Chemical Restraints

[MedicPrincess]

What do you guys use?

We carry Droperidal on our trucks. Some of our medics are quick to use it....others, like mine would prefer to first try and tie the patient down.

Do you guys have to call for orders for it first or is it part of protocols? We carry it, but have to get Med Control on the phone before using it. But then, we brought an extremely combative pt in from an MVA the other day and our Medical Director told my medic if he is in the ER and she needs it, just use it and tell him when she gets there.

 

[MMiz]

As a BLS unit I honestly don't know, and I've never seen it used in the field for a combative patient. I've had loads of patients on Vitamin H, that that's given by the hospital prior to transport.

 

[Wingnut]

I think we use Ativan or Versed. I know we carry both but we haven't had to chemically restrain anyone yet.

 

[Ridryder911]

Droperidol is actually an anti-emetic, and is good on sedation purposes, the problem with it is it has a nasty side effects of Torsades de Pointes (V-tach type) ... one should administer it cautiously.....

R/r 911

 

[fyrdog]

Good timing on your Question. We just had an incident in Hartford where a patient died in the ER after EMS administered a drug to calm an out of control patient. I know that we carry Haldol, Ativan and Versed. The protocol calls for a mix of Haldol and Ativan which can be given under standing orders.

This is the article from the Hartford Courant which is the only source of info that I currently have.


Hartford police Thursday identified a man who died after a violent struggle Wednesday with several officers as Don M. Johnson, 28, of New Haven.

But officials at the chief state medical examiner's office were not able to immediately determine how Johnson died. A spokeswoman for the office said an autopsy was conducted, but the cause and manner of death were not immediately available "pending further study."

Johnson died early Wednesday morning after the struggle, which followed a domestic dispute. Police and witnesses said that police were called after he punched a woman on Redding Street. Johnson fought with police officers, who attempted to calm him down using restraints and pepper spray, police and witnesses said.

Police Chief Daryl Roberts said the officers involved were Ricardo Martinez, Ivette Perez, Carlos Ocasio and Jeremy Ball . They sustained injuries during the struggle but remained on active duty.

Witnesses said the man had been taking ecstasy and drinking cognac before the police were called.

After paramedics arrived, they injected Johnson with a unspecified drug. Johnson then collapsed, witnesses said. The paramedics took him to Hartford Hospital, where he was pronounced dead.

 

[DT4EMS]

We will see what the autopsy reveals. Sounds more like "Restraint Asphyxia" to me. The patient possibly would have died even if the medics did not give him anything.

If the patient would have been allowed to continue to struggle against the restraints the same outcome would have been likely.

The medics did what they were trained to do. If two officers were injured during the initial struggle.......... it was not your run of the mill call.

 

[Luno]

Dt4ems

Restraint Asphyxia is a good possibility, but I'd also take a look at a condition 2nd to adrenaline and the extasy that pt was on. I have to go back through my notes, but they are now looking at two causes for "in custody" deaths, positional asphyxia and a second cause, usually secondary to cocaine/stimulant usage.

 

[DT4EMS]

Luno My BruddaH!!

Restraint Asphyxia is a good possibility, but I'd also take a look at a condition 2nd to adrenaline and the extasy that pt was on. I have to go back through my notes, but they are now looking at two causes for "in custody" deaths, positional asphyxia and a second cause, usually secondary to cocaine/stimulant usage.

Yeah, usually restraint asphyxia is secondary to the "Cocaine Psycosis and or Excited Delirium".

Gald to see you are still around my Bruddah! Miss having your input.

 

[Jon]

Restraint Asphyxia is a good possibility, but I'd also take a look at a condition 2nd to adrenaline and the extasy that pt was on. I have to go back through my notes, but they are now looking at two causes for "in custody" deaths, positional asphyxia and a second cause, usually secondary to cocaine/stimulant usage.

Yep... Exicted Delirium is the "buzzword" these days for the hopped-up maniacs who jump on car hoods, naked, urinating on the cops

 

[Firechic]

Haldol and Versed
It's a part of the protocols.

 

[skooter92]

Good reference page

Charly Miller's page on restraint asphyxia has some more info on this topic, especially concerning patients with something in their system:
http://www.charlydmiller.com/

 

[DT4EMS]

Charly Miller's page on restraint asphyxia has some more info on this topic, especially concerning patients with something in their system:
http://www.charlydmiller.com/

Yup. Look here:

http://emtlife.com/showthread.php?t=3141

 

[aline]

Haldol and Benedryl - Standing orders
Valium and Versed - Call in

 

[rescuecpt]

I HATE Haldol... It stays in your system for soooooooooo long (weeks) and just knocks normal people onto their butts.

 

[fyrdog]

I tired to follow up on the incident in Hartford this week. It is still being investigated so there is no new info. There are some rumors but I dont feel that it would be right to post those. If I hear any facts about it I'll post them as availible.

Right now I do not have an answer if the Patient died on scene, during transport or at the hospital.

Things that we have dicussed at work in regards to restraining any Pt
phyically restraining a patient vs giving meds
Proper pt postioning - supine head elevated - Never prone
constant monitoring of mental and respiratory status during transport
Dont cover the pt's face or head. If the pt is spitting consider a hepa mask - NEVER an o2 mask with no o2 running, a towel or pillow case.

 

[Rangat]

If we don't have ALS, we generally like, take the spine board, place on top of pt, and sit on board. the pt almost always cooperates.
What the ALS do, (and a lot of them do it easily and quickly) is as soon as the pt becomes a problem, tritrate to effect:
Morphine Sulfate + Medazolam.

Nice & easy.

 

[rescuecpt]

If we don't have ALS, we generally like, take the spine board, place on top of pt, and sit on board. the pt almost always cooperates.
What the ALS do, (and a lot of them do it easily and quickly) is as soon as the pt becomes a problem, tritrate to effect:
Morphine Sulfate + Medazolam.

Nice & easy.

Man, South Africa is sooooo much cooler than the US.

 

[Rangat]

haha, be careful!
Remember, for a paramedic to be an indipendant clinician, you have to get the experience.

And to get the experience, you have to try and error on someone. h34r:

 

[doc5242]

protocol= Versed 5mg IM for combative

call for orders=Etomidate and SUX for sedation with ET tube

no orders= "O2 therapy" with a good hard E cylinder