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.

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Nope. First company had leathers, second company had soft restraints. Personally, I'd like to see more restraint options for companies engaged in interfacility transports like vest style restraints.
Standby for the law and order court room gasp...

We have no restraints physical or chemical full stop. I've been at this game for 5 years now and I don't think I've ever had a case where they would be needed. Personally I don't agree with this whole restraint business and the article that was in JEMS a while back didn't do the whole process any favours in my mind.

Violence and agression towards EMS is on the increase here the UK and we have stepped up research in to why in order to better inform our education and practice. Alot of the time, the incident spurs from an attitude or flippent comment from the EMS provider. Our conflict resolution education package aims to remove this as a factor.

EMS here is becoming more and more involved with mental health transfers both acute in the field for patients being detained and routine interfacility transfers. Our new mental health act deems the term "most humane way to transfer a patient with mental illness" so that they are seen as a patient rather than a prisoner. We have no powers under the act to detain patients nor restrain them. Police to not travel on these calls unless there is an imediate danger to the public by making specific and deemed genuine threats.

We are taught if the patient wants to leave, they leave and a description of them is passed to the police. If they want to smash up the ambulance, they smash it up. That is what insurance coverage is for. Vehicles can be replaced providers can't.

The question then becomes would I restrain someone if I had the protocol? Answer no, its a fine line ethically for me. the drugs involved are sedatives and can become too easily misused. Restraining someone is a complex process tying up multiple providers that could be better used treating other patients. Communication is the key, if that fails, law enforcement can restrain, they are trained well to do it, have the legal protection to do it and are paid the money to match....

Be interested to see what others thought?
Florida BEMS requires that a set of restraints be available on all transport ambulances. Since all of my experience in EMS has been in the state of Florida my answer to the question posed is no.

Have I used physical restraints? You betcha. Do I see a need for then? Yes, in certain situation and when appropriately applied. The key to the decision to apply restraints is patient safety. Is it an EMS or LEO function to apply restraints? Depends on the situation and if you have a real patient or just a jerk that's acting out.

If you work for an agency that has protocols for physical restraints I do offer some advice. When you apply restraints, apply them appropriately and completely; not too tight, just tight enough. Remember to be aware of positional asphyxia. You have in your care a patient. Never forget that. Every use of restraints (physical or chemical) should be an automatic QA/QI post incident review.
Yes, I worked for two agencies without restraint protocols.
In the 27 years that I have worked EMS, I have never had an ambulance that (officially) carried physical restraints.

Currently we have chemical restraints which may be used after consulting Medical Control. I have used chemical restraint in the field only once.

I can count on one hand the incidences where physical restraints (including roll gauze, sheets, and creative seatbelts) were necessary . Most of these were because the patient had become uncontrollable before EMS arrived.

With a calm approach, demonstrated respect for the patient, and a lot of patience, most behavioral patients will buy into going to the hospital for help. Then with their permission, I apply all stretcher straps, hide the release buttons, lock the doors, dim the lights, and quietly watch them like a hawk.

Call me lucky, charmed, or magically delicious, but it works >90% of the time.

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.

Thanks

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.

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