Restraints for combative patients

[Qulevrius]

I get what you're saying, but the rule of thumb is that a suicidal pt may as well be homicidal. And I have an actual 'I think we can handle one little girl' case to back that up with. A very calm, cute and innocent looking 110 lbs chic who was taken on a 5150 by 2 very fit medics, who decided that she looks harmless enough to forego the restraints. It took the attending medic only 10 sec to turn her back on the pt, and she unbuckled herself, grabbed the portable O2 and decked her in the face. When her partner slammed the brakes and went to the back door, he got facewrecked too, this time by an extinguisher. The pt set off running and was later upprehended by PD. The female medic quit her job, after an extensive reconstruction surgery.

Sorry, if the pt is on a 5150, the restraints go on. No exceptions.

 

[chaz90]

I get what you're saying, but the rule of thumb is that a suicidal pt may as well be homicidal.

I think that's a pretty ridiculous assumption to make. Anecdotal evidence has no bearing, since I'm sure we can all relate stories of patients who became aggressive when we didn't expect it.

 

[gotbeerz001]

If they are suicidal, they go on a hold. If they are hearing voices, depressed, non-violent with no suicidal ideation then they can go self-commit.

The logistics issue we have is that if they are self-commit and need medical clearance, the system doesn't provide transport to PES from the ED.

 

[Qulevrius]

I think that's a pretty ridiculous assumption to make. Anecdotal evidence has no bearing, since I'm sure we can all relate stories of patients who became aggressive when we didn't expect it.

It's a rephrased question right out of a textbook test. You can take it up with whoever wrote it. As for anecdotal evidences, there's a thread in a sister forum where people repeatedly state that every seemingly ridiculous rule in the book is based on a (tragic) precedent.

 

[teedubbyaw]

It's a rephrased question right out of a textbook test. You can take it up with whoever wrote it. As for anecdotal evidences, there's a thread in a sister forum where people repeatedly state that every seemingly ridiculous rule in the book is based on a (tragic) precedent.

So you get your information from test questions?

The majority of suicidal patients want to be alone and have no intentions on hurting anyone but themselves. Educate yourself.

 

[gotbeerz001]

I can choose who and who not to restrain. Bottom line is that if they are on a hold, I don't restrain them and there an issue that results in an injury to myself or the pt, I will have some explaining to do. Some in our system see that as a reason to restrain every single pt on a hold. I apply them to all pts who displayed violence PTA. I will also apply them to those who seem erratic and unpredictable; I just tell them that it is a company preference and I thank them for being understanding. Usually works out with no issues.

 

[Qulevrius]

^ very true. I personally do not feel qualified to determine whether a psych pt will or will not flip on me, based purely on Hx and my 5-min long acquaintance with them, and since I don't plan on presenting a precedent to yet another rule in the book, I'd rather follow the protocols.

 

[gotbeerz001]

^ very true. I personally do not feel qualified to determine whether a psych pt will or will not flip on me, based purely on Hx and my 5-min long acquaintance with them, and since I don't plan on presenting a precedent to yet another rule in the book, I'd rather follow the protocols.

I wasn't advocating restraining everyone, just saying that some coworkers are lazy but justify it with the argument you lay out. LE hands out 5150s like crazy since it is an easy way to avoid both paperwork and liability; they don't have to book the person and they also kept them from being released back to the system... Hell, the cops don't even have to drive them anywhere!

I restrain (maybe) 25% of my 5150 pts. Also, if I think it is a BS hold I will take them to a hospital where on-site psych can clear the them without the further trauma of sitting at the county mental health facility.

I may change my tune if I get burned but for now I'd like to think I practice medicine with equal parts pt advocacy and CYA attitude.

 

[Tigger]

^ very true. I personally do not feel qualified to determine whether a psych pt will or will not flip on me, based purely on Hx and my 5-min long acquaintance with them, and since I don't plan on presenting a precedent to yet another rule in the book, I'd rather follow the protocols.

Then educate yourself. You are doing nothing to help your patients with such a line of thinking and are probably making their condition worse. All because you are somehow afraid of an exceptionally rare occurrence.

 

[Jim37F]

We just went over patient restraints in my new hire orientation. Reason for application boils down to one of 4 check boxes (per company policy/form): Danger to self, Danger to others, Attempt to remove medical devices, and In custody. So in line with the county policy:

"Purpose: To provide guidelines for emergency procedures and use of restraints in the field or during transport of patients who are violent or potentially violent, or who may harm self or others." (emphasis mine)

So if they're on a hold, that's pretty much one of the first two check boxes right there, or what @gotshirtz001 said, ALOC grabbing at stuff get restraints. As well as what @Akulahawk said, if they're A&O and not cooperative then they're also pretty much AMA (although I could see an alert patient wanting transport but nothing else, not even vital signs done, no need to restrain and force them againot their will, just document they're refusing treatment and leave it at that). Any questions in the field should be punted to your on duty field supervisor.

 

[Qulevrius]

Cleared it with the OP manager this morning. Long story short, there's no specific protocol and the company goes by LACo's 838 which is extremely vague in that regard. So, we're expected to 'err on the side of pt'. What it means is to try and cut the AMAs as short as possible. Specific to the case I described, I was expected to *somehow* get the pt on the gurney and then, if he continues being combative, apply the restrains. Everything else is read between the lines.

 

[gotbeerz001]

It is vague because it leaves the possibility that each case has unique properties which require provider judgement... In my experience, areas that have vague policies/procedures do so as to not limit provider judgement (i.e. they trust their people more). The double-edged sword is that the you may be on the hook to defend your actions if there is a negative outcome and there wasn't a clear-cut protocol on how to treat. Good providers appreciate this and lazy medics eventually get eaten up by it.

 

[luke_31]

If you took that patient and they didn't want to go with you, without a 5150 or declaration that the patient was incapable of handling their own affairs it is kidnapping. Your OPS manager's direction can get you into trouble if the patient is legally competent and not on a hold.

 

[Qulevrius]

If you took that patient and they didn't want to go with you, without a 5150 or declaration that the patient was incapable of handling their own affairs it is kidnapping. Your OPS manager's direction can get you into trouble if the patient is legally competent and not on a hold.

And that is exactly why I left the pt @ the BHU. There is one story too many about people who were thrown under the bus when the management had to save face, but that's a subject for a different thread.

Thanks to everyone for their input, I learned a lot !

 

[luke_31]

And that is exactly why I left the pt @ the BHU. There is one story too many about people who were thrown under the bus when the management had to save face, but that's a subject for a different thread.

Thanks to everyone for their input, I learned a lot !

Glad you understand that concept. Management has your back up till there is trouble, then it becomes well you shouldn't have don't that it's against policy. Mind you up to that point at least for private EMS, policy is transport everyone so we can bill and make a profit.

 

[Qulevrius]

Oh that concept is nothing new. It's the BS pseudo-'corporate' mentality, where everyone is deemed expendable. Not exactly EMS-exclusive.