Restraining Patients with Dementia

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exodus

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Reading the Mental PT jumps from moving ambulance thread Aidey said:

Aidey said:
Aside from the violent/threatening pts, the only other type of pt I restrain on a semi-regular basis are the elderly dementia pts/ALOC pts who aren't violent, but won't stop pulling at IVs, Oxygen, J-Tubes, Catheters etc.
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So I got to thinking, legally speaking what are we allowed to or able to restrain? Our protocols say we can only restrain after we have exhausted any other efforts. With a pt with end stage dementia we really can't negotiate with them verbally, and as a BLS we can't give them drugs to calm them down. So does that make our first line of defense soft restraints?

What would you do?

Edit: And by legally speaking, I mean, when are we not 'kidnapping'.
 
In my system, yes. The justification goes something like this (this is in my own words).

The pt has an altered level of consciousness for whatever reason, so implied consent is in place, or the consent of the pts guardian/caregiver. Unless otherwise excluded by an advanced directive, I will institute any treatments that I deem necessary to help the patient. If the pt interferes with these treatments, they are posing a risk to themselves by preventing needed medical care from being delivered. Because of this, I will put them in restraints depending on how vital the treatment is.

For example, if I want to give Narcan and the patient is fighting an IV, rather than restraining them to put in an IV, I will use the MAD to give it. But if it is a hypoglycemic patient, I need that IV, so they will be restrained. I won't do IM injections on resistant pts not in restraints, too much risk for the needle going somewhere it shouldn't.

They are still technically being restrained because they are a risk to themselves, it is just in a roundabout way.

We also sometimes pick up patients already in restraints for those reasons from facilities.

To be honest, most of the time these patients don't get put in full restraints. I will restrain one hand first, and then the other if needed. Rarely do I need to restrain their feet because they aren't violent and aren't kicking. I had an OD patient that was totally wonked out, wouldn't respond to anything, but he kept pulling at his IV with the other hand. I restrained the non-IV hand, and he was fine for the rest of the transport. Another example I can think of was a very hypoxic patient, who kept pulling the O2 mask off. Finally we restrained his hands, and once his O2 sats came up, he was much more cooperative.

Does that all make sense? I think I rambled a bit.
 
It makes sense, if they're aloc then we can operate under implied consent an will assume that they would want us to restrain them if they were in a proper state of mind to help them get definitive care. Correct?
 
Yes if they pose threat to self or others.

The restraint must be reasonable and safe. Generally this means physical restraints unless you have orders in some form to chemically restrain them.
And for hypoglycemic patients who are not behaving nicely, try darting them with some Glucagon if you have the order.

Many times our sense of urgency to them is like you or I waking up because someone is shouting orders at us and maybe grabbing. One guy I knew used whispering. The drunk or whoever would settle to be able to hear him.

Then we'd pounce on him.
 
We restrain all our patients that are flight risks or danger to others or self. Per our policies, of course. It is a judgement call. If the patient is restained when you find the patient, you better get out your retstaints.
 
If you're ever unsure about whether restraints would be permissible, talk to your supervisor and/or your medical director. As others have said, if they're a risk to themself or others (and other means are exhausted), then it may be best to restrain them. Just remember, restraints aren't a punitive thing, they're meant to prevent further injury.
 
my rig doesn't even carry restraints other than the straps on the stretcher, and im a basic, so no chemicals. i usually crouch next to the stretcher w/ one hand on the pt's wrist, and the other forearm diagonal across their chest. i try my best not to injure them. if they get to biting i wont deal with it anymore... my safety or my partners safety will always come first.... tighten the straps as much as i can without possibly leaving bruises, and just watch them until we get where we're going.
 
C-collars work well to prevent biting. The pt can't move their head enough to come at you, so it severely diminishes the range they can bite at.

Although, this is something you should clear with your MD first. I know that it is ok in my system, but our MD prefers that it is done after the pt has attempted to bite, and been warned rather than as a precaution.
 
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Dementia is considered to be a Mental Illness & in most cases will fall under the relevant Mental Health Acts.

If you can restrain a person it that situation, you can restrain a dementia patient.
 
If someone presents a danger to themselves or to others, I'll restrain them, using appropriate measures & methods. Sometimes that's just using a soft voice, sometimes that's using very physical methods and whatever devices that will secure a limb. (Hard Restraints are for LEO use) I have once, however, talked someone into restraints... but he was already having mental problems (and aware of it) and he thought it was a good idea...
 
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