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.
That is awesome.
5150 transport
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That is awesome.
SD EMT OPS
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I Have implemented a simple minimum level of restraint policy at my BLS company for all 5150 transports... I have added a 3rd seat belt to our stretchers that goes around the Pt's chest and secures on the back side of the stretcher. Its non-invasive or confrontational, the only people that know the Pt is restrained are my EMTs. its very effective and will allow enough time for the attendant to signal to the driver to pull over and assist in the Pt compartment and prevent the Pt from jumping off the stretcher in route. Obviously the minimum level would be based off of Pt history and crew assessment. we should always consider Pt and crew safety first.
Sasha
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I didn't know that stretchers came with less than three seat belts...
SD EMT OPS
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our strykers come with 2
Run Forest! Run!
I have transported my fair share of psych patients.
Some have tried to run. Some have succeeded.
Towards the end of my street time I wrestled with a patient trying to escape. After she reached for my trauma shears and it became a battle over them, my opinion is to let them jump out the back if they are so hell bent on it. We'll just change the destination to the trauma center.
If their goal is to hurt me, my solution is opening the door and pressing the cot release.
I have never worked for any organization that had less than 3 cot straps. 99% of them had shoulder straps as well.
In 2 countries I have provided care in, physical restraint is not permitted or only as a very last resort in extreme circumstances.
Given that psych disorders are considered biochemical in nature, I agree with the philosophy that chemical restraint should be the first treatment. But I understand the US systems make that difficult or impossible in some cases.
System fail...
To physically restrain every psych diagnosis regardless of presentation seems to me like a human rights violation. Akin to locking up or handcuffing psych patients because they are.
(Not to mention it is more trouble than it is worth)
No patients should be riding on a cot without the proper seat restraints in place.
I have transported my fair share of psych patients.
Some have tried to run. Some have succeeded.
Towards the end of my street time I wrestled with a patient trying to escape. After she reached for my trauma shears and it became a battle over them, my opinion is to let them jump out the back if they are so hell bent on it. We'll just change the destination to the trauma center.
If their goal is to hurt me, my solution is opening the door and pressing the cot release.
I have never worked for any organization that had less than 3 cot straps. 99% of them had shoulder straps as well.
In 2 countries I have provided care in, physical restraint is not permitted or only as a very last resort in extreme circumstances.
Given that psych disorders are considered biochemical in nature, I agree with the philosophy that chemical restraint should be the first treatment. But I understand the US systems make that difficult or impossible in some cases.
System fail...
To physically restrain every psych diagnosis regardless of presentation seems to me like a human rights violation. Akin to locking up or handcuffing psych patients because they are.
(Not to mention it is more trouble than it is worth)
No patients should be riding on a cot without the proper seat restraints in place.
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JPINFV
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When I worked in So Cal, everyone used just a chest belt (no shoulder loops) and a leg belt. However in Massachusetts, it was a waste, chest, legs, as well as shoulder belts.
DesertMedic66
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CA is so broke they can't afford 3 straps?
policy for my company is 5 straps at all times.... and we are in cali. we have feet, waist, chest, 2 shoulder (supervisor) straps.
those straps go on all patients. ifs its a 5150 then all those straps plus 2 ankle and 2 wrist straps.
SD EMT OPS
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your pt look like this?
DesertMedic66
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Frozennoodle
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I read a thread earlier about 201/302 patients and now 5150 patients. I could quote LRS:14 all day long and no one would have a clue what I was referring to unless you happened to be a LEO in Louisiana. Why use local codes on an international forum?
DesertMedic66
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Thats just what we are used to using.
HotelCo
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+100
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My company requires four point restraints on all 5150 transports as well.
I tell patients up front, before they touch my gurney,what is going to happen and why. The cooperative ones get them put on loosely and with most range of motion. Basically just enough to cover my a** if my manager decides to drop by.
This is mostly only on IFT's as the cops are usually to lazy to write up the paperwork on 911's
I tell patients up front, before they touch my gurney,what is going to happen and why. The cooperative ones get them put on loosely and with most range of motion. Basically just enough to cover my a** if my manager decides to drop by.
This is mostly only on IFT's as the cops are usually to lazy to write up the paperwork on 911's
I am starting to wonder if this is really for safety or used as a technicality to get medicare or medicade to pay for the transport.
I think it is time to give the good folks over there an email and find out if this is simply a form of fraud and abuse.
slb862
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I use the: "we can do it my way or your way".
Most of our psych. (chapter 51, here in Wisconsin). The police are the only ones that can Chapter someone. When in the hospital, a "Crisis Worker" is called to determine the needs of the pt. and then the pt. alot of times will be transported by the Police.
Most of my psych calls, come with a police officer on scene. The service I work for, protocol allow us to use a chemical restraint (Ativan), if needed. I have used it twice. No additional restraints were needed after each case. But, for most psych cases, all that was needed was a soft and reassuring voice. And the explaination as to what is going to be done, prior and during transport to the hospital. With the police either in the back of my rig or following behind.
You can also try the swaddling with a blanket, then the straps from the cot. Works good for the elderly.
Most of our psych. (chapter 51, here in Wisconsin). The police are the only ones that can Chapter someone. When in the hospital, a "Crisis Worker" is called to determine the needs of the pt. and then the pt. alot of times will be transported by the Police.
Most of my psych calls, come with a police officer on scene. The service I work for, protocol allow us to use a chemical restraint (Ativan), if needed. I have used it twice. No additional restraints were needed after each case. But, for most psych cases, all that was needed was a soft and reassuring voice. And the explaination as to what is going to be done, prior and during transport to the hospital. With the police either in the back of my rig or following behind.
You can also try the swaddling with a blanket, then the straps from the cot. Works good for the elderly.
I think that this is highly dependent on the situation. If you have a patient who's voluntarily coming with EMS to a medical facility, who has shown no signs of violence, and does not appear to be agitated, hallucinating, delirious, intoxicated, etc. then you may feel comfortable transporting without restraints.
On the other hand, if they've tried to fight the cops, are acting irrationally, aggressively, and you're concerned for your safety, then both chemical and physical restraint should probably be liberally applied.
I don't think this is the sort of situation where someone should try to plan for all contingencies in a rigid protocol. The paramedics / EMTs on the call should be allowed to use their best judgment. But they also have to be ready to be responsible for it.
The decision to use chemical restraint has to be balanced between the risks of a sedation procedure, and the potential benefit of facilitating transport, and preventing harm to caregivers, law enforcement, or the patient. Both leaving an agitated patients screaming and thrashing in restraints and snowing them into hypercapnia and near-apnea are irresponsible, and poor care. There has to be a balance in between.
Personally, I've found few people I haven't like more after they've had a little SL ativan.
On the other hand, if they've tried to fight the cops, are acting irrationally, aggressively, and you're concerned for your safety, then both chemical and physical restraint should probably be liberally applied.
I don't think this is the sort of situation where someone should try to plan for all contingencies in a rigid protocol. The paramedics / EMTs on the call should be allowed to use their best judgment. But they also have to be ready to be responsible for it.
The decision to use chemical restraint has to be balanced between the risks of a sedation procedure, and the potential benefit of facilitating transport, and preventing harm to caregivers, law enforcement, or the patient. Both leaving an agitated patients screaming and thrashing in restraints and snowing them into hypercapnia and near-apnea are irresponsible, and poor care. There has to be a balance in between.
Personally, I've found few people I haven't like more after they've had a little SL ativan.
My perception of the issue.
The physical or chemical restraining of psych patients is not medically indicated in all cases.
I think it is an absolute betrayal of the priviledge, esteem, and trust placed in medical professions in order to globally apply such interventions masquerading in the name of safety.
Especially when considering that a restrained patient is a medically acceptable criteria for the use and payment of ambulance transport.
It speaks ill of providers and the ambulance driver labor pool when people aspiring to be esteemed healthcare providers will tie down a patient or chemically snow them in order to make a few dollars.
Probably good that these technicians (aka laborers) aren't taught how to harvest organs or any other common surgical procedure.
What is especially troubling is the effort to hide behind SOP as an excuse in perpetrating this overt malpractice and releive oneself of personal responsibility for the act.
These ambulance drivers and owners are an embaressment to the medical community.
The physical or chemical restraining of psych patients is not medically indicated in all cases.
I think it is an absolute betrayal of the priviledge, esteem, and trust placed in medical professions in order to globally apply such interventions masquerading in the name of safety.
Especially when considering that a restrained patient is a medically acceptable criteria for the use and payment of ambulance transport.
It speaks ill of providers and the ambulance driver labor pool when people aspiring to be esteemed healthcare providers will tie down a patient or chemically snow them in order to make a few dollars.
Probably good that these technicians (aka laborers) aren't taught how to harvest organs or any other common surgical procedure.
What is especially troubling is the effort to hide behind SOP as an excuse in perpetrating this overt malpractice and releive oneself of personal responsibility for the act.
These ambulance drivers and owners are an embaressment to the medical community.