Patient restraints

[Grady_emt]

Fluid bags don't leave marks... h34r:

This is a very situation dependent topic. I would reccomend the book "Verbal Judo" for anyone interested in expanding their skill-set when it comes to verbal de-escalation of situations.

It seems that my partner and I get fairly regular practice with restraining pts. When it comes to physical restriant, I find it best to explain to the pt what is going to happen. Don't be a whimp, assertively explain that there are two ways that this is going to happen. First, they can cooperate, allow you to put the restraints on and take a ride to the hospital to talk to the doc. OR, if they fight, you can call down to the hospital, get orders to sedate him/her, and then put restraints on. Either way they are going to the hospital, and that by cooperating they are making things much easier for themselves.

 

[BossyCow]

Fluid bags don't leave marks... h34r:

So does the fluid then become a patient charge item? Might be difficult to explain to billing why there was a charge for the fluid but no IV tubing, cath etc. Hmmm is that why they call it a 'solution'????

 

[DT4EMS]

Let me ask some simple questions....................

1) Why are you restraining the person?
a. Is it for your safety?
b. Is it for the safety of the person?

2) Is it a true medical emergency requiring the NEED for restraints?


Think about these questions and I will give some "opinions" after we get a few answers. The answer can be much easier than we make it.

 

[Sasha]

So does the fluid then become a patient charge item? Might be difficult to explain to billing why there was a charge for the fluid but no IV tubing, cath etc. Hmmm is that why they call it a 'solution'????

You were irrigating a lac to their finger, with NS because you forgot to stock the distilled water. And you didnt dress the lac cause the patient wanted to air it out after being irrigated.

 

[Buzz]

at the risk of your life. brilliant decision sir!!!!



for future reference, this is where you turn and run. i couldnt care less if the patient wants to hurt themselves but they will not be taking me down with them. retreat, regroup, call for reinforcements.

Not so much danger after we got it away from her when she initially attacked us which we did not expect. It was at a nursing home. Would expect an 80+ year old patient to pull a weapon on you? She swung it and my reaction was to block with my hand, which luckily ended up just hitting her hand and making it easy for me to get it away from her. My partner was right on top of things as well. Not an ideal situation but given the situation it was the best we could have hoped for.


DT4EMS,

1. In my situation, the patient was mostly restrained for her own safety and partially for ours. We didn't want her trying to get off the stretcher while we were moving it or getting her hands on anything sharp in the back of our rig.

2. I'm not certain if there was any other way. Staff said they'd administered her routine pain meds and had gotten an order from the doctor to give her sedatives which had no effect. Talking down didn't work. Is there an option there I am not seeing?

 

[DT4EMS]

Not so much danger after we got it away from her when she initially attacked us which we did not expect. It was at a nursing home. Would expect an 80+ year old patient to pull a weapon on you? She swung it and my reaction was to block with my hand, which luckily ended up just hitting her hand and making it easy for me to get it away from her. My partner was right on top of things as well. Not an ideal situation but given the situation it was the best we could have hoped for.


DT4EMS,

1. In my situation, the patient was mostly restrained for her own safety and partially for ours. We didn't want her trying to get off the stretcher while we were moving it or getting her hands on anything sharp in the back of our rig.

2. I'm not certain if there was any other way. Staff said they'd administered her routine pain meds and had gotten an order from the doctor to give her sedatives which had no effect. Talking down didn't work. Is there an option there I am not seeing?

There are a couple of points here:

1) Exact reason for my article on "How safe IS your scene?" Most EMS providers are surprised by an assault. The reason..... you are trained not to go into unsafe scenes.

2) If a person is in an altered mental state (CVA, Sz, hypoxia, IDDM etc) your restraint is medical. You are providing safety for the treatment of the patient. If the AMS is due to drug or alcohol.......... well.............. you shouldn't be trying to restrain them for your safety. I have been arguing this for some time. LEO should be restraining the person not EMS.

There is a huge difference between and uncooperative patient and a combative subject. You must understand and define the differences. When a female medic gets thrown from the back of a moving ambulance by a drunk who was involved in an prior MVC........... well enough said.

That was on an episode of cops.

Here is a little tip. Control the middle joint. I did an article on "Elbow Control". It is amazing how little force is used to buy yourself a second to make a better decision when this principle is used.

 

[ffemt8978]

There is a huge difference between and uncooperative patient and a combative subject. You must understand and define the differences.

Well said, and this is where a lot of EMT's get in trouble applying restraints.

 

[jochi1543]

They tell us 4 people minimum - one person per limb. Makes sense to me. With fewer people, it might become more of a fight than a professional restraining maneuver. I'd never try to restrain someone if it was just me and my partner to do it - if I was seriously threatened and police was not nearby, I'd just run.

 

[DT4EMS]

They tell us 4 people minimum - one person per limb. Makes sense to me. With fewer people, it might become more of a fight than a professional restraining maneuver. I'd never try to restrain someone if it was just me and my partner to do it - if I was seriously threatened and police was not nearby, I'd just run.

Which again continues my argument.............


So, if you have a policy that states you are supposed to have a min. of 4 people to restrain and you use less............... and someone (you or the patient) gets injured and someone sues............

Who is left out to dry? YOU because you didn't follow the rules. That is why I contacted the NAEMSP about their position paper. It sets EMS up for serious lawsuits. Not the admin guys, but the folks on the front line.

Kip