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

[StCEMT]

It's not policy for me to use restraints, just up to my discretion. I've come close to jumping straight to chemical, but have yet to have to do that since medic school. I've had more issues with people who aren't my patients or with patients that are already in the destination hospital than I have with the majority of patients themselves.

 

[Jim37F]

I worked for a company that had the "Every pt on a 5150 hold gets minimum 2 point restraints. Period" policy, and have heard of a few others around here, though my current company does not have this policy.

Suicidal ideation automatically trades your right to refuse treatment/transport for an automatic trip to the hospital. You will go, even if that means calling PD or restraining you to the gurney. Now if the ambulance crew felt that since they already had to carry you to the gurney that they didn't trust you to get squirrelly on them later and undo your seatbelts and bolt out the back on the freeway or something (that's actually happened before...how much do you think the family managed to sue that company for?) so they applied restraints as a precautionary measure (or perhaps they've ran on you before where you've gotten agitated enough to warrant restraints then, perfectly reasonable to anticipate needing them now).

Even in my mother-may-i system where medics have to call base for practically anything ALS, where BLS is treated more like Uber with a bed (and entrusted roughly the same amount of skills) I can still apply restraints to any patient at any time without calling anyone...all I have to do is articulate a reason why and document that I didn't accidentally apply tourniquets instead and that's it.

 

[Qulevrius]

I worked for a company that had the "Every pt on a 5150 hold gets minimum 2 point restraints. Period" policy, and have heard of a few others around here, though my current company does not have this policy.

Which is either cocky or irresponsible, if you ask me. I'm just going to put it here: http://file.lacounty.gov/SDSInter/dhs/206355_838.pdf

To sum it up, it gives a prehospital medical provider a carte blanche with restraints application when it comes to [potentially] unruly psychs. That being said, even if the definition of 'unruly' is purposely left to the provider's discretion, a 5150 is a 5150 is a 5150. I'm not sure if McCormick expects you guys to brawl with psychs or otherwise subdue them with brute physical force, but having a mandatory restraints policy actually helps the employees.

I'm sure we all had our share of rowdy psych pts, and know that even a 70-something y.o. grandma can be quite violent when she feels like it.

 

[EpiEMS]

I've got no rule requiring me to use restraints...though I had a partner who loved to talk about the ersatz triangular bandage as wrist restraints "technique" (if you can call it that).

I had an SI patient recently...no medical complaints, just a PD order for transport - totally non-combative and willing to be taken in. We took the patient in BLS, and no restraints were used. Why? The patient was cooperative (and 90 pounds wet, but that's not super relevant). Would it have been reasonable to use restraints? Sure - but it isn't going to make the patient's bad day less fun, and if they are cooperative at all points in time, I wouldn't say it is too incautious to eschew restraints.

 

[Seirende]

Suicidal ideation automatically trades your right to refuse treatment/transport for an automatic trip to the hospital.

Just a note, ideation is VERY different from intent. I experience suicidal ideation on a daily basis, but I am not a risk to myself. It's just involuntary thoughts.

Now, if I was prepared to take action to harm myself, THAT would require a hold.

 

[Qulevrius]

Just a note, ideation is VERY different from intent. I experience suicidal ideation on a daily basis, but I am not a risk to myself. It's just involuntary thoughts.

Now, if I was prepared to take action to harm myself, THAT would require a hold.

There's a good reason that the 1st question asked is 'do you want to harm yourself ?', followed by 'do you have a plan ?'. If plan>0 then int=psych hold.

 

[VFlutter]

Has anyone happened to be in an ICU and seen the insane amount of documentation we need just for soft wrist restraints on an intubated patient? Behavioral restraints require constant 1:1 observation, q15 min neuro/vasc checks, and a MD check every 2 hours. Legally speaking anytime you physically restrain a patient it is a huge deal. Also, if a patient arrests within 24 hours of being in restraints it is a medical examiner case.

 

[Fry14MN]

Has anyone happened to be in an ICU and seen the insane amount of documentation we need just for soft wrist restraints on an intubated patient? Behavioral restraints require constant 1:1 observation, q15 min neuro/vasc checks, and a MD check every 2 hours. Legally speaking anytime you physically restrain a patient it is a huge deal. Also, if a patient arrests within 24 hours of being in restraints it is a medical examiner case.

I work at a hospital and I have seen that "insane amount" of paperwork you are talking about. Putting someone in restraints in general is a big deal and everyone has to make sure they are covering themselves. If a patient was to get hurt while in restraints or worst case scenario as you stated above, that could end someones career if the polices and procedures that were put into place were not followed.

I see people in restraints every day. The youngest restrained patient that I have seen was 4 and I've seen ever demographic and age group you can think of. It's for their safety, the nurses and mine. I have also seen arm escorts like the OP mentioned. Just like everyone else has said, it's all about safety. If restraints is the way to go to keep everyone safe then restrain them. I've seen cases where someone should of been restrained and someone ended up getting hurt.

 

[EpiEMS]

Has anyone happened to be in an ICU and seen the insane amount of documentation we need just for soft wrist restraints on an intubated patient?

Do we need to be documenting wrist restraints for, say, field RSI'ed patients?

 

[akflightmedic]

You should ALWAYS document any and all procedures....wrist restraints is a procedure and if you did it, then it should be documented.

 

[VFlutter]

Do we need to be documenting wrist restraints for, say, field RSI'ed patients?

I am usually not one to "cover my ***" with charting but I would definitely document it and state neuro/vascular was checked every so often and that the patient was still in a condition to justify the restraints such as "to protect ETT and lines" etc because someone somewhere is going to look back and ask why an intubated sedated patient needed wrist restraints when you documented an adequate sedation score.

 

[EpiEMS]

I am usually not one to "cover my ***" with charting but I would definitely document it and state neuro/vascular was checked every so often and that the patient was still in a condition to justify the restraints such as "to protect ETT and lines" etc because someone somewhere is going to look back and ask why an intubated sedated patient needed wrist restraints when you documented an adequate sedation score.

Makes sense to me - unfortunately, when there is an ALS procedure, I'm not usually writing the chart...though I should probably be making sure to review every chart for inaccuracies (many of my colleagues aren't the most skilled at documenting).