EMSGeek Posted July 9, 2008 Posted July 9, 2008 If you or your partner are immediate danger use force up to the level of force being used against you and then evacuate the area. You have a responsibility to keep yourself safe, then your partner, then your patient, in that order. If you need help but can hold the situation down for a bit call for law and let them do there magic. As far as specific methods I've found that triangle bandages in a four point approach works well. A straight sheet folded to approx 2' wide and secured across the torso helps minimize the damage the pt can do to their wrists. This prevents them from bucking their shoulders a lot. When securing hands if you can secure one low towards their waist and one towards their shoulders it creates a little muscle discord making it harder for them to fight.
Richard B the EMT Posted July 9, 2008 Posted July 9, 2008 I trust everyone remembers I am in a big city, and (usually) have LEO resources readily available to back me up. The LEOs are there, just by the call type, in case the patient exibits as a danger to themselves or others. If they have to restrain the patient, it is not an "Arrest'" it is "Protective Custody", although the tactics and materials they use in restraining, don't look different, because they are not different.
letmesleep Posted July 9, 2008 Author Posted July 9, 2008 CBEMT, thank you for the article first of all. I do want to pull a single sentence from it tho, sorry my quoting ability sucks.... at the end of the second paragraph the sentence is: "At no time did the ambulance personnel or anyone else evaluate his vital signs during this process." A simple question for continued discussion........WHY? As I stated before I will certainly think twice before transporting in the prone position, but under NO circumstances is it acceptable (in my opinion, and I hope all of yours) to not monitor your Pt. Again restraints are not a substitute for Pt care!!!!!! thanks again CBEMT
CBEMT Posted July 9, 2008 Posted July 9, 2008 I'm sorry but not once did I experience a highly combative pt. having airway problems. Since it didn't happen to you, it's never going to, is that it? You think we're making this shit up? Here, I'll even give you the first few Google hits: http://en.wikipedia.org/wiki/Positional_asphyxia http://www.charlydmiller.com/ranewz.html http://www.zarc.com/english/other_sprays/r...l_asphyxia.html http://www.ncbi.nlm.nih.gov/pubmed/12960668 http://www.chicagoreporter.com/index.php/c...tional_Asphyxia http://www.aele.org/law/Digests/civil169f.html
Richard B the EMT Posted July 9, 2008 Posted July 9, 2008 Letmesleep, I have no knowledge of what your experience in the field is. I will try to stay away from anything negative, but, have you never had a patient who is squirming so violently, even when restrained, that you either cannot slip a BP Cuff around their arm, or they keep banging against your equipment so that you cannot make out the sounds? I agree that vitals should be taken on all patient contacts for which a call report is filed (not nessesarily just those transported, but the Refused Medical Assistance/Against Medical Advice, and even those who are not taken as they are "pronounced" on scene), but sometimes you cannot do what you know you should do. All I can suggest, and with your local protocols as your guide, follow the triple "D" of "document, Document, DOCUMENT" as to why you were unable to attain the vital signs, with notation of witnesses, usually the LEOs, to back you up if the document should be questioned.
JPINFV Posted July 9, 2008 Posted July 9, 2008 at the end of the second paragraph the sentence is: "At no time did the ambulance personnel or anyone else evaluate his vital signs during this process." A simple question for continued discussion........WHY? As I stated before I will certainly think twice before transporting in the prone position, but under NO circumstances is it acceptable (in my opinion, and I hope all of yours) to not monitor your Pt. Again restraints are not a substitute for Pt care!!!!!! Probably because the patient never actually left the emergency room. I can probably count on one hand the number of times on a non-emergent transport that I've taken vital signs before loading the patient into the ambulance. That said, I've never restrained a patient prone under a LBB either.
Richard B the EMT Posted July 9, 2008 Posted July 9, 2008 This is coincidence, but the first posting on this other string has relevance to this string here. You'll know it when you read it! http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=
EMT347744 Posted July 10, 2008 Posted July 10, 2008 Another thought, and a few of us have mentioned "THE SPITTER". I have seen use of the NRB mask noted and the surgical mask, What are your thoughts on these two devices, and do you use anything else? I have heard of a pillow case being use in this situation, the trick is to keep turning it to a dry area through transport so you don't compromise the airway, Thoughts? By the way, sounds like most of the debate has been well stated about prone vs. supine, and honestly I will think differently about prone transport the next time I'm faced with that issue. Also let me throw out there that most of the practices (from the old days) that I and YOU all have mentioned are HUGE no no's these days like the LBB sandwich. Good debate, keep it going!!!! I absolutely put any SPITTER on a NRB mask at 12 lpm....whats it gona hurt?? Not a thing!!! Pillow cases not so good, and NO pt goes prone on my stretcher!
letmesleep Posted July 10, 2008 Author Posted July 10, 2008 Richard, with all due respect, thank you for not wanting to get into a negative debate. Just for the record I have been on a truck for 15 years both in the rural setting and in a "big city". I have worked private sector and tax based. I agree that it isn't always reasonable to obtain VS, but I never said get a set or even a full set of VS. My statement is monitoring your Pt. VS are good, but even a partial set will do if that is all you can do. talking to your Pt, even if all it does is agitate them, to assure they have a patent airway. How many time have you seen people tie down the Pt then start writing their trip sheet/ report? there is no reason not to monitor your Pt some how, hell even if your actively struggling with them you can tell a lot about them like......they are still alive! respectfully, Letmesleep
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