YOU, THE VIOLENT PSYCH, AND THE RESTRAINTS.......

[Eydawn]

You asked us why, were given reasons as to the danger of its use and the opinion of most providers that it is an unnecessary risk (and by extension, therefore, never to be used). Then you responded and said why are you saying never do this- after it was explained by multiple providers.

In continually arguing that it has merit in isolated instances of use, you are in effect asking us to change our opinion and add it to our toolboxes as a "last resort" type deal... or at least asking us to concede that it may be appropriate as a last ditch resort for some providers, even if we choose never to use it.

I disagree! Obviously... I think it's something where the risk far outweighs potential benefit and I'd much rather wait for the person to calm down or for chemical sedation to be available... or for more hands to get them restrained seated or supine.

Now, will I shoot you if you say you used a prone restraint because you ran out of options, and it was prone or let them get hit by a car? No... but you better be ready to justify how you did it and what safeguarding steps you used. And I will still probably second guess you... because that's what we do here on the forum. We Monday morning quarterback every call, to see what could be done differently next time.

Wendy

CO EMT-B

[letmesleep]

Obviously there is 2 sides to this issue, and it appears to have a similar effect as Roe vs. Wade.........

I have done this before, it has been many, many years ago. As I have stated in this thread, I will think twice about using a prone position to transport in the future. I also have stated different ways to ensure the safety of the Pt. This isn't some random/ unheard of means of transport, and does take a little more time and effort than simply sitting back and relaxing after the Pt has been restrained. I didn't ask YOU or anybody here to put this in your "toolbox" of treatments, in fact don't! If you are uncomfortable with this, by all means stay as far away as possible from it, but don't judge me for using it. I have also used the "coma cocktail", and epi down the tube in the past, so what? Times have changed and WE as professionals should be responsible for changing with the times. All of the different means for restraint mentioned early in the thread are old (LBB sandwich as an example), and may still get used, but just because we have evolved from those days, does that make it wrong to use them these days? If somebody out there throws MAST pants on a Pt with IVs, are they wrong for doing that?

[Eydawn]

Yes, if that patient has abdominal trauma and we're squeezing all the blood into their abdomen for a false sense of elevated pressure and symptomatic relief. That would be wrong. And since I'm not an X-ray and don't have MRI visualization capacity... I'm not going to waste time with an intervention that is more likely to be harmful.

When we learn new things about the risks and benefits of treatments, that should absolutely change our treatment decisions. That's why we go through continuing education... right? It *may* be appropriate in individual instances to restrain and transport someone prone. But I'm willing to bet you that even in those instances, one could probably find a safer solution than just falling back on the "old school" and what's "been done in the past."

There's a reason we don't bleed people with fevers anymore... but do apply leeches post-surgical reattachment....

Wendy

CO EMT-B

[Eydawn]

By the way... any provider that assumes that their job is done once the person is restrained (supine or otherwise) and fails to provide other treatment during transport is an idiot and needs serious review.

Can you illustrate why you feel prone restraint is beneficial, over the wait for resources method? What instances have you used it in, and how did it provide better patient care? Not saying that it doesn't, I just would like to see your rationale on it.

Wendy

CO EMT-B

[reaper]

You may use the prone restraint, if you want. If that pt happens to get a lawyer, you will have a hard time justifying it's use. It is documented that it can lead to death. A lawyer will eat you alive on that one, even if nothing happens to the pt.

You must remember what has been stated already, Standard Of Care! This means that if the lawyer were to ask other EMS providers, would they state that it was acceptable!

You have already seen that all but one person on here has stated that they would not use it. That is Standard Of Care! :shock:

[firedoc5]

See my topic of "Freak Out" and that is one instance for using prone. When it takes seven police and fire personnel to just get him to stop digging his finger nails into the asphalt, trying to kill anyone in his arm reach, and feeling no pain, yes, it's time to put him prone. Try getting all those people into the rig, along with yourself and your partner. In that case he was prone for all of 7-10 minutes. We had a high incident rate of such cases for a town of a little less than 20,000. I've seen guys that have already been given 100mg. of Thorazine and massive amounts of Valium and keep right going. How do you restrain someone that had just been tazered six times and still go on to break a police officer's nose? Shoot 'em. I've seen that before too.

I'm not trying to get anyone to change the way do it. If you're against it, then don't do it. But for those of us that have had to do it, don't put it down. Nobody died from it in our care. We had safeguards for both us and the patient. I've heard of instances where someone had died while being prone, but how much of it was from other influences, OD, alcohol toxicity, whatever was making them violent in the first place? That's what should be looked at first.

[Laura Anne]

From my point of view, I have yet to come across a patient that I would have to restrain in a prone position. Doesn't mean it'll never happen.....

Heck, I had my first tree impaled into a patient approx a month ago. Try backboarding that! :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock:

Basically, I agree with the 'never say never' theory: until I am stuck in a situation that calls for the care of my unruly patient, or a patient in a unique position to be placed prone, I will be able to justify it. If you can't justify it, I'd recommend not doing it.

What frightens me is the providers out there that think they can do anything they want (AKA MACHO SYNDROME) and think they can justify their actions. The problem is that from their training and point of view, the care provided is justifiable. Looking in from the outside though, we can all give our reasons/views as to why their choice wasn't the best option and VIOLA!!!!! places like EMTCITY are created.

This is an educational tool and the comments from all should be taken in with a grain of salt and appreciation. This is why I love these posts because I learn a ton from reading them.... 8)

[letmesleep]

OK, time out wendy. Why is their treatment wrong if they still have protocols and equipment on their truck in the case of the MAST pants? This is my whole argument. WE both do agree on the continuing education, and sounds like WE both agree on changing with an ever evolving medicine, but why are they wrong? Another point that I'm trying to make (and I will concede that my point may not be coming acrossed very well) is, as you stated that you are not an x-ray or MRI, is there another way to evaluate this pt?

As far as transporting in the prone position, it has been done before by me and others, and as far as improved medical care (or better) from your choice of treatment there is none, It would be the same as far as over all Tx. When a Pt gets transported in the prone position, they should be evaluated more closely than a "typical" Pt in a supine position. Even if talking to your Pt pisses them off and aggitates them you know they have an airway (much like a baby crying in a peds scenario), but also in this situation the provider should increase how often the VS are taken. Firedoc also pointed out that the Pt should be turned back over as soon as they have calmed down, either on there own or with sedation.....and that should be done immediately! This Pt shouldn't be left alone at any time including after arrival in the ED. It's not so black and white which is why medicine is a science, all I'm saying is that there may be a time, and if that time occurs what are we going to do? Call in your ALS truck for transport, but don't look down on others that take another approach.

I think this has gotten way of the original issue about restraining your (generalized) Pt, and I haven't heard back from those who said they would hand the whole thing over to PD.

[JPINFV]

OK, time out wendy. Why is their treatment wrong if they still have protocols and equipment on their truck in the case of the MAST pants? This is my whole argument. WE both do agree on the continuing education, and sounds like WE both agree on changing with an ever evolving medicine, but why are they wrong?

What exactly is the point of CMEs and following changes in medicine if we don't change our standards? What was right 10-20 years ago might not be right today. Similarly, what was wrong 10-20 years ago might be right today. Just because someone was around 20 years ago doesn't mean that they should still be providing care the same as 20 years ago. Similarly, a provider who restrains a patient supine is wrong because they are violating the standard of care (which is more than just a simple vote of current providers. There are way too many morons out there providing care to make me not care what an average EMT-B thinks) of today. Sure, it might have been the standard 20 years ago, but that was 20 years ago, not today. Otherwise we should be carrying leaches since they were the standard of care 100 years ago for just about everything.

[Eydawn]

JP, I know you mean restraining prone not restraining supine *wink.*

Their treatment is not violating protocol if they work for somewhere so archaic that they still carry and use MAST. Note the use of the word archaic... most services don't carry MAST anymore, because it's been proven to have little beneficial effect for the patient. There are many here who would argue that those protocols, if still in place in that service, are wrong. Doing harm, or doing something that does absolutely nothing of benefit and delays you on scene, thereby delaying definitive treatment, is *wrong.* Might be time for the agency to update its protocols based on research... not on "what they've always done."

Medicine is not black and white, nor is it an exact science. Very much agree with you there, and improvisation is the name of the game. Note my previous statements about it potentially being useful in isolated incidents-- here's the crux though-- but not to the extent that it should be incorporated as an approved method of treatment/transport for everyday protocols.

I do not foresee, in my area, a need to transport a patient in a prone restrained position. As a matter of fact, I would think that if you can get them under control in a prone position, that you could potentially get them into a recovery or supine position, which would be more suitable for transport. I know it's hard to think quickly when your butt is getting whooped, however... I completely understand having someone go ape-shit on you and struggling to get ANY control over them to protect yourself and those around you.

I think it is never appropriate for ME to transport someone restrained prone, where I am and working with who I work with. I would caution about using prone restraint elsewhere, save in case of extreme last resort... and I would advise anyone finding themselves confronted with such a transport to ensure that PD rides along, and that documentation (including photographs of the exact position) be very thorough and clear.

We all have to do things that are a little screwy sometimes to get the job done. It doesn't mean we should make screwy the standard of care... because then people get lazy and patients die. Does my position make sense?

I'm very sensitive to the issue of restraint in general, because in the developmental disabilities world, we have a set of person-person restraints (no kerlex or cuffs) that we are allowed to utilize... and you do *not* deviate from approved holds without a damn good reason and some really in depth documentation to explain just why you had to vary on what's been approved. The reason we don't do any floor restraints, prone or supine, is because 2 individuals in Denver died a few years ago after being placed into prone floor holds. Does my reticence in regard to prone holds/restraints make more sense now?

Wendy

CO EMT-B