The current EMT-Basic DOT National Standard Guidelines for Patient Restraint
seem to advocate the use of prone restraint. However! They DO NOT.

Consider the following FACTS:

• The DOT EMT-Basic RESTRAINT guidelines were NOT updated in 1994 (when the majority of other DOT EMT-Basic protocols were last updated). Thus, the DOT's restraint protocols are WELL over 10 years old ... perhaps over 20 years old!!!

• The DOT EMT-Basic restraint guidelines are ONLY found within Module 4, Lesson 8: "Behavioral Emergencies." Thus, the DOT curriculum demonstrates the common Restraint-Thought-Process-Error described in the Restraint Protocol Introduction.

• The DOT EMT-Basic restraint guidelines entirely fail to remind instructors, students, and Medical Directors that: when TRAUMA is involved, Spinal Immobilization protocols SUPERCEDE restraint protocols. Both the DOT EMT-Basic and -Paramedic protocols have clearly established care standards requiring SUPINE spinal immobilization of ALL trauma patients.

• There are NO DOT EMT-Paramedic National Standards established for the application of restraint (even in the 1998-updated curriculum). Thus, the inadequate, likely 20-year-old,
  EMT-Basic restraint standards are the ONLY restraint guidelines offered by the DOT.

ALSO, Consider these UNIVERSAL
DOT National Standard Guidelines:

• From the DOT EMT-Basic curriculum: "The EMT-Basic curriculum is a core curriculum of minimum required information ... It is recognized that there is additional specific education that will be required of EMT-Basics who operate in the field ... Enrichment programs and continuing education will help fulfill other specific needs for the EMT-Basic's education ... annual updates should be scheduled to inform instructors of current trends in prehospital emergency medicine ..."

• From the DOT EMT-Paramedic curriculum: "Continuing education is an integral component of any professional education process and the paramedic must be committed to life-long learning. The Paramedic curriculum must fit within the context of a continuing educational system. This is necessary due to the continually changing dynamics and evolution of medical knowledge. ... Quality improvement is also a required component of EMS training. The role of medical direction is paramount in assuring the provision of highest quality out-of-hospital care. Medical Directors should work with individuals and systems to review out-of-hospital cases and strive to achieve a sound method of continuous quality improvement."

The DOT does NOT PROVIDE a National Standard Guideline for patient restraint application that reflects the "current trends in prehospital emergency medicine."

Thus, the DOT DOES NOT SUPPORT the continued use of prone restraint.

Thus, any service that continues to employ prone restraint, does so against the basic dictates of the DOT National Standards for emergency care.

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"