Seven Flawless Physical Restraint Tips

Physical restraint techniques and procedures are a subject of debate and controversy in EMS. Few agencies have taken the time and energy to research and develop a comprehensive restraint guideline for field providers to follow.

When violent or aggressive patients show up (and they always do) EMT’s are left to fend for themselves. In these situations we take on a great deal of risk, both personal and legal, to bring the patient safely to the hospital.

I’ve had my share of both good and bad take-downs. When things go well the call transitions smoothly from the street to the hospital. The patient stays protected, the prehospital personnel stay safe and everyone goes back in service happy.

When things go badly people get hurt, patient care gets compromised and everyone ends up writing a lot of paperwork. In the worst cases you may end up sitting across from your patient in a courtroom explaining why you made the decisions that you made.

Here are some tips to help make your next patient restraint scenario go smoothly. Follow these guidelines and you’ll reduce the possibility of ever having to explain your actions. If you do end up needing to justify your decisions, you can take comfort in the fact that these gudeliness give you a rock solid foundation of compassionate, patient centered care. 

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“Just Plain Actin’ Crazy”

A Quick Guide to Abnormal Behavior.

I’m not going to beat around the bush about this. We deal with some folks who act weird. First you have the folks that you work with. As a group the EMS community can be a bit on the strange side. But right now I’m talking about our patients.

The spectrum of odd human behavior can be so vast that we are often at a loss to classify the patients presentation. It can be difficult to separate the delusion from the hallucination and the paranoia from the psychosis. Was that an episode of hysteria or mania? Here’s a quick guide to the clinical definitions of these terms that we kick around when our patient’s behavior transitions into the abnormal.

Catatonia:

• The state of catatonia can have both physical and emotional components. If the patient is willing to interact they tend to be emotionally flat or without affect. More commonly they are non-communicative. Body posture can be rigid or flaccid with very little movement.

• Catatonia occurs commonly in the schizophrenic patient population. The patient may be found sitting or standing and staring into space without regard for their surroundings. Take care not to mistake absence or complex-partial seizures as catatonic events. These states can also indicate toxic levels of the patient’s home medications so transport is necessary.

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