Restraining patients

[Ridryder 911]

Okay hot topic.. What is your standards or operations on restraining patients ?

Leather, kling, commercial, chemical ?....

R/R 911

[hammerpcp]

Technically we are not allowed to restrain a pt in by means. If we require physical assistance with a pt we are supposed to get police involved. The police must then decide weather they can restrain this person under the mental health act. Of course this leaves a lot of gray area for both us and the police. Hardly ideal. I am interested to know what is allowed in other areas.

[hfdff422]

Any soft restraints are allowed. We prefer the SD help, but it is not always feasible. We have a commercial restraint, but I am partial to Curlex (one roll per wrist).

[epi-do]

We are allowed to use restraints in situations in which the patient is "exhibiting behavior that presents a danger to themselves or others." We are only allowed to use padded leather or soft restraints. The only time a patient can be restrained with handcuffs is when law enforcement rides in the ambulance with the patient. Protocol here states that the only time we can restrain a patient without involving law enforcement is if a life threatening emergency (or the potential for one) exists.

The protocol goes on to explain how the patient should be positioned on the cot, how often we are to assess the extremities for PMS, what to include in our run sheet for documentation of the situation, and what to do if an unrestrained patient becomes violent during transport.

On a recent run where we did need to restrain a patient (I had been punched in the face, and my partner kicked in the chest) we used kerlix to do it since we don't carry padded leather restraints. We aren't allowed to use any sort of chemical restraints.

[flight-lp]

Ground EMS - Chemical (Versed) with soft restraints

Air - Haldol and flex cuffs, if it fails to control them, they get RSI'd

[nsmedic393]

Versed with soft restraints also.

[vs-eh?]

Midazolam or Diazepam with ummmm triangulars, and if police are around, cuffs.

[medic001918]

We use soft restraints and have 5mg Haldol/2mg Versed on standing order for violent patients. The hospitals actually prefer us to come in with combative patients sedated already. Saves them the trouble of doing it.

Shane

NREMT-P

[TechMedic05]

As from NH's Protocols:

Restrain if necessary and only for the patient's and crew's safety.

Use soft restraints and monitor distal circulation.

Consider Paramedic Intercept

Restraint Notes:

Use minimum force necessary. Restraint is never for punitive reasons

Frequent Airway Monitoring

Do not restrain patient:

- Face Down

-With hands behind back

-With both hands over the head to the top bar of stretcher [one is acceptable]

-with straps over lower thorax or upper abdomen

- Using a "sandwich" restraint with scoop or backboard.

Paramedic Standing Orders - Adult

Consider:

Haloperidol 2 mg IV or 5 mg IM, may repeat every 5 minutes to a maximum dose of 10 mg and/or any one of the following:

Lorazepam 1mg IV or 2 mg IM, may repeat once in 5 minutes or

Midazolam 2.5 mg IV may repeat once in 5 minutes or

Diazepam 2 mg IV or 5 mg IM, may repeat once in 5 minutes.

Flumazenil 0.2 mg IV over 30 seconds to reverse the iatrogenic effects of benzodiazepines

Diphenhydramine 50 mg IV/IM for acute dystonic reaction to haloperidol.

NH State Protocols

Other than that, most places I've worked have had a policy that the patient be evaluated in under an hour by a physician for continuation/ evaluation of possible injuries caused by restraints.

And it is typically easier to just let the police restrain people. They have better toys for it.

And I don't fly, but I know if anyone is going to be flown, the Air team will just RSI.

[chazmedic]

Mag light.

For peds, Mini-Mag light.

Just kidding folks.

Mr. Haldol, Mr. Versed, Mr. Kerlix, Mr. Coban.

I got scratched by a head trauma patient once in the ER. Blood all over the place. Pinched and scratched, actually. Hurt. Nurse did not allow the patient to be restrained. When it was ordered, she loosened the restraints. See above scratch.

Now for the punch line... he had full blown-about-to-die-AIDS. None of that HIV ca ca. No sir, right to the front row we go. This was in '98, I was given the "3 drug cocktail" for "prophylactic precautions"... 'til those drugs tried to shut down my kidneys.....

Mag light.