Any one ever had to do an "arm escort"?

jaeems · Apr 11, 2017

So here's the kind of funny thing, I used to be physically escorted and restrained most times when I took an Ambulance, and I didn't think it was necessary and probably it wasn't even needed.
Anyways, when and if any of you do an arm escort and restrain, how does your medical control work in you area, and do you have police on scene already?

hometownmedic5 · Apr 11, 2017

"Most times when I took an ambulance"...

Sounds like there's a whole lot of this story you're electing not to tell us while asking us to rate the care provided to you.

Pass.

jaeems · Apr 11, 2017

hometownmedic5 said:
"Most times when I took an ambulance"...

Sounds like there's a whole lot of this story you're electing not to tell us while asking us to rate the care provided to you.

Pass.

You are right. Bad wording on my part. I would not fight them or become violent, they would simply do it because I would refuse and saw no need for hospitalization. But they did it anyways.

I hope this is better?

hometownmedic5 · Apr 11, 2017

Getting closer, but still quite far away from enough information to pass judgement.

jaeems · Apr 11, 2017

hometownmedic5 said:
Getting closer, but still quite far away from enough information to pass judgement.

Okay....
I was suicidal, and had been to hospital multiple times before. And would get released the same night/day, wouldn't be admitted.
Then, "most times I took an ambulance..." I would edit the original comment, but the time limit has passed, so I'll edit it here:
"So here's the kind of funny thing, I would be escorted and restrained in cases where I was being refusive, threatening to run away, or harming myself... Personally, I didn't think it was necessary and probably it wasn't even needed.
Anyways, when and if any of you do an arm escort and restrain, how does your medical control work in you area, and do you have to have police on scene already?"

hometownmedic5 · Apr 11, 2017

Patients either have capacity to refuse or they do not. If they are underage, on a psych hold order, or are in police custody(all potentially applicable here), they have no capacity to refuse, so they're going. They can choose to go willingly, in which case they would not be restrained; or they can go unwilling(which sounds applicable here). If they are unwilling to go voluntarily, are without capacity to refuse, and being resistive/combative, threatening elopement and or self harm, chances are most excellent they are going to be restrained. Once you're in my care, I'm responsible for your safety. If your rabbit, or grab something and harm yourself, I'm screwed.

So, still reserving judgement on the care you actually received, a patient behaving as you described would very likely be restrained by me. I do not fight patients. You either cooperate or you get restrained(physically or chemically or both depending on the patients presentation). I flatly refuse to put myself in a position where you're going to hurt me or yourself while in my care. Properly restrained, I have removed the threat and we can proceede safely and without concern.

Some people engage in this behavior involuntarily due to some measure of psychosis or disability. It's a shame to have to restrain them, but safety comes first. Others engage in this behavior with full consciousness. I feel no sympathy for someone who chooses this path.

hometownmedic5 · Apr 11, 2017

I don't need medical control for restraints, physical or chemical. I get police on all psych calls, or calls that sound like they could be.

I don't know what an "arm escort", but if I had to guess, I'd say you mean someone being led by the arm. If you're fighting me, the stretcher is coming to me and you're not walking around; so I don't really know how to answer that.

jaeems · Apr 11, 2017

Thanks for the response.

And "Arm Escort" as in when the police and a paramedic, or both police, etc. Grab the pt's arms and walk them to the ambulance. At least, that's what they called it in my EMT books and the EMT's/Paramedic themselves.

NomadicMedic · Apr 11, 2017

OP, are you a EMS provider?
This seems like it's getting close to the "medical advice" area.
I suggest that you speak with you local agency regarding their restraint protocol. Each agency is different.

MonkeyArrow · Apr 11, 2017

Or if you feel as if you have gotten inadequate care, meet with a medical malpractice attorney. We do not provide legal advice here.

jaeems · Apr 11, 2017

MonkeyArrow said:
Or if you feel as if you have gotten inadequate care, meet with a medical malpractice attorney. We do not provide legal advice here.

Oh, no. I was not saying that at all. I wasn't hoping for any medical advice. I was just trying to see by why the EMS personnel choose to do in the example and not other option. I including one of my experiences so no one would ask. (natural instinct...)

akflightmedic · Apr 11, 2017

Interesting enough, I was heavily involved in a discussion on a FB page regarding PTSD within EMS/FD and how we should be more open to screening for it during our careers but ALSO doing more extensive pre-screen before letting anyone in as there are certain indicators which preclude one to PTSD and subsequently suicide. In short, not everyone gets a trophy....just cause you want to be something does not mean you SHOULD be something....

Here is a prime example.

DrParasite · Apr 11, 2017

Lili said:
I was just trying to see by why the EMS personnel choose to do in the example and not other option.

Ok, I'll bite..... put yourself in their shoes: you have a potentially violent individual (who is threatening to harm themselves, and maybe others), who is a flight risk (read any news articles about people who jump out of moving ambulances), and they were refusing to be cooperative, despite a doctor or law enforcement saying they need to go.... what would you do?

Qulevrius · Apr 11, 2017

Lili said:
Oh, no. I was not saying that at all. I wasn't hoping for any medical advice. I was just trying to see by why the EMS personnel choose to do in the example and not other option. I including one of my experiences so no one would ask. (natural instinct...)

Because if you're dispatched to a psych call where the pt is acting up, it is yours - as an EMS provider - responsibility to make sure that nobody gets hurt. That's the 1st thing that your EMS textbook should've covered, along with scene size-up. Why, would you rather have a medic chemically restrain you instead ?

jaeems · Apr 11, 2017

Qulevrius said:
Because if you're dispatched to a psych call where the pt is acting up, it is yours - as an EMS provider - responsibility to make sure that nobody gets hurt. That's the 1st thing that your EMS textbook should've covered, along with scene size-up. Why, would you rather have a medic chemically restrain you instead ?

No, no kind of restraint is something no one would want (unless they want to for some reason, but they shouldn't). And it is supposed to be prevented, as last resort, correct?

akflightmedic · Apr 11, 2017

No. It should not be last resort. If you wait until it is last resort...well it is too late. It is called proper assessment, not only of patient condition but also all known potential risks and how to mitigate them.

Ever heard the adage "better to have and not need, than need and not have"?

jaeems · Apr 11, 2017

akflightmedic said:
No. It should not be last resort. If you wait until it is last resort...well it is too late. It is called proper assessment, not only of patient condition but also all known potential risks and how to mitigate them.

Ever heard the adage "better to have and not need, than need and not have"?

Yes, it's very good to go by.

Qulevrius · Apr 11, 2017

Lili said:
No, no kind of restraint is something no one would want (unless they want to for some reason, but they shouldn't). And it is supposed to be prevented, as last resort, correct?

It depends on whether the pt is on a psych hold or not, and whether the care had been transferred over to you.

If they're on a hold, then it's mandatory - regardless of what some might say - to transport them in soft restraints. I've heard plenty of spiels about how that 'degrades the pt' and how pts with SI 'just want to be left alone', and am not buying into any of it. You want to play it safe ? Restrain them. Later on during the ride, if it's a long one and the pt is being calm and cooperative, you could consider removing one restraint off of their non-dominant arm, but you do not have to do it (and technically, should not do it at all).

If they aren't on a hold, the care has been transferred but they're acting up - it is your obligation to make sure that everyone stays safe. That includes, first and foremost, yourself and your partner. So if the pt is thrashing about and acting like a punk - by all means, cue them in on what's about to happen and if they're still at it, apply le restraints. They keep acting up with 2 points on ? Do all 4 and enjoy the ride.

jaeems · Apr 11, 2017

Qulevrius said:
It depends on whether the pt is on a psych hold or not, and whether the care had been transferred over to you.

If they're on a hold, then it's mandatory - regardless of what some might say - to transport them in soft restraints. I've heard plenty of spiels about how that 'degrades the pt' and how pts with SI 'just want to be left alone', and am not buying into any of it. You want to play it safe ? Restrain them. Later on during the ride, if it's a long one and the pt is being calm and cooperative, you could consider removing one restraint off of their non-dominant arm, but you do not have to do it (and technically, should not do it at all).

If they aren't on a hold, the care has been transferred but they're acting up - it is your obligation to make sure that everyone stays safe. That includes, first and foremost, yourself and your partner. So if the pt is thrashing about and acting like a punk - by all means, cue them in on what's about to happen and if they're still at it, apply le restraints. They keep acting up with 2 points on ? Do all 4 and enjoy the ride.

Not trying to be any what mean to the patient or EMS personnel, but it's a good way to put it. "Do all 4 and enjoy the ride."

Bullets · Apr 11, 2017

As others have alluded to, if the patient has made threats to themselves, then they no longer have a capacity to refuse treatment and transport. At the point you are given a choice, you can come with us peaceably or you get carried out. I usually give the patient a couple of chances before we go hands on. Once we determine that the patient will not be cooperative, we may restrain them.

Qulevrius said:
It depends on whether the pt is on a psych hold or not, and whether the care had been transferred over to you.

If they're on a hold, then it's mandatory - regardless of what some might say - to transport them in soft restraints.

I think this might be a local policy, im not aware of this in my area

Any one ever had to do an "arm escort"?

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