Physical "Restraints"...share your knowledge.

Mostly we used soft, wide restraints that were velcro type. Most of the time, they worked pretty well, however, you must be constantly aware that "bridging" is possible and the restraints can be released. Think about the ROM of the limbs and how can you limit their ROM... soft restraints around the ankles works, but a seatbelt just above the knees that's fairly tight can limit the amount of thrashing that can be done. A shoulder harness/lap belt can be buckled and tightened just enough to prevent "bridging" but you also must prevent the ability for the patient to really get going... so gain control of the elbows too. You don't need tight, just enough to control where the forearms can go and help increase the effectiveness of the wrist restraints. And ALWAYS secure your restraints to the frame. The rails aren't strong enough to handle the stress and strain of someone who is really, really combative with you.

Biomechanics knowledge and perhaps a bit of knowledge of Aikido or Judo can help with the concepts. ;)

Always keep a calm, firm, yet gentle voice...

And never, ever leave the patient unmonitored. Not for an instant.

Hard restraints (handcuffs) must have a key close at hand AND when secured correctly, do not allow much movement, do not cut off circulation, and can prevent escape. For those patients that might be able to get their hands small enough to fit through the cuffs, you want to prevent any ROM that would allow them to pull against the cuff to allow the hands to slip out. Dangerous patients those ones can be...

The only patients I've ever had to have restrained in hard restraints were prisoners. High Security Prisoners at that and those always came with escorts...
 
Treating handcuff and zip-tied patients.

Setting up for a mass demonstration one time, we were confronted with the possibility of having to get patients out of zip-tied wrist restraints. This led to a discusion of zip-ties (or "butterflies") and handcuffs.

BUTTERFLIES= Plus: they don't ratchet shut with pressure, the good ones are almost an inch wide so they tend not to cut or dig in as much, since they are tight together there is less room to relax then snap taut the device causing trauma.
Minus: they often get pulled on too tightly in the heat of the moment, and they can't be released with a key, have to manage to cut them off. (Would a cast saw work at that?).

STEEL CUFFS= plus: They can be relaxed instantaneously with a key so you would never have to force shears between swollen skin and restraint to cut them off like plastic.
Minus: They ratchet tighter and tighter, so a resistant person can make it worse and worse. Just leaning on them in the squad car can do that with each road bump. As with butterflies, they can be put on too tightly at the time of arrest. Theyn also seem to cut off venous return to the arm through the wrist, creating swollen purple hands.

Akulahawk, I hear you about manual restraint and restrain theory in general. Hold the limb or torso in its weaker position (usually highly flexed, except for the torso) and they are mechanically unable (mostly) to use strength to get loose or fight. Used to grab both pants cuffs and twist them together, then move up onto the knees.

In case the readers don't know what "bridging" is yet, it is when the exceptionally strong extension muscles of the torso and legs are used to prevent the patient/subject from being immobilized in a supine position, the ultimate expression being when the subject is literally on elbows, occiput, and heels. Find pictures of old time tretanus patients and you will see this, since in tetany the strongest muscles predominate. (Solution: don't jump on the abdomen, but pull the elbows apart one person on each side. The neck will tire more quickly).

I give you....Opisthotonus in tetanus (Sir Charles Bell, 1809)
Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg
 
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Mycrofft: Excellent find for the bridging... and once the patient does this, if the restraints allow enough movement, they can bring their hands together underneath that bridge in an attempt to release their restraints. Remember, the shortest path between 2 points is a straight line. Bridging allows that to happen. Prevent the ability to do it and it becomes more difficult to get the hands underneath to undo the restraints. Prevent that much movement and again, you prevent the patient from being able to self-release.

Remember, remove the mechanical advantage, control the ROM, and you make it extremely difficult to escape. By allowing the chest and abdomen to rise and fall essentially freely, positional asphyxia is avoided.

If the patient is very cooperative, 4 point + seatbelts will do just fine. If the patient is NOT cooperative... that's when you have to start seriously working on the control part of restraint and minimizing their ability to move effectively. It's for your safety as well as theirs.
 
I don't like to use restraints, they often make the situation worse. Many times it's all in how you approach the patient that sets the tone for transport (barring some dementia and psychs.)

If you go in all "Okay we have the easy or the hard way" you put them on the defensive immediatly.

Once I was working with a jerk of a partner, we went to go get a psych. We told her she needs to sit on the stretcher. She said "No" and backed up. My partner went "I'm going to go get the poseys".

Nope, not gonna happen. I walked over to the patient, asked her "please get on the stretcher so we can get you out of here." and she was very cooperative. We didn't restrain.

I will restrain if being nice to them doesn't help, but it's usually a last resort and not the first.
 
Just to make something clear: Like Sasha, I'm not a fan of restraints. I'm not saying you should be a fan of restraints either, but you should know how to do it safely, effectively, and efficiently when they're indicated. My rule is simply this: Act like a decent human being and you'll be treated as a decent human being. Act like an animal and I'll treat you like one. It's all on them and their decisions. No need to act tough or whatever... it's just a fact and should be treated as such. Follow up on your statement. As long as they're being decently behaved, be nice to them. It's amazing how well that actually does work! (Even for the Dementia Patient.)
 
Akulahawk said:
Just to make something clear: Like Sasha, I'm not a fan of restraints. I'm not saying you should be a fan of restraints either, but you should know how to do it safely, effectively, and efficiently when they're indicated. My rule is simply this: Act like a decent human being and you'll be treated as a decent human being. Act like an animal and I'll treat you like one. It's all on them and their decisions. No need to act tough or whatever... it's just a fact and should be treated as such. Follow up on your statement. As long as they're being decently behaved, be nice to them. It's amazing how well that actually does work! (Even for the Dementia Patient.)
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Depends on the dementia patient, if they're convinced you're kidnapping them out of their homes, it doesn't matter how nice you are they might fight you... with good reason. They're scared out of their minds.
 
Sasha said:
Depends on the dementia patient, if they're convinced you're kidnapping them out of their homes, it doesn't matter how nice you are they might fight you... with good reason. They're scared out of their minds.
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Yep. That's when you must be ready for "Plan B" and implement it for safety reasons, yours and theirs.

I had a lady that pretty well into Dementia... She most emphatically lived in "Las Gaddis" but if you told her that she was going to "Los Gatos" she'd fight you... otherwise she'd be perfectly good for ya. Locals there pronounce the name the first way. :cool:

She's likely long deceased by now. But she taught me some good lessons along the way. And I'm probably one of the few people who transported her to have ever gotten her to cooperate and get a full set of vitals from her without her fighting the whole time.
 
All of our cots have soft 4 pt restraints on them at all times. I do try to avoid using them, however. I think only twice in the last 2 months. I am usually good at talking people down from being violent... As for handcuffs. If they're cuffed, an LEO or CO is coming along for the ride. That's my terms and it's my truck. We do have a state prison in our district, so we take prisoners and COs along on a pretty regular basis. They are usually in cuffs w/ a belly chain and leg irons when we have them. (and one or two have had a shock device attached to their leg.)
 
Amazing how wrestling and restraining takes away from quality treatment time.

We never used poseys or such on the civilian ambulances I worked on, just the three litter belts (before shoulder restraints were required). Most folks were OK once we were in the ambulance.

I just remembered the guy they brought in to an USAF ER I was training in. He had lost it on a field exercise, they sandwiched him with 2 canvas D ring litters, and he had rubbed his forehead raw.
 
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