5150 transport

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a 5150 is a patient has been deemed a danger to self or danger to others. should this patient HAVE to be in some level of restraints during transport?
 
SD EMT OPS said:
a 5150 is a patient has been deemed a danger to self or danger to others. should this patient HAVE to be in some level of restraints during transport?
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Yes. My protocol/ company policy says arm and leg restraints at all times.
 
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Depends on the PT.

I'm assuming a 5150 is like a Section 12 in Mass or such. The only PTs that get restrained are the combative ones. If someone is transported for SI or whatnot, I won't restrain them unless it's necessary.

Most of them I've found, if you're civil to them, they'll be civil back. Unfortunately, most people don't treat them that way. That's my experience anyways
 
my company policy is the same... all 5150 pts are to be restrained in some way. does anyone know if there is a rule, law, protocol or standard of care that dictates the required minimum level of care an SI or psyc pt must be transported with?
 
SD EMT OPS said:
my company policy is the same... all 5150 pts are to be restrained in some way. does anyone know if there is a rule, law, protocol or standard of care that dictates the required minimum level of care an SI or psyc pt must be transported with?
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I've seen them get transported on BLS rigs and ALS rigs. So I'm guessing it just depends on how stable they are.
 
It depends on you're company's policy, and your county protocol. Most private ambulance companies will require any 5150 pt to be restrained and this is mostly for the safety of you as the transporting attendant, as well as the fact that the 5150 hold does not allow the patient to refuse transport on their own free will. That being said, I don't see a lot of 5150 patients being restrained.
 
I think it's stupid and unnecessarily traumatic to restrain all psych patients. Use a little common sense, watch your patient so they don't get a chance to unbuckle themselves. If they're combative, absolutely, restrain them. If they're the scared little teenager who just wanted attention or a calm, quiet schizo, then don't restrain them.

It's silly.

Amazingly a majority of the patients who are "problem" patients for the hospitals are not for me. Why? Because I treat them with kindness and respect. Approaching a patient going "I know you're being good, but because you're a little nuts I'm going to restrain you anyway" just sets the tone for a bad transport.
 
Sasha said:
I think it's stupid and unnecessarily traumatic to restrain all psych patients. Use a little common sense, watch your patient so they don't get a chance to unbuckle themselves. If they're combative, absolutely, restrain them. If they're the scared little teenager who just wanted attention or a calm, quiet schizo, then don't restrain them.

It's silly.

Amazingly a majority of the patients who are "problem" patients for the hospitals are not for me. Why? Because I treat them with kindness and respect. Approaching a patient going "I know you're being good, but because you're a little nuts I'm going to restrain you anyway" just sets the tone for a bad transport.
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If it's a 911 transport from the public into a hospital then we will normally watch them. If it's a 5150 transport then we don't have a choice. It could be a 5 year old or 105 year old. They have to have 4 restraints on at all times.
 
It's a stupid policy and probably causes more problems than they fix.
 
How about doing a bit more of a detailed assessment (the part where you actually have to talk to the patient... however traumatic that may sound). If they have suicidal iteration, do they have a plan? What methods? Timing?
Do they have the means? motive? while in your care? Are they combative? Are they calm?

Within the scope of your training and protocols, select the treatment that is appropriate to your assessment of the patient's condition. Do you slap an NRB on everyone who has had chest pain, nausea, or difficulty breathing in the last 3 months? (Oh wait...P?)
 
emt.dan said:
How about doing a bit more of a detailed assessment (the part where you actually have to talk to the patient... however traumatic that may sound). If they have suicidal iteration, do they have a plan? What methods? Timing?
Do they have the means? motive? while in your care? Are they combative? Are they calm?

Within the scope of your training and protocols, select the treatment that is appropriate to your assessment of the patient's condition. Do you slap an NRB on everyone who has had chest pain, nausea, or difficulty breathing in the last 3 months? (Oh wait...P?)
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If my protocol and company policy say that is what your supposed to do then I am going to do it. I'm don't plan on getting fired for not following policy :P
 
All patients should be restrained, even if it's just wearing a seatbelt or stretcher starps. You're going to have to follow your local protocol for any restraints beyond that.

At my service, where we did a lot of psych. transports, we didn't carry restraints and most patients were only restrained by the three stretcher belts. If a patient was to be restrained beyond that we'd get disposable restraints from the facility, or use their leather ones and return them.

A big private service in the area they required all psch. patients to be in four point restraints.

I don't think there is any best solution, but I tend to believe in giving the provider the opportunity to pick the best restraint method. Whether that be a MD or EMT, I think we can make the judgment call.
 
SD EMT OPS said:
does anyone know if there is a rule, law, protocol or standard of care that dictates the required minimum level of care an SI or psyc pt must be transported with?
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San Diego EMSA protocol for application of restraints only says the following in regards to when to use restraints, "C. Restraints are to be used only for patients who are violent or potentially violent, or who may harm self or
others."
http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/EMS-PolicyProtocolManual_2010online.pdf
Starts on page 326.

It essentially leaves the decision up to the transport crew. I think that applying it to everyone who has suicidal, or even homicidal, ideations is overkill. Conduct an assessment, and then make the decision based on the assessment. To give a good example for homicidal ideation, I once transported a patient (sans restraints, completely cooperative) who had a lengthy psychiatric history who was being seen in an outpatient clinic because he wanted to kill his wife. However, he recognized that that want was bad, hence why he was seeking treatment. Does someone who is having bad thoughts, and recognizes those bad thoughts as bad and symptoms of their illness, really need restraints beyond seat belts? Does the slightly inebriated woman who just broke up with a long time boy friend and who's BFF called police based on how the patient was venting her emotions over the phone really need restraints?

There is no simple or protocol answer to this, nor should there be. Patients present differently, and just being under a legal hold should never enough of a reason to be placed under physical restraints.
 
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SD EMT OPS said:
a 5150 is a patient has been deemed a danger to self or danger to others. should this patient HAVE to be in some level of restraints during transport?
Click to expand...

Sure. Actually, all patients should be restrained... with seat belts.
 
nonsense said:
It depends on you're company's policy, and your county protocol. Most private ambulance companies will require any 5150 pt to be restrained and this is mostly for the safety of you as the transporting attendant, as well as the fact that the 5150 hold does not allow the patient to refuse transport on their own free will. That being said, I don't see a lot of 5150 patients being restrained.
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Why should some one who is gravely disabled due to a psychiatric disorder be restrained? Are you regularly picking up patients from psychatric facilities or emergency departments restrained?
 
emt.dan said:
Do you slap an NRB on everyone who has had chest pain, nausea, or difficulty breathing in the last 3 months? (Oh wait...P?)
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I've seen protocols (a few years ago, when someone posted a link based on a request from me) that require all patients, regardless of complaint, to receive a NRB.


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We are allowed to make the decision, based upon how the patient presents. If they are being cooperative, and not acting as if they are going to be a threat or cause any problems, we do not have to restrain them (outside of the cot straps or seat belts that every patient must use). We also have the discretion to determine when physical restraints are appropriate, and when chemical restraints are a better option.

Typically, if a psych patient is going voluntarily, they aren't going to be restrained. It is the ones that are being forced to go that may end up getting restrained. With those patients, it is also policy to have a police officer follow us to the ER since they are the ones responsible for completing the paperwork for the hold. If we have a patient that we opted to not restrain suddenly require restraints for some reason, all we have to do is stop and the officer will assist us in doing so.
 
JP - *snicker*

I'm with Sasha and JP on this one.

Honestly the majority of people I restrain are intoxicated in some manner, usually alcohol, meth or cocaine (or some combination thereof). After that it is probably unmedicated schizophrenics, but with them it isn't usually because they are violent towards me, it is to keep them on the gurney.
 
It's my opinion that there should be a level of restraint above seatbelts, but below wrist restraints.

If a patient decides to suddenly unbuckle both seatbelts (standard around here is 1 lap belt and one leg belt) and leap forward toward the doors, he has a high probability...especially if he's been in and out of psych hospitals and used to the ambulance operations. The taller ones can do it more easily . . . if you're on the freeway, by the time you unbuckle your belt to reach them, it's going to be pretty dangerous try to struggle to keep them from jumping out if you're on the freeway (which has happened a NUMBER of times locally).

All you really need is something to slow down the process of unbuckling to give time for your partner to stop the ambulance (usually).

I do feel bad putting 4-point restraints on the 110 lb 16 year-old girl who is on a psych hold from the night before because she was cutting at her wrists when her boyfriend broke up with her. She's embarrassed and terrified enough.

But in the end it's all weighing pros/cons.
 
We normally transport a TON of SI/Psych patients. We are told in the dispatch the reported mood of the patient and given the notice "restraints prn" on the MDC.

If a pt is calm and collected, just the belts, (SD protocol is a minimum of 3 belts but we use the shoulder as well.) and no restraints. If the pt is hostile and poses even the slightest of a "threat" then the prn comes into play, :)

But to answer your question, no.. there is nothing I've ever read on a county or even city level that mandates 5150, 5250, or even a voluntary psych patient MUST be restrained.

-S-
 
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