This page is STILL under CONSTRUCTION!
Until this "blurb" is REMOVED, this page remains a "rough draft" version, and its contents should NOT NECESSARILY be implemented as currently written. However! Protocol-writers with a strong understanding of the information contained within the articles, "All Tied Up & No Place To Go" and "Restraint Asphyxia – Silent Killer," should be able to use this "ROUGH" information to build their own protocol. If you have "time" to delay your protocol writing, PLZ check back here periodically, to see if MY version of this protocol has been completed!

If indicated, performance of Basic Life Support protocols, Defibrillation, and Spinal Immobilization protocols supercede and precede initiation of Restraint protocols.

If artificial ventilation is required and Intubation cannot immediately be performed, implement "Crotch Restraint" of the Unconscious Patient's Wrists Immediately AFTER Initiating Bag-Valve-Mask Ventilations.

If artificial ventilation is required and Intubation CAN immediately be performed, implement "Crotch Restraint" of the Unconscious Patient's Wrists DURING or Immediately AFTER Intubation.

If artificial ventilation is NOT required, implement "Crotch Restraint" of the Unconscious Patient's Wrists Immediately AFTER Initiating supplemental oxygenation – BEFORE initiating IV access and/or transportation.

CROTCH RESTRAINT:

Crotch Restraint may be initiated on EITHER the right or left side of the patient. For instruction purposes only, this protocol will begin with the RIGHT side.

1. Place the middle of a Gauze Strap at the medial (inside) aspect of the patient's right upper leg
   (at the right side of the patient's "crotch" or "groin").
2. Tie a half-knot at the lateral (outside) aspect of the right leg. Tighten the half-knot so that the Gauze Strap "tails" are of equal length, and the restraint is tight, but does not impede circulation to the leg.
3. Tie another half-knot to create a full-knot that locks the Right Crotch Restraint in place, and prevents it from becoming tighter.
4. Place the posterior (back) of the Right wrist AT the Right Crotch Restraint knot.
5. Tie a half-knot at the front (anterior) of the patient's right wrist. Tighten the half-knot so that the wrist restraint is snug enough not to slip off of the patient's wrist, but not so tight that it impedes circulation to the hand.
6. Tie another half-knot to create a full-knot that locks the Right Wrist Restraint in place, and prevents it from becoming tighter or looser.
7. Repeat the above steps on the patient's Left side with a second Gauze Strap.

If the patient regains consciousness subsequent to treatment, and becomes Resistively Confused or Violently Confused, implement the correspondingly-appropriate restraint protocol.

If the patient regains consciousness subsequent to treatment, becomes alert and well-oriented, and is unresistive to treatment/transport, counsel the patient regarding the necessity of allowing the soft restraints to remain in place until arrival at the emergency department, for safety reasons.
"A COOPERATIVE patient will COOPERATE with restraints!
If the patient complains of discomfort, adjust the restraints as necessary, without diminishing their effectiveness and safety. Increase the patient's comfort by ensuring that the patient is warm enough, cool enough, and the like. Adjust the patient's position (head elevation) to increase the patient's comfort.

NOTE:

CROTCH RESTRAINT may temporarily be utilized, in combination with an ankle hobble, in situations wherein a Resistively Confused, Violently Confused, or Combative patient is encountered in an area that cannot safely be accessed with a wheeled stretcher or a horizontally-carried long back board.

[If the long back board cannot be horizontally-carried to the patient's side, once restrained to the long back board, the PATIENT cannot be horizontally-carried to the wheeled stretcher!]

APPROPRIATE, SAFE & EFFECTIVE, RESTRAINT PROTOCOLS:

• 1) Introduction to Patient Restraint
  Universal Reasons For, and Basic Principles Regarding, SAFE Patient Restraint

• 3) Resistively Confused Patient Restraint Protocol

• 4) Violently Confused or Combative Patient Restraint Protocol

• 5) Response When Forceful-Prone-Restraint (or Hobble Restraint)
  is Employed Prior To Your Arrival

• 6) Spinal Immobilization Protocol for the
  Violently Confused or Combative Trauma Patient

• 7) Documentation Guidelines for Every Restraint Application

• "Quick Look" On-Scene Restraint Reference Card

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