I was recently asked about restraining the combative or disoriented patient. The practice of patient restraint is one of the more dangerous things a Medic can be called upon to perform. It should always be very carefully considered, and even more carefully monitored. Here is what we know. About a half dozen patients every year die while restrained. Tying people up can be very dangerous to their health. Even the use of Chemical Restraints is dangerous and except for in a helicopter, usually unwarranted.
There was a day; I thought “playing with drunks” had an entertainment value. Forget the “cowboy” mentality, and view patient restraint as a dangerous practice with potentially fatal complications. EMT’s get hurt every day trying to do it. Patients get killed. Medics get sued, and lawyers get fat. Walk away. Yep, that’s right, I said walk away. Run, if you have to.
If you are confronted with a situation where you are considering the restraint of a combative patient ask yourself first why. Who is really at risk here? Is the patient really at risk of hurting himself or herself? Look for signs of self-damaging behavior, cuts, bad scrapes, and fresh bruises. If there are none, then ask yourself again, are they in immediate risk of hurting themselves? If not, they are not your responsibility.
Next ask yourself, are they about to hurt someone else? Is there a reasonable risk someone is at immediate risk of bodily harm? If yes, this means it’s time to get the guys with pretty badges and guns. Anyone who poses a danger to the public is also not your job. Police Officers have years of training in the appropriate use of force. They and only they, have the tools and training to SAFELY restrain someone who poses a danger to others.
Let’s assume for some reason patient restraint is unavoidable. How should you perform patient restraint? Always restrain the patient on their back. Never, ever restrain a patient face down. Never ever place anything on top of them. The myth about putting them face down with a scoop stretcher on top is a dangerous one. The primary reason people die while being restrained is suffocation. Always be able to continuously monitor the patient’s airway and breathing status. Always use enough people to effect restraint safely. If you do not have at least four people available (one for each extremity), call for help and wait until you do. When in doubt, see paragraph two.
I developed a well thought out restraint system for EMS use some years ago. I wanted one that worked on an ambulance cot, and kept the patient secure during the transfer to the hospital bed. It needed to lock fast, without a key – and it needed to be easy to clean. I developed the EMS Restraint System with a company called Human Restraints. They have been in this business for many years, and they did a great job on the product. But not many EMS services bought them, so I don’t know if they are even still available.
I can’t advise any common device or technique, because they are all bad. Handcuffs and Nylon Ties create some nasty injuries that I hate having to explain. Kerlix and Cravats are entirely dependant on your knot-tying skill, and usually a mess. Most hospital/extended care restraints were intended for a demented granny, not a 6 foot wacko on Steroids and Meth. Typical leathers are painfully slow, and the straps are way too long for a cot.
Unfortunately, this issue is still pretty low on the national radar. I doubt any serious efforts to improve pre-hospital restraint devices will be undertaken until a few more patients die needlessly. Until then use plenty of people, or use the Police. It is not your job to secure the unruly. Instead, I suggest you run away. Once you are safe radio for help.