The "proper" way to restrain someone in EMS

[DrParasite]

Totally serious question, and one i am going to ask for a text book or some other documentable reference for.

What is the "proper" way to restrain someone in EMS? Is there a proper method to restrain a limb, that is taught in a text book? Is there a proper device?

I would usually just let law enforcement do their thing, but I was helping to teach an EMT class yesterday, and the instructor said that sometimes City PD are unable to restrain an altered person, so they need EMS to help (didn't give me confidence in city PD, but I digress).

The technique that I was taught was apparently incorrect, and the technique that I was told was wrong (or rather, not the best way) was what was being taught to new people.

So I ask again, in the world of EMS, what is the proper way to restrain someone, and what is the textbook citation you found this information in?

 

[DieselBolus]

Ideally this is training that your agency should have strongly emphasized as it presents a tremendous amount of liability.

I'm not aware of any specific techniques that are right or wrong, so I'll largely state the obvious. It's heavily discretionary and the way that one would restrain a CVA patient is hugely different from how one would restrain a violent person with a medical complaint.

Have lots of hands ready, but involve as few as possible. Explain every step to the patient. Apologize but describe how it's for everyone's safety. Use your agency approved and provided restraints. Be prepared for everything to go wrong because it often will not go smoothly and the "correct" way described in a textbook will go out the window.

If feasible, don't forget to assess for PMS before and after. Also check for circulation, motor, and senses (teehee).

I don't have a textbook citation at the ready, but it really is fundamentally the same as immobilizing any other body part as far as assessment.

 

[STXmedic]

Ketamine.

 

[Household6]

All I was told was "face up, recovery position or lateral recumbant".

The last way I transported a restrained patient was with two pairs of cuffs chained to ankle shackles, then wrapped up in our blue sheet, and completely strapped into the Stryker.. He was a meth OD mummy..

 

[squirrel15]

I don't think that there is a "proper" way of doing it other than what is the safest way for you and the patient that is within your company policy.

 

[DrParasite]

btw, this was in an EMT class, so no one was working for an agency or company, we were educating the minds of future providers, and I didn't want to give them the wrong information.

 

[triemal04]

I don't think that there is a "proper" way of doing it other than what is the safest way for you and the patient that is within your company policy.

This.

Why is it that there is this expectation within EMS that there will be a "proper way" or an "EMS way" of doing things? Even the more trivial things, or things that can be accomplished in a multitude of ways?

My preferred method is what works for the given situation, based on how many people I have, their size, their willingness to get involved, the size of the patient, our location and future location, how much they are actually fighting, why they need to be restrained, if they are sedated, if they will be sedated, if they have another condition that needs to be treated, and if I think they will calm down. So really, it varies.

The most secure way I've seen is face up on the gurney with both feet tied down, one arm tied at their side, and the other above their head. Of course, this does up the chance of a shoulder dislocation if they are really going to go wild and try and break free.

Handcuffed is always good, but for the average person get the hands at their sides (and in a pinch you can tie the restraints to their upper thighs) and put a strap across their chests to prevent them sitting up. The feet can be ignored more often than not from what I've dealt with.

 

[STXmedic]

This.

Why is it that there is this expectation within EMS that there will be a "proper way" or an "EMS way" of doing things? Even the more trivial things, or things that can be accomplished in a multitude of ways?

My preferred method is what works for the given situation, based on how many people I have, their size, their willingness to get involved, the size of the patient, our location and future location, how much they are actually fighting, why they need to be restrained, if they are sedated, if they will be sedated, if they have another condition that needs to be treated, and if I think they will calm down. So really, it varies.

The most secure way I've seen is face up on the gurney with both feet tied down, one arm tied at their side, and the other above their head. Of course, this does up the chance of a shoulder dislocation if they are really going to go wild and try and break free.

Handcuffed is always good, but for the average person get the hands at their sides (and in a pinch you can tie the restraints to their upper thighs) and put a strap across their chests to prevent them sitting up. The feet can be ignored more often than not from what I've dealt with.

This. The way that gets the job done without causing harm. Getting students to see in shades other than black and white is one of our jobs as instructors. There is very little black and white in medicine.

 

[Chewy20]

Chances are if you are putting up enough of a fight you are getting chemically restrained (thank the lord) then soft restraints. Each foot tied to end of stretcher, one arm on the side, on arm on head of stretcher.

Like others have said, its all situational. Tell them its not rocket science.

 

[Underoath87]

I've only seen/used soft Posey restraints on the wrists (and ankles for those who are kicking). Generally in semi-Fowler position with the wrists tied to the handrails and ankles to the frame.

But these are hard to apply correctly, so you need a few extra people to hold the limbs down while you're trying them.

 

[COmedic17]

Haldol followed by benedryl.. You know... To rule out a dystonic reaction.


The reality is you do whatever you have to do to keep both you, and your patient safe. There have been times we could just pin their limbs down enough to get restraints on, and there have been times people were on drugs trying to bite us so I had to use both hands to pin their forehead down while PD assisted my partner with the restraints. Whatever is the safest. It really depends on the patient. Personally, I just sedate them first.

 

[BigBadWolf]

My final was less than a month ago and the test answer was "with soft restraints with hands in front of the patient." We never went into more detail than that other than we were told dont use cuffs and dont sandwich them between 2 backboards.

 

[DrParasite]

Why is it that there is this expectation within EMS that there will be a "proper way" or an "EMS way" of doing things? Even the more trivial things, or things that can be accomplished in a multitude of ways?

because, if you do an improper way, you can find yourself without a job, or worse, without a career?

And as the old fear mongering in EMT class did, if you get called into court over one of your actions, can you back it up based on something you found in a text book, vs an old EMTs tale? After all, putting someone between two backboards can be incredibly effective, and i'm sure it was done back in the day, but now it's frowned upon and can result in you losing your job.

The most secure way I've seen is face up on the gurney with both feet tied down, one arm tied at their side, and the other above their head. Of course, this does up the chance of a shoulder dislocation if they are really going to go wild and try and break free.

And that was the issue in question.

Back in the day, I was taught always tie one arm up top and the other by their side, because it makes it harder for them to push off. When my two fellow instructors saw me demonstrate it, they said to never do that, as it can increase the chance of a shoulder dislocation. So their line of thinking was, if that technique is done, and the patient's shoulder is injured, wouldn't you be responsible since you put them in that position? and because it does increase the possibility, shouldn't you chose a position that is safer for the patient, such as both arms down?

 

[triemal04]

because, if you do an improper way, you can find yourself without a job, or worse, without a career?

Hmmm...you get certified as an EMT and learn the "proper" and apparently only way to restrain someone. Then you get a job at Company A and use that technique on a patient. Then you get fired because the "proper" way you learned was not what THEY use. So you get a job at Company B, and use the technique from Company A to restrain someone. Then you get fired because you got you and your partner hurt by using a technique that was innapropriate for the situation. Then you get a job at Company C... Do I need to go on, or do you get the point?

I really hope what is being taught is that there is no one technique that will always work, and not that if you do anything else it is wrong, dangerous, and will get you in trouble; THAT is fear mongering, and poor instruction. Teach whatever technique in class you want, but what really needs to be taught is that nothing will work for every situation, whatever is done needs to be safe for you and your partner, as safe as possible for the patient, and what will work will depend on a host of variable things.

 

[DrankTheKoolaid]

Hogtied prone on a backboard isn't an option?


I kid I kid!

Your agency should have very clear policy on this.

 

[medichopeful]

In the ED, when someone needs to be placed into 4-point restraints (for violent, destructive behavior as opposed to for a medical reason such as protection of a tube), we do both legs, then one arm up, one arm down. Chemical restraints are the absolute last resort because they're the most invasive and restrictive (you can easily remove a limb restraint. Not really possible to remove a dose of Haldol). All restraints are soft, locked restraints, patient then becomes a 1-1 with security or a sitter and is placed on a cardiac monitor. For the "medical" restraints (if you want to call them that) to protect an ET tube, for example, both arms are placed down with soft, non-locked restraints. Sedatives are given continuously (propofol, etc). I have seen "medical" restraints with both legs restrained too, but that's pretty rare and only in very odd circumstances. Restraints are removed as soon as appropriate.

As others have said, there's no "right" way to restrain a patient, but there sure as hell are wrong ways. Strength is numbers is a good strategy to prevent injury to providers and patients. People who do cravat restraints that get tighter the more somebody struggles, however, need to be re-educated.