Have you ever worked in a system with no protocols for restraints or no supplied restraints? Have you ever had an adverse outcome as a result of that? Fortunately, the agency that I work for has commercial soft restraints and a good chemical restraint protocol (diazepam 5-20mg, midazolam 2.5-10mg). Both are off-line, we don't have to call for orders to use them.
I worked at an agency in the past that specified "the only acceptable restraint device is a bedsheet". I didn't think much of it in the past because it was a pretty quiet place, we'd always have police backup on calls that might have been dicey. But now, looking back I just cringe about what could have happened.
So Brian, I finally had a pt that required physical restraints for transport (residence to ER. Pt awake, oriented to person, place, situation, but not to time, visual and auditory hallucination, interacting with surroundings, dehydrated and too weak to stand, but still able to pack a punch, verbally and physically combative). With no commercial device provided, here is how we did it.
We brought in law enforcement, and the pt's family. We formed a plan to place the pt on the transport cot, and discussed the plan with all responders. We informed the pt of what we were about to do.
Using 2 responders at the torso and 1 responder per extremity, we placed the pt onto the cot. A sheet was placed over the pt. The cot straps were placed over the sheet, and the blanket was placed over the straps. 1 roll of bulky gauze bandage was cut into 3 pieces; 1 for each wrist and the remaining length for the ankles, we used these to secure the extremities to the frame of the cot (keeping the pt from going up and over at the head). The upper torso cot straps went beneath the pt's arms and accross the chest Keeping the pt from going down off the foot of the stretcher. Cot straps over the shoulders to the upper torso strap prevented the pt from pulling up at the head. During transport (with a dimmed, quiet cabin, and locked doors) we monitored the hands and feet for impaired circulation.
The pt was still able to move his arms and legs (just not the hands and feet), and stopped physically resisting after a couple of minutes.
We had ample access to the pt's extremities for VS monitoring and IV access.
We informed the ER of the situation, so ample hands were available upon arrival.
This worked because we made a plan and everyone was on the same page. Our protocol is pretty open: consider the safety of the pt and the responders, have the ER on-board.
I hope the details are helpful to any rookies out there.
Never worked at somewhere with anything more fancy than soft wrist cuffs. Nominally all PA services have a chemical restraint protocol, so that's taken care of.
Doc...Yes we have chemical restrain protocol in PA, but only after Patient has been physically restrained(per protocol) by med command orders. However, if patient is combative and in need of transport I will not physically restrain them and will call for orders for sedation and it makes everything a lot easier after that.