Sedating mentally ill

[paramedicmike]

Is the litter the portable Stretcher we call a number 9. If so, once the stretcher is snapped it becomes a fixed part of the plane.

I din't get this statement, either. A fixed component of the aircraft means it doesn't come out. The litter comes out and is not fixed to the aircraft. It's not fixed to the aircraft even when properly secured.

So I'm not sure I understand their argument.

Some excellent points have been raised against sedating patients. Sometimes it has to be done. But blanket policy covering an entire class of patient seems discriminitory and potentially detrminental.

[Asysin2leads]

While we're on the subject of chemical restraints, a person I know who is one of the foremost experts in mental illness mentioned to me the dangers of using benzos as a chemical restraint. Apparently, while not common, a person who is agitated can have a paradoxical effect to a benzodiazepine and go completely out of control. 'Paradoxical effect' is kind of a misnomer, apparently what happens is the benzodiazepine has the effect of completely eliminating a person's inhibitions, and you can imagine what that does to a person who is already agitated. This is why haldol is the prefer sedative in these cases.

[Happiness]

Who told you this? If it was someone at TC I would suggest getting a second opinion.

http://www.tc.gc.ca/...ction11-231.htm

http://www.tc.gc.ca/.../551/acsi32.htm

Therefore, if your Number 9 cot can be removed from your aircraft, it is not a fixed part of the craft, the mounting brackets are. The only requirement that I can see regarding a patient restraint is that it must have a quick release mechanism, like a belt buckle, or, in our case, a velcro strap. There is no reason that the patient can't be restrained to the cot.

However, you're asking the wrong people in this forum, Transport Canada would be the proper authority here. Also, the pilot would be the one responsible for ensuring the CARS are followed.

I did ask transport canada qne got an email back

Next issue with restraints is the what if, if your pt is strapped to the stretcher and they start to vomit, if you cant roll them over then the you will have a whole new set of problems. This whole thing is just a dammed if you do and dammed if you don't.

Edited May 29, 2012 by Happiness

[paramedicmike]

Next issue with restraints is the what if, if your pt is strapped to the stretcher and they start to vomit, if you cant roll them over then the you will have a whole new set of problems. This whole thing is just a dammed if you do and dammed if you don't.

Do you guys not carry suction devices on your aircraft? I've run into this on multiple occasions. We just suction them until they stop vomiting. Never had a problem.

[Happiness]

yep we do, i guess i just have the vison of chunks and a bit of a brain fart I am going to contact transport cananda and directly ask if the Number 9 is cocidered a fixed part of the air craft. I reread the reply from them and it is just implied.

[Arctickat]

That's one reason for the quick release. Whomever responded to you from TC needs some remedial education, the stretcher mounts are permanent fixtures, the stretcher itself, is not. Besides, regardless the purpose for the restraint, provided it has a quick release, it can be attached to any fixed part of the structure of the aircraft. Just as a seat belt would be.

I hope you get a good answer from TC, in my experience, they're more concerned with CYA than anything else.

Edited May 29, 2012 by Arctickat

[systemet]

There's an article about this from 2009 here:

http://www.bcmj.org/article/criteria-sedation-psychiatric-patients-air-transport-british-columbia

[emtdennis]

The stretcher becomes "fixed" only due to the fact it will not roll around. Does that mean that once a person puts on a seat belt, they become fixed?

We are all taught scene, personnel, and patient safety come first. An aircraft of any kind is unstable even in the best of hands and you do have to consider the patients welfare.

Some times chemical restraint is necessary, but wrist type straps should be mandatory..

Just a simple opinion!!

[A Pox On This Place]

I have a question about chemical restraints in a prehospital setting. At a Level I that I worked at the infamous B-52 (haldol/ativan with a seperate syringe of benadryl) was often prescribed in in-patient psych when patients were combative or a danger to self or others. What chemcial restraints do you use in the field?

Edited May 30, 2012 by A Pox On This Place

[Happiness]

In the field I use my body and velcro straps. In the hospital setting They will start with adivan and gravol and use haldol if required.

The stretcher itself has to be secured to the aircraft. What are the normal procedres briefed. for evacuating a stretcher patient? Would they be evacuated on the stretcher or removed from it? Perhaps that provides you with the answer. Again it will normally come back to the individual airline's policy in their adherence to the regulations.

My question was does the stretcher become a fixed part of the plane and this is the answer that I recieved.

Systemt that is a good artical but they got one very important discription wrong.

The guy who jumped was being transported by a seaplane not a heli from Masset to Prince Rupert with a guard. This guy on his way down the ramp to the plane was yelling at the top of his head he was going to jump and take the guard with him as he was hand cuffed to the guard. They get over the straights and he flipped out and lucky the guard (a 120 lb female) was able to get the key and unlock the cuff. After he got to the door and the grabbed her by the belt and she hung on for her life. The guy finally let go and hit the ocean. The hx on this guy is that he had held his GF hostage in a hotel room in Port Clements and repeatedly raped and assualted her. Not only was he depressed he showed alot of violent tendencies that not one person considered a red flag. Now remember this is RCMP not BCAS but it can happen. Also the plane had other people on the there and not one person helped. Oh just so you know I personally knew the guard and this is where my information comes from. The guys name is Donald Biggs.