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This is copy and pasted directly from our standing orders
Restraints -Mechanical/Pharmacological
INDICATIONS
Patients with actual or potential threat to self or others.Patients at risk or exhibiting S/S of the excitable phenomenon known as excited delirium.
APPLICATION
1.The senior personnel on scene is to evaluate the need for restraints. Restraints should be considered only as a last resort after verbal techniques have failed. They are never to be used for disciplinary reasons or for the convenience of EMS personnel
2.Request law enforcement assistance and Contact Medical Control for restraint order. When the patients and/or safety of othersis in jeopardy, the senior personnel on scene shall use his/her best judgmentto use mechanical and/or chemical restraints if a physicians order cannot be immediately obtainedor if, in their opinion,the time lapsein obtaining those orders would be detrimental to any individuals safety. In such cases, the senior personnel will contact medical control and the Shift Captain as soon thereafter as time permits.
3.Contact Shift Captain regarding the situation.
4. The least amount of restraint necessary to accomplish the desired purpose should be used. The restraints used may includepadded leather devices, additional nylon straps, cravats, towels, additional sheets or Haloperidol/Haldol, 5mg IM injectionin conjunction with Midazolam/Versed 2 mg IV or 5 mg IM or IN.
5.The restraints should not be limiting to the patient's peripheral or central circulation or respiratory status.
6.Soft restraints such as cravats or roller bandages can be used for extremity restraints.
7.Sheets may be used to limit upper body or lower extremity movement.
8.The restraints should be frequently monitored during transport. Breathing, circulation and neurovascular status of restrained parts must be monitored for impedance from the restraint. Care should be taken to insure that injuries to the patient are not aggravated by the restraints. The patient should never be left without at least one EMT or EMT-P in attendance.
9.Place pt. supine, fowlers or on side. Placing pts. prone/face down has been found to increase the incidences of sudden cardiac arrest
10. Raise the head of the patient slightly in order to prevent aspiration unless contraindicated by the possibility of spinal injury. In that incidence, the head of backboard may be elevated.
11. If using chemical restraint, an EMT-P must be in attendance providing continuous cardiac and SPO2 monitoring. ConsiderETCO2 monitoring if applicable. With some medications there is a tendency for a patient to develop seizure activity as well as hyper/hypotension.
12. If transport occurs from a medical facility to a mental health facility or from one mental facility to another and transport timewill exceed 45 min., a written order for a chemical agent must be obtained prior to the transport from the evaluating physician.A copy of the written order is to be attached to the patient care report.
13. In circumstances where law enforcement personnel are present and their handcuffs/shackles are used to restrain the patient, an officer with a key to the locks will remain with the patientuntil those particular restraints are removed. If the handcuffs/shacklesare to be left on the patient during transport, the law enforcement personnel must accompany patient inside the EMS unit. Documentation on call report should include reason, type of restraints, time restraints were placed and removed.
14. Any time EMS personnel use any of the above mentioned restraining methods, the facts will be documented in the P C R and an Incident Report will be filled out in detail with one copy to the Shift Captain and one copy to the Operations Director. Documentation shall include the reason for use, type used and time placed and removed from pt.
Restraints -Mechanical/Pharmacological
INDICATIONS
Patients with actual or potential threat to self or others.Patients at risk or exhibiting S/S of the excitable phenomenon known as excited delirium.
APPLICATION
1.The senior personnel on scene is to evaluate the need for restraints. Restraints should be considered only as a last resort after verbal techniques have failed. They are never to be used for disciplinary reasons or for the convenience of EMS personnel
2.Request law enforcement assistance and Contact Medical Control for restraint order. When the patients and/or safety of othersis in jeopardy, the senior personnel on scene shall use his/her best judgmentto use mechanical and/or chemical restraints if a physicians order cannot be immediately obtainedor if, in their opinion,the time lapsein obtaining those orders would be detrimental to any individuals safety. In such cases, the senior personnel will contact medical control and the Shift Captain as soon thereafter as time permits.
3.Contact Shift Captain regarding the situation.
4. The least amount of restraint necessary to accomplish the desired purpose should be used. The restraints used may includepadded leather devices, additional nylon straps, cravats, towels, additional sheets or Haloperidol/Haldol, 5mg IM injectionin conjunction with Midazolam/Versed 2 mg IV or 5 mg IM or IN.
5.The restraints should not be limiting to the patient's peripheral or central circulation or respiratory status.
6.Soft restraints such as cravats or roller bandages can be used for extremity restraints.
7.Sheets may be used to limit upper body or lower extremity movement.
8.The restraints should be frequently monitored during transport. Breathing, circulation and neurovascular status of restrained parts must be monitored for impedance from the restraint. Care should be taken to insure that injuries to the patient are not aggravated by the restraints. The patient should never be left without at least one EMT or EMT-P in attendance.
9.Place pt. supine, fowlers or on side. Placing pts. prone/face down has been found to increase the incidences of sudden cardiac arrest
10. Raise the head of the patient slightly in order to prevent aspiration unless contraindicated by the possibility of spinal injury. In that incidence, the head of backboard may be elevated.
11. If using chemical restraint, an EMT-P must be in attendance providing continuous cardiac and SPO2 monitoring. ConsiderETCO2 monitoring if applicable. With some medications there is a tendency for a patient to develop seizure activity as well as hyper/hypotension.
12. If transport occurs from a medical facility to a mental health facility or from one mental facility to another and transport timewill exceed 45 min., a written order for a chemical agent must be obtained prior to the transport from the evaluating physician.A copy of the written order is to be attached to the patient care report.
13. In circumstances where law enforcement personnel are present and their handcuffs/shackles are used to restrain the patient, an officer with a key to the locks will remain with the patientuntil those particular restraints are removed. If the handcuffs/shacklesare to be left on the patient during transport, the law enforcement personnel must accompany patient inside the EMS unit. Documentation on call report should include reason, type of restraints, time restraints were placed and removed.
14. Any time EMS personnel use any of the above mentioned restraining methods, the facts will be documented in the P C R and an Incident Report will be filled out in detail with one copy to the Shift Captain and one copy to the Operations Director. Documentation shall include the reason for use, type used and time placed and removed from pt.
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