Physical "Restraints"...share your knowledge.

mycrofft

mycrofft

Still crazy but elsewhere
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Thoughts, anecdotes, and especially references and studies! What works, what doesn't, what harms patients, when you can or cannot use it.

Ever been restrained for medical or law enforcement or training purposes yourself?

If you want a warm-up, use SEACH, or just go to the thread about combative opiate patients.

Let's leave chemical restraint for another day.:)
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I do transport BLS in NJ and in order to apply physical restraints to a pt you need a doctors order prior to the restraint, but in most cases if the doc thinks they will become combative or if they have a combative past then they will write an order for restraints just in case you need to use them. But the kicker is 911 BLS and 911 or transport ALS can restrain w/o orders.

I've never actually had to restrain someone but ive had docs write me orders for them before. My partners that have have always told me to hit the record button on the drive cam while I do it if i have to though.
 
I would tell you but I am physically restrained.
 
Send your cards and cakes with hacksaw blades to Firecoins, at...

:rofl:
 
In my limited experience, I'd say agitated psych pts are handled very well. I have nothing but admiration for the security in the ED. Of anyone involved in healthcare, Drs, nurses, paramedics, they more than any other seem to be able to say, "They're sick, its not their fault".

I'm passionate about (and involved in) mental health advocacy and least restrictive means and all that, and to be honest I'd be strapping/drugging a lot more people down than they do.


We have four point padded restraints on all the trucks. Put them on and hide them under a towel if you think you'll need them. Problem is, esp with some fire in their belly, the pt can sit up/head but/bite. I've heard that moving one of the arm restraints up over the head so that one arm is restrained down near the hip and the other above the head prevents this nicely. Apparently there is some issue (pain or discomfort or some rubbish). I've tried it and I didn't think it put me in any unreasonable discomfort. I'd be happy to use it and just keep a good eye on the pt. At the end of the day, if they dislocate a shoulder or similar its easy fixed and its better than them dislocating my face then jumping out of the ambulance on the freeway.

P2 mask over the face for spitting pts.

I have some personal insight in mental health problems (good for building bridges) and received some pretty good education in de-escalation, which is a bloody good thing because I sure don't have any muscle to hide behind. I do wish we had more options for chemical restraint.
 
Remember and remind about ambulance litters and restraints.

1. Once they are fastened to the litter they can still tip it or make it move around. Lower it, and keep constant contact.
2. The raise-able side rails and other smaller rods and thingees are NOT designed to take the full fury of a 350 lb battling meth head via handcuffs, manacles, or medical restraint straps.

PS: I watched a skinny little manic guy get almost all the way out of a prostraint chair twice in ten minutes. Restraint often operates by persuading the subject that "resistance is futile".
 
We don't restrain here. I have been told that the clip boards we use come in handy tho. We have those metal clipboards with the compartment on the inside, they weigh like 2 pounds by themselves.
 
Just had a pissing contest with the associate medical director last week during her excited delirium lecture which was just before our 4 hour class on defensive tactics and hand cuffing. Apparently handcuffs are o.k., haldol not so much....<_<
 
Melclin said:
We have four point padded restraints on all the trucks. Put them on and hide them under a towel if you think you'll need them. Problem is, esp with some fire in their belly, the pt can sit up/head but/bite.
Click to expand...

Our cot has a standard 4 point harness as part of the cot belts which prevents this as well. We use wide band ankle and wrist restraints on anyone who is combative regardless of the situation...even the altered head injury patient who starts plucking away at their IVs or O2 masks. We used to use a rolled up sling but that would compromise distal circulation. We apply the restraints so that a determined patient can actually free himself eventually, but the meddic has plenty of warning before he's free and is able to prevent his escape.
 
5 NJ EMTs had their certs suspended in 2010 for the death of a combative head injury patient. They restrained him while he was prone and it looks like he was in cardiac arrest by the time they got him to the rig. Cause of death was positional asphyxia.

State's suspension letter to one of those involved


News article
 
I'm wholeheartedly against them unless you're transporting a patient that hasn't been affected by a full round of attempted chemical restraint, or you're waking someone from an OD or diabetic coma that has a Hx of being violent upon awakening.

And then I go and work for a company that mandates all psych patients be placed in four point restraints.
 
I am yet to use restrains on any sort of psych transportation, regardless of history. If we are taking a patient out of a nursing home or ER, most of the time the staff has been kind enough to have provided the patient with plenty of Hadol.

If it's scene call in the city for a Section 12 (i.e. involuntary committal) and we cannot verbally persuade the person to sit on the stretcher, I'm calling dispatch and asking for a police response if they weren't sent already. It seems that two men with guns are far better 'restraints" than two EMTs with four point restraints. It's not realistic to think that my partner and I are going to get a combative patient onto the stretcher and into restraints by ourselves without someone getting hurt. Furthermore, many of our psych patient's are elderly, and I have no desire to struggle with an elderly person for fear of causing further and unnecessary injuries.
 
Soft cuffs, secured with knots that can be released in one motion, in 4 points. I don't use them often, but when I do, its one of the only choices.

Never ever restrain someone in the prone position, never leave them alone/let go of the cot with a restrained patient on there.

My personal handcuff policy is that if the patient actually needs handcuffs, the keyholder stays on the truck or on the back bumper in his own car. I will not have a patient that can't be free from his restraints in less than a few seconds.
 
i have to restrain pts often. Usually they are ETOH or on something else. I just use cravats and tie them down to the frame of the cot (not the side rails).

We do not need to be cleared by med control but we do put it in our radio reports and PCRs.

If pd is called to an intoxicated, they can either take them to lock up or call EMS (unfortunatley). That means we do get a bunch of combative pts.
 
adamjh3 said:
I'm wholeheartedly against them unless you're transporting a patient that hasn't been affected by a full round of attempted chemical restraint, or you're waking someone from an OD or diabetic coma that has a Hx of being violent upon awakening.

And then I go and work for a company that mandates all psych patients be placed in four point restraints.
Click to expand...


I think it really depends. Pretty much all of the non-incarcerated patients that I've transported in restraints were patients who resisted being put on the gurney, but once on the gurney were peaceful. Obviously your money will vary, but it's completely situationally dependent.
 
feldy, how long are your response times?

And a note about handcuffs. I've seen many soft tissue injuries cases, all minor. I've seen people making pretty credible claims about tingling paresthesia, but in a week or two it tends to go away.

Shortly after I was hired, I helped clean out the "supply room" and found a honest to gosh strait jacket. That went bye-bye REAL quick.
 
+1

I'm not a cop, I'll never use hand cuffs. Our patients are restrained because they are incapable of reason and are more likely to hurt themselves with handcuffs. Criminals are cuffed because they are within their faculties and a risk yet know there is no point in fighting against the restraints.
 
mycrofft said:
And a note about handcuffs. I've seen many soft tissue injuries cases, all minor. I've seen people making pretty credible claims about tingling paresthesia, but in a week or two it tends to go away.

Shortly after I was hired, I helped clean out the "supply room" and found a honest to gosh strait jacket. That went bye-bye REAL quick.
Click to expand...

our response times can vary depending on what part of the city we are in with respect to the call. i think on avg its about 6-8 mins.

handcuff can obviously cause some bruising if the pt fights back...in my opinion i would they pts would fight more with handcuffs on than soft restraints b/c the handcuffs would be more uncomfortable. Also, being that they are metal...if the pt fits you while u are trying to put them on...now they become a weapon and could easily strike you in the face (no thanks).
 
I was thinking more about treating handcuff injuries.

I digressed.
 
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