5150 transport

[sir.shocksalot]

I agree with Vene and the others that have said it's situationally dependent. There is 0% reason to physically restrain someone who is just sad that their GF or BF or whatever left them. In fact to do so is completely inhuman, you have basically said that this person is so F*cked in the head that they must be strapped down to a stretcher so they may not move at all. These individuals have already felt like they lost everything, now they have lost their rights by being placed on a mental health hold, now you have made this view worse by strapping people down to a bed.

Do you guys also restrain all diabetics and people with a history of seizures because "If your sugar gets low or you have a seizure and become post-ictal you might become combative"? It's completely ridiculous.

I encourage all of you who have such protocols that basically constitute some kind of human rights violation to urge their employers to look into the purchase of bucklegarde. It's what we use for those that tend to the uncooperative side of things, it simply goes over the buckle and prevents anyone without something small and pointy from opening the seatbelt.

As someone with a mental illness, I think the way some providers treat the mentally ill is completely inhuman. If I ever see anyone restraining someone because they are on a mental health hold I will correct you on the spot.

 

[Veneficus]

I agree with Vene and the others that have said it's situationally dependent. There is 0% reason to physically restrain someone who is just sad that their GF or BF or whatever left them. In fact to do so is completely inhuman, you have basically said that this person is so F*cked in the head that they must be strapped down to a stretcher so they may not move at all. These individuals have already felt like they lost everything, now they have lost their rights by being placed on a mental health hold, now you have made this view worse by strapping people down to a bed.

Do you guys also restrain all diabetics and people with a history of seizures because "If your sugar gets low or you have a seizure and become post-ictal you might become combative"? It's completely ridiculous.

I encourage all of you who have such protocols that basically constitute some kind of human rights violation to urge their employers to look into the purchase of bucklegarde. It's what we use for those that tend to the uncooperative side of things, it simply goes over the buckle and prevents anyone without something small and pointy from opening the seatbelt.

As someone with a mental illness, I think the way some providers treat the mentally ill is completely inhuman. If I ever see anyone restraining someone because they are on a mental health hold I will correct you on the spot.

I am thinking it is not so much a medical SOP as an operational mandate so the patient will meet the criteria for ambulance transport for billing purposes.

Let's face it, when basically ignoring human rights, what's a little fraud?

 

[DesertMedic66]

I agree with Vene and the others that have said it's situationally dependent. There is 0% reason to physically restrain someone who is just sad that their GF or BF or whatever left them. In fact to do so is completely inhuman, you have basically said that this person is so F*cked in the head that they must be strapped down to a stretcher so they may not move at all. These individuals have already felt like they lost everything, now they have lost their rights by being placed on a mental health hold, now you have made this view worse by strapping people down to a bed.

Do you guys also restrain all diabetics and people with a history of seizures because "If your sugar gets low or you have a seizure and become post-ictal you might become combative"? It's completely ridiculous.

I encourage all of you who have such protocols that basically constitute some kind of human rights violation to urge their employers to look into the purchase of bucklegarde. It's what we use for those that tend to the uncooperative side of things, it simply goes over the buckle and prevents anyone without something small and pointy from opening the seatbelt.

As someone with a mental illness, I think the way some providers treat the mentally ill is completely inhuman. If I ever see anyone restraining someone because they are on a mental health hold I will correct you on the spot.

If it's a 5150 IFT then we have to restrain no matter what (company rules). If they become combative we have two choices; try to restrain them or let them jump out of the rig, then call for PD.

If it's a 911 call then the crew gets to decide if they want restrants or not.

 

[JPINFV]

Could I ask all of those who have a company policy to place psych patients in physical restraint if they could just PM me what county they are in so I may send an email to the appropriate medical director to clarify the medical position on this?

I'll help you out publically with this one. Riverside County's protocol calls for 2 point restraints for all patients on a hold.


"Restraints are to be used when necessary in those situations where the patient is exhibiting or has exhibited behavior deemed to present danger to self or to the field personnel. Two-point restraints are presumptive for 5150 patients and escalation to 4-point restraints will be based on medical and safety issues. Refer to Policy # 5520, Restraints."

- http://www.remsa.us/policy/5510.pdf


"The minimum restraint necessary to accomplish needed patient care and safe transportation should be utilized. 5150 patients should receive, at minimum, 2-pt extremity restraints."

- http://www.remsa.us/policy/5520.pdf

 

[Monkey]

it boggles my mind why a pt that is NOT agressive, just depressed with SI, would need restrained.

I transport about 12+ psych holds a week between IFT's and 911's. I have YET to have to restrain one. Even the really bad schitzo effectives RARELY actually need restrained.

If a pt is not restrained by the hospital staff, why should we have to? If like a recent call, i have a 20 something pt that is depressed over life, is somber and just mopey, wouldn't strapping his limbs down like some gitmo detainee make it worse?

These private IFT's need to use their heads a bit more.

 

[DesertMedic66]

it boggles my mind why a pt that is NOT agressive, just depressed with SI, would need restrained.

I transport about 12+ psych holds a week between IFT's and 911's. I have YET to have to restrain one. Even the really bad schitzo effectives RARELY actually need restrained.

If a pt is not restrained by the hospital staff, why should we have to? If like a recent call, i have a 20 something pt that is depressed over life, is somber and just mopey, wouldn't strapping his limbs down like some gitmo detainee make it worse?

These private IFT's need to use their heads a bit more.

It all depends on how the call comes in for my company. If it comes in as a 5150 hold or psych patient then we have to use restraints. If it comes in as something else then it's the crews choice.

 

[Monkey]

so if a it's an IFT, say from a hoptial ER to a psych/BHU and the pt is just depressed but on a hold, you slap 'em in restraints?

 

[DesertMedic66]

so if a it's an IFT, say from a hoptial ER to a psych/BHU and the pt is just depressed but on a hold, you slap 'em in restraints?

Yep. It's in my county protocols for at least 2 restraints and my company protocols say 4 restraints. My company has laid off employees for not following protocols.

 

[DrParasite]

not to defend a blanket policy but....

If a pt is not restrained by the hospital staff, why should we have to?

in a hospital, you have one nurse and one tech attending to the patient area, plus security/hospital PD available with a rapid response, as well as every other doctor, nurse and tech within earshot (as well as one hospital I know has the maintenance guy help out). so in the span of (approx) 30 seconds you have have the patient restrained by lots of help. in an ambulance, it's one person in an enclosed area, and if the person goes beserk, you better hope your partner can stop hop out and run to the back of the truck to help you, or you can dive out the side door and call for help. much different scenario.

If like a recent call, i have a 20 something pt that is depressed over life, is somber and just mopey, wouldn't strapping his limbs down like some gitmo detainee make it worse?

probably not. just explain why you are doing it. it he is mopey and depressed, being restrained for a short trip isn't going to make him worse.

again, I don't like blanket policies, but I have restrained people in the ambulance (and had two LEO's with me) and the hospital didn't want them restrained, and I have brought ambulatory psychs in that the hospital ended up putting in 4-points. it all depends on the situation

but follow company and local protocols, because those are what you will be able to fall back on in case there is an issue.

 

[Veneficus]

I'll help you out publically with this one. Riverside County's protocol calls for 2 point restraints for all patients on a hold.


"Restraints are to be used when necessary in those situations where the patient is exhibiting or has exhibited behavior deemed to present danger to self or to the field personnel. Two-point restraints are presumptive for 5150 patients and escalation to 4-point restraints will be based on medical and safety issues. Refer to Policy # 5520, Restraints."

- http://www.remsa.us/policy/5510.pdf


"The minimum restraint necessary to accomplish needed patient care and safe transportation should be utilized. 5150 patients should receive, at minimum, 2-pt extremity restraints."

- http://www.remsa.us/policy/5520.pdf

Thanks,

I actually wrote to the CA Psychiatric Association to solicit their input on if they found that an acceptable practice.

 

[DesertMedic66]

Thanks,

I actually wrote to the CA Psychiatric Association to solicit their input on if they found that an acceptable practice.

If REMS does change their protocol about restraining patients I highly doubt that my company will change it's protocols about it. So if I didn't restrain a patient I wouldnt lose my EMT cert but I probably would get fired for not following company protocol. Not worth it to me

 

[adamjh3]

Vene, I am very interested in hearing their reply as I'm currently trying to fight my company's absolutely ludicrous policy of all 5150 patients being placed in 4 point restraints

 

[SD EMT OPS]

A psych pt could present totally calm and cooperative while in the hospital and during your initial assessment while on scene, answer all questions appropriately and state they understand whats happening and why the requesting party is sending them to a psych facility on a 72 hold (in-order to be placed on a hold -5150 et sec- the patient must be deemed a danger to self or others by police, ER MD, or psychiatrist). the RN then tells you they have been totally calm and cooperative the entire time the pt has been in the ER and they don't need to be restrained. So you say "OK" and don't restrain the patient. during the transport the pt freaks and jumps out the back committing suicide by ambulance. (actually happens) whose fault?? the transporting crew gets the blame.. and company gets sued for wrongful death and possibly the the Medic or EMT could be sued. I have NEVER had a pt say " i'm going to freak out and jump out the rig in 5 min."
so in-order to prevent this situation from happening our companies policy is that all patients on an involuntary hold must be retained in some way. that level of restraint is based on Pt history and your pt assessment. not all need to be placed in 4 point leathers. there are far less invasive ways to secure a patient to the stretcher to allow the driver enough time to pull over and assist the attendant in the back or prevent the pt from exiting the rig in the middle of a freeway.

 

[kevin1988]

Just because the person is in restraints doesn't mean they are strapped down tight to the gurney. Like I said earlier my company's policy is 4 point restraints on all 5150 IFT's. I do it because I don't feel the need to be written up for violating policy.

With that being said, if the patient is cooperative and calm, I put the restraints on extremely loose and they still have full range of motion. It's basically CYA for me against my employer.

I've had a few patients that were cool, calm and collected in the ER go apesh*t in the back of the rig during transport. It's nice to be able to just tighten up the restraints instead of fighting with the patient to get the restraints put on.

 

[JPINFV]

why the requesting party is sending them to a psych facility on a 72 hold (in-order to be placed on a hold -5150 et sec- the patient must be deemed a danger to self or others by police, ER MD, or psychiatrist).

You are missing a third indication for a 5150. A patient may be placed on a 5150 hold if they are gravely disabled due to a psychiatric disorder. Additionally, deemed a danger to self or others does not necessarily mean that they dangerous at the time of the encounter. Additionally, if they are an acute danger to self or others, the hospital isn't just going to have security sit with them, even with the additional resources that the hospital has.

so in-order to prevent this situation from happening our companies policy is that all patients on an involuntary hold must be retained in some way. that level of restraint is based on Pt history and your pt assessment. not all need to be placed in 4 point leathers. there are far less invasive ways to secure a patient to the stretcher to allow the driver enough time to pull over and assist the attendant in the back or prevent the pt from exiting the rig in the middle of a freeway.

So, in other words all psychiatric patients are restrained with, at minimum, seat belts? Does your company regularly condone transporting non-psychiatric patients without seat belts?

 

[JPINFV]

Just because the person is in restraints doesn't mean they are strapped down tight to the gurney. Like I said earlier my company's policy is 4 point restraints on all 5150 IFT's. I do it because I don't feel the need to be written up for violating policy.

The last thing I would want to do is try to justify anything with "Befehl ist Befehl." I've of the understanding that that argument doesn't work well...

With that being said, if the patient is cooperative and calm, I put the restraints on extremely loose and they still have full range of motion. It's basically CYA for me against my employer.

How long are your straps that they allow full range of movement? Pretty much just as importantly, if the patient has full range of movement, are restraints really doing anything? Can the patient, say, wipe his nose?

 

[SD EMT OPS]

So, in other words all psychiatric patients are restrained with, at minimum, seat belts? Does your company regularly condone transporting non-psychiatric patients without seat belts?

thats why i said involuntary hold... not all psychiatric patients

 

[SD EMT OPS]

seat belts would not be considered a form of restraint when the pt can reach down and unfasten them. and yes ALL pt's as well as any/all other occupants in the ambulance must be seat belted .. thats state law.

 

[JPINFV]

...but what sort of non-locking restraint are you equipped with that allows both a full range of movement, yet can't be reached to be unlocked?

 

[Monkey]

Much of the policies sound like distrust in the EMT. If the EMT is with the pt, not in the captains chair at the head, and is paying attention to what the pt is doing, then it'd be pretty damn hard to commit death by ambulance if they all of a sudden snapped and went from calm to crazy in my opinion.

and yes, the 5150 hold includes those that are a danger to self as well as gravely disabled, both stating in the paperwork that they cannot properly care for their daily needs and well being, not always being a danger in the sense they're maniacs.

I also agree that the ER has more staff, and usually when we arrive, they have a sitter or security watching the pt outside the room, but that is SOP around here.

I don't know, I guess it just seems overkill and sort of barbaric to have to restrain a person, just because.