiddle about with the restraints while holding a limb. When restraining, each person should be assigned a role/limb prior to even approaching a patient as well as having the gurney set up to accept the patient. In addition to restraints, it is helpful to have a surgical mask available in case the patient begins to spit.
Finally, verbal deescalation is much more important that restraints. I've never gotten the entire fetish thing that the majority of EMS has with restraining psychiatric patients. That's not to say that I have a problem with restraints. They do have their uses. It's just that generally restraints are near the bottom of my list of things to use when dealing with patients.
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tydek07
Forum Captain
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Hi,
First off, JPINFV is correct. There is no answer to this question as each situation is different. With the cases I have had to use physical restraints, usually 4 people are enough... one for each limb. Now, when I have used chemical restraints, we have had upwords of 6 people (Police, EMS, Fire) holding the pt down while we give the "sleepy time" drugs.
I can go on and on, ramble ramble ramble away... but at the end, will still not be able to answer your question.
Take Care,
First off, JPINFV is correct. There is no answer to this question as each situation is different. With the cases I have had to use physical restraints, usually 4 people are enough... one for each limb. Now, when I have used chemical restraints, we have had upwords of 6 people (Police, EMS, Fire) holding the pt down while we give the "sleepy time" drugs.
I can go on and on, ramble ramble ramble away... but at the end, will still not be able to answer your question.
Take Care,
firecoins
IFT Puppet
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2 people. Thats all I got. If we need more help we are calling for back up.
Agreed. I've seen plenty of patients who could have been transported without restraints had the crew been more diplomatic. Too often I think that EMTs, especially Basics, make things far more difficult for themselves, and provide worse care for their patients, by not taking the time to actually talk to their patients. And no, ordering them onto the cot does not count.
I've done plenty of psych pickups (911) and interfacility transfers, and quite honestly, most patients become cooperative and calm once they're in the ambulance, away from the stresses of the scene, police, family, etc.
Read Dr. Bryan Bledsoe's presntation on the subject.
It can be found at
http://www.bryanbledsoe.com/handouts
It can be found at
http://www.bryanbledsoe.com/handouts
mycrofft
Still crazy but elsewhere
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Restraints, and restraints. "Retraints restraint"?
Step back, big picture.
1. Know your company or agency policy.
2. Know why the pt is restrained. In fact, consider if you want to take the responsibility for assuming this case. (One classic joker is an Elvail OD; fast and furious then flatline). If the pt is being transported from a care facility, why isn't the pt stabilized? Are you continuing an "illegal arrest" and kidnapping perpetrated by an illegal restraint then unwilling transport?
3. Remember once the restraints are on they have to stay. Do your distal sense/circ/ROM checks but the restraints stay on until you arrive or are replaced by another official (no improv) mode due to medical necessity.
4. In jail, ideally a minimum of four for takedown and transfer to Prostraint chair. Eight is too many to participate but their presence can quell troble before it starts.
5. And if you are forced to do this, do not improvise unless it is life or death, because improv restraints can kill the subject (if he struggles to death and you improvised, you killed him); never secure restraints to the siderails or small bars under tha matress, secure them to nice big rail running around the mattress pad; if you accidentally secure them to the bottom bar you normally lift by, the pt does interesting things when you go to raise the litter, or lower it.
Step back, big picture.
1. Know your company or agency policy.
2. Know why the pt is restrained. In fact, consider if you want to take the responsibility for assuming this case. (One classic joker is an Elvail OD; fast and furious then flatline). If the pt is being transported from a care facility, why isn't the pt stabilized? Are you continuing an "illegal arrest" and kidnapping perpetrated by an illegal restraint then unwilling transport?
3. Remember once the restraints are on they have to stay. Do your distal sense/circ/ROM checks but the restraints stay on until you arrive or are replaced by another official (no improv) mode due to medical necessity.
4. In jail, ideally a minimum of four for takedown and transfer to Prostraint chair. Eight is too many to participate but their presence can quell troble before it starts.
5. And if you are forced to do this, do not improvise unless it is life or death, because improv restraints can kill the subject (if he struggles to death and you improvised, you killed him); never secure restraints to the siderails or small bars under tha matress, secure them to nice big rail running around the mattress pad; if you accidentally secure them to the bottom bar you normally lift by, the pt does interesting things when you go to raise the litter, or lower it.
Sasha
Forum Chief
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When I've restrained someone, the medic had me sit on the person while he got the limbs in the posey's and tied them down. It's really hard to sit on someone who wants to kick your partner's bum.
Buzz
Forum Captain
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My partner and I have had a couple of incidents where we needed to get creative with a sheet and the 5-point... One was a Behavioral patient picked up from a nursing home who actually tried to stab us with a shiv when we showed up. The nursing home staff said they didn't want to get the police involved <_< so they called us instead. We just sort of wrapped her with the sheet and then put the 5 point harness over top of that so she couldn't get a hand free. Looking back, yeah--we probably should have called for PD but she was also displaying self destructive behavior (slamming her head into things) and we wanted to minimize the damage she was doing to herself.
KEVD18
Forum Deputy Chief
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at the risk of your life. brilliant decision sir!!!!
for future reference, this is where you turn and run. i couldnt care less if the patient wants to hurt themselves but they will not be taking me down with them. retreat, regroup, call for reinforcements.
WuLabsWuTecH
Forum Deputy Chief
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I read in there that hogtying has resulted in patient death. How did that happen? We learned not to do it but never elaborated on how the pt dies b/c you hogtie them!
It's either excited delirium or positional asphyxia, usually.
mycrofft
Still crazy but elsewhere
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Positional asphyxia is the biggee
That's why PD's stopped cuffing arrestees to floor grates and bought prostraint chairs.
That's why PD's stopped cuffing arrestees to floor grates and bought prostraint chairs.
BossyCow
Forum Deputy Chief
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Your agency should have a written protocol regarding restraints in addition to the regional protocols regarding them. Face it, you are not going to be using full restraints on your nicest patients so being within your protocols is extremely important.
In our protocols, there must be 'documented' attempts to verbally de-escalate the situation before deciding on the restraints. Then the decision to restrain must also be fully documented with an acceptable reason. (he pissed me off not counting as acceptable) No chemical restraints can be used without documenting that it was for pt safety ie: life saving treatment could not be given without it, or pt was going to worsen injuries from thrashing. We are also forbidden to fasten the pts hands behind their back.
I'd really recommend getting a copy of your protocols and checking out the procedures allowed and disallowed. You don't want to learn that information in court.
In our protocols, there must be 'documented' attempts to verbally de-escalate the situation before deciding on the restraints. Then the decision to restrain must also be fully documented with an acceptable reason. (he pissed me off not counting as acceptable) No chemical restraints can be used without documenting that it was for pt safety ie: life saving treatment could not be given without it, or pt was going to worsen injuries from thrashing. We are also forbidden to fasten the pts hands behind their back.
I'd really recommend getting a copy of your protocols and checking out the procedures allowed and disallowed. You don't want to learn that information in court.
mikie
Forum Lurker
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Med control must be sought to restrain a patient (my protocols)
DT4EMS
Kip Teitsort, Founder
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Well, I have a surprise for several in this thread..................
You are under a barrell so to speak and are unaware. I can assure you lawyers ARE aware.
The NAEMSP put out a position paper in 2005 stating it takes 5 people to medically restrain a patient.
I called and spoke to some of the people involved with this 'postion paper" and advised them of the problem. How many of us have 5 people present when a medical restraint is needed?
Restraints are a very touchy subject. Why do you think police officers have "tools" for people who don't want to be placed into restraints (Handcuffs).
In teaching Defensive Tactics (DT) I explain, no one person can restrain another person UNLESS the person being restrained allows the restrain to take place.
You are under a barrell so to speak and are unaware. I can assure you lawyers ARE aware.
The NAEMSP put out a position paper in 2005 stating it takes 5 people to medically restrain a patient.
I called and spoke to some of the people involved with this 'postion paper" and advised them of the problem. How many of us have 5 people present when a medical restraint is needed?
Restraints are a very touchy subject. Why do you think police officers have "tools" for people who don't want to be placed into restraints (Handcuffs).
In teaching Defensive Tactics (DT) I explain, no one person can restrain another person UNLESS the person being restrained allows the restrain to take place.
Ridryder911
EMS Guru
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Hello medical control, we are getting beat up, mind ...uh.. if we can restrain them ..over.. Medical Control? .... Stand-by, we'll get the physician.. Yeah, this is the physician what is it you need...Over.
Let's be real about it. Like Chip described those that write the policies are the ones that never have to deal with the situation. We need to develop emergency criteria that is safe to to the crews and safe to the patient. Awaiting for orders, awaiting for five people to assist is unrealistic.
Maybe we can start a dialogue of proven and safe measures.
R/r 911
BossyCow
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Yep... 5 people is the minimum listed in my protocols with one for each limb and one for the head.I wonder though, it is referring to having to restrain an unrestrained pt. In most cases for us, the restraints are being put on someone who is already restrained by law enforcement and generally has the cuffs on and hands behind their back. Transferring that to a soft restraint system can be a real picnic! Plus having to wait at the ER for the pt to be released from the restraints so you can get your gurney back. I was at an ER for several hours one morning because that halodol just wasn't working good enough yet!
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mycrofft
Still crazy but elsewhere
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Five to hold, then who puts on the restraints?
Medical, humane manual restraint takes five, but going on to apply the physical restraining devices takes another one or two.
Know your protocols then practice them. Here the officers have recently had the greenlight to prostraint inmates before things get frenzied, once the need is established. Accidents related to the process and physical harm to inmates (and staff) generally have gone down. Practice and critique (all restraint episodes are videotaped closeup with sound) make for safe quick performance.
Medical, humane manual restraint takes five, but going on to apply the physical restraining devices takes another one or two.
Know your protocols then practice them. Here the officers have recently had the greenlight to prostraint inmates before things get frenzied, once the need is established. Accidents related to the process and physical harm to inmates (and staff) generally have gone down. Practice and critique (all restraint episodes are videotaped closeup with sound) make for safe quick performance.
BossyCow
Forum Deputy Chief
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We just did this in drill. I picked the strongest, fiestiest, most devious little firefighter we got to be the pt. I told him I'd pay him $20 if the volunteers weren't able to restrain him. Was a real eye opener!