Restraints

Shishkabob

Shishkabob

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What is your company's policy on restraining a patient? Do you have free reign, or do you have to call it in? Chemical or physical, or both?


I've had 4 combative patients in the past 4 weeks, 2 that I sedated chemically and 2 that we used restraints on.


I'm lucky as my med control has all of our restraints as standing orders (Valium, Haldol, and physical) and allows us to do what we deem necessary and safest for our safety and the safety of the patient... and the one time I called it in he fully backed me (then reminded me I didn't have to call ^_^)
 
It's all chemical in the UK, but ambo crews don't have access to any of the useful stuff.

I use lorazepam PO and IM all the time, haloperidol occasionally and rarely diazepam.
 
My company's policy is provider's discretion, unfortunately they also mandate 4 pt restraints on all psych Pts.
 
How do you like Haldol? I've used only Valium IM so far, as I'm not quite sure how Haldol would work. We can do 5mg Valium or 10mg Haldol, repeated as necessary. The Valium seems to take effect rather quickly (less than a minute before they calm down a bit)
 
Linuss said:
How do you like Haldol?
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It has it's place.

I use it when there is a florid psychotic component, in my experience, these patients are often very hard to sedate safely. They can require large doses of benzos and the effects frequently wear off quickly. I would use it in combination with lorazepam - the so-called "ten-and-two" (10mg Haloperidol, 2mg Lorazepam) - which will drop them, or at least slow them down, long enough for the sedating and antipsychotic effects of the H to kick in and calm them down.

Rather sadly, I have to do this most often to demented and disoriented little old ladies, a small dose of loraz will drop them and have them doze for the rest of the day (careful lads!).

Loraz is really quick acting (caught me by surprise the first time I used it), you have to be careful to catch them on the way down. If the situation permits, we often use security to position them on a horizontal surface before injecting.
 
Medic internship in ABQ was standing orders. We could give Versed IM and also carried Valium which we could give IM/IV. But if we needed chemical restraints we also had to have them 4ptd
 
adamjh3 said:
My company's policy is provider's discretion, unfortunately they also mandate 4 pt restraints on all psych Pts.
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What in the name of Lord :censored::censored::censored::censored:? Who wrote that :censored::censored::censored::censored:?
 
Does Haldol have a higher incidence of bad reaction than other similar drugs? I know this was a single case, but they put my grandfather on the Haldol/Morphine combo after surgery and it really messed him up. He was fighting with the nurses (and note this is an 80yo cancer patient) and pulling tubes and IVs everywhere. Of course, after the first time this happened they begged the nurses to remove his orders for Haldol, which they didn't do, and it happened again...

On another note, I was checking off meds with a medic on a ride along. Saw the haloperidol...asked if that was Haldol...they said no...
 
As a Basic in my agency, we have soft restraints that we can use at will (but you better document your reason and it better be valid!!!) On a pysch patient, if they are restrained, a police officer must ride with us.

We can't do anything chemically - not sure about ALS.
 
mar7967 said:
On a pysch patient, if they are restrained, a police officer must ride with us.
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So... umm... do you call the police before you do an interfacility transport on a patient who is restrained?
 
JPINFV said:
So... umm... do you call the police before you do an interfacility transport on a patient who is restrained?
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We don't typically do interfacility transports...we run 911 mainly, with a handful of interfacility transports per year which are not psych.

When we have a psych call, we typically stage until the police clear us into the scene.
 
Working as an EMT-Basic at a private ambulance service, often times psych patients would be transported with Haldol before transport.

Doing transports between facilities, about 25% of our psych patients in restraints, though our protocol said that they had to be provided by the sending institution. Sometimes we got disposable restraints, sometimes the leather ones.

For patients that had to be restrained on scene we used gauze rolls to restrain a patient to the cot. Usually at that point police would be called. It wasn't pretty, but it worked.
 
LondonMedic said:
What in the name of Lord :censored::censored::censored::censored:? Who wrote that :censored::censored::censored::censored:?
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I don't know, but I'm trying to find ways to bring it up and make it all provider discretion, if anyone would care to help me in my research? I've only felt the need to restrain one patient thus far. It's been my experience, though, that the majority don't become combative until after you start applying the restraints. It's ridiculous, and I hate having to do it. But being the new kid on the block I can't really do much about it now.
 
adamjh3 said:
I don't know, but I'm trying to find ways to bring it up and make it all provider discretion, if anyone would care to help me in my research? I've only felt the need to restrain one patient thus far. It's been my experience, though, that the majority don't become combative until after you start applying the restraints. It's ridiculous, and I hate having to do it. But being the new kid on the block I can't really do much about it now.
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Are you with AMR? I know that AMR had a policy that all psych patients went in four point restraints. Doesn't make sense to me, but that's what they did.
 
adamjh3 said:
I don't know, but I'm trying to find ways to bring it up and make it all provider discretion, if anyone would care to help me in my research? I've only felt the need to restrain one patient thus far. It's been my experience, though, that the majority don't become combative until after you start applying the restraints. It's ridiculous, and I hate having to do it. But being the new kid on the block I can't really do much about it now.
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So a depressed patient gets restrained and the cops ride with you?....I love blanket policies. :wacko:
 
MMiz said:
Are you with AMR? I know that AMR had a policy that all psych patients went in four point restraints. Doesn't make sense to me, but that's what they did.
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Eh, I guess it depends on your branch because I'm with AMR and I have no such policy.
 
No, I'm not with AMR, but a smaller company called Priority One.

And no, no cops here. But I am a fan of the sweeping policies like... no excercise equipment at the stations :rolleyes:
 
MMiz said:
For patients that had to be restrained on scene we used gauze rolls to restrain a patient to the cot. Usually at that point police would be called. It wasn't pretty, but it worked.
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Same here. And the option to restrain in in our stading orders. Makes it nice when you dont have to watch someone destroy the back of your ambulance while you try to get someone at your med control hospital to listen to you.

We only have to call LE if we can't handle the pt I believe. Usually though, if we have something go to heck, the first thing I do is get on the horn with dispatch and request SO or PD.
 
What, no E-cylinder stories!? GOOD!

I've used as much Ativan and valium over the years as I weigh. Benzo thoughts:
1. Benzos make you worry less and have low potential for depressing resps versus other meds. They also suppress seizureform activity and rage impulses of a neuro origin. They don't work as well if your liver is kaput, and if it wakes up all the extra benzo you gave them kicks in. Some folks have a "paradoxic effect", sort of like a "mean drunk" or "in valium veritas", and get bizarre, elated or combative. More benzo is not the answer.

Haldol thoughts
2. Haldol...has side effects but usually not unless pt has been on it a while. If you didn't know they had been/are using it, you could get tardive dyskinesthias including spastic torticolis. I've seen it used for delerium tremens and acid trips with some success.

Before you snow the pt, try to determine if they have a point to their rant, like positional asphyxia, pain, etc.

ANY restraint has potential legal and civil fallout.
 
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