By Charly D. Miller, Paramedic; EMS Author, Educator, & Consultant

PLZ READ the Following
“VITAL NOTES & FAQs” SECTION!!!
[ONLY if you already have READ the Vital Notes & FAQs may you
click here to “skip” to the LINKS LIST.]

VITAL NOTES & FAQs! SECTION:

1) A COMPLETE UNDERSTANDING of these Patient Restraint Protocols –
by the MEDICAL DIRECTORS who are considering them, AND
by the Care-Providers mandated to adopt them! –
REQUIRES the reading of ALL THREE PARTS of BOTH my Restraint Articles,
PRIOR TO study (or implementation) of the Protocols.
If YOU haven’t already read BOTH of these articles – in their entirety –
PLZ DO SO NOW, and then come back here.
All Tied Up & No Place To Go
Restraint Asphyxia – Silent Killer

Indeed! The FIRST “REQUIREMENT” of my Restraint Protocols is that ALL Care Providers governed by these protocols be required to read these two articles PRIOR TO studying and implementing the Patient Restraint Protocols. (I include the Internet Address for each article within the protocols.)

2) Why is this material “Required Reading”?
It’s not for self-aggrandizement – I assure you.
It is because the NATIONAL STANDARDS for EMS care related to PATIENT
RESTRAINT, as established by the National Highway Traffic Safety Administration,
Department of Transportation, haven’t been updated since 1984!
Thus, NO Medical or EMS Text Books cover this subject adequately. NONE of them!
And, NO “Core-Curriculum” Medical or EMS Training Programs cover this subject adequately.
NONE of them!
Obviously, I would much prefer that Medical Directors and Care Providers attend a comprehensive educational program that includes ALL the information contained within my articles (and that they have an opportunity to “ASSUME THE POSITION”). But, I can’t “require” that people bring me in to teach!
THEREFORE, this “Required Reading” is a MUST! If it is not accomplished, Medical Directors and Care Providers will approach these protocols with Little-To-NO understanding of the subject. Without an understanding of this subject, they will have difficulty recognizing the “reasons” for many patient restraint protocol requirements. And, therefore, Medical Directors and Care Providers will have serious difficulty implementing these (or any other) Restraint Protocols.

3) Why Is “HAVE THE POLICE RESTRAIN THEM”
Entirely Inappropriate and Inadequate to ALL
“PATIENT RESTRAINT PROTOCOLS” ???

“POCKETBOOK” ($) ARGUMENTS:

• Law Enforcement is not dispatched to, nor available for, every emergency medical call.
  In emergency situations involving potential injury to the patient or others, the only time restraint and medical assessment/care should be delayed until the late-arrival of law enforcement officers, is when there are not enough emergency responders present to safely and effectively restrain the individual.
  • Should a patient (or bystander!) incur injury while medical personnel are delaying assessment and treatment merely because they have been ordered to wait for law enforcement officers to arrive, and …
  • Should it be shown that the patient could, safely and effectively, have been restrained by the medical personnel present prior to law enforcement arrival, …
  • It is highly likely that civil litigation, for contributing to the injury that occurred during the delay, could successfully be brought against the Service (and Medical Director) that refused to educate emergency responders how to safely and effectively assure the patient’s care and protection prior to law enforcement’s arrival.
• Law Enforcement restraint usually consists of metal restraints, and is often NOT perceived as “humane” restraint by the patient, bystanders, and family members –
  a perception that often encourages litigious thought processes.
• Metal restraint use is accompanied by high incidence of restraint-related injuries –
  something that often generates opportunities for litigation.

• Medical Restraint does NOT require metal restraint. With education, Medical Restraint can be safely and effectively accomplished using soft forms of restraint, in a humane manner, and without producing ANY serious restraint-related injury.
• Law Enforcement Restraint INTERFERES WITH Medical Assessment and Care!
  Law Enforcement restraint requires ONLY that someone be “tied up” so that they cannot “strike out” at others. Medical Restraint requires that someone be “immobilized” in a way that prevents them from interfering with thorough assessment and care provision (and without causing them injury).
  Standard handcuffs cannot be utilized to restrain wrists in front of the patient: if this is done, the handcuffed wrists become a deadly WEAPON! When handcuffed behind the back, access for thorough assessment and care is seriously impeded, if not entirely impossible to accomplish. (Blood pressure measurement and IV access is especially difficult to accomplish.) Should the patient’s condition suddenly worsen, appropriate medical response (especially that of airway care) is seriously delayed by having to release the metal restraints. Should the patient seize, injury WILL occur prior to accomplishing release from metal restraint.
  Law Enforcement officers are not trained in Medical Restraint techniques. Should a restraint protocol dictate that law enforcement officers be given “medical restraints” with which to accomplish patient restraint, the officers will simply “tie up” the patient. The patient will still be able to move portions of his anatomy, interfering with assessment and increasing the amount of struggle required to provide care (increasing the opportunity for patient and provider injury).

4) Why Are There So MANY Protocols For Patient Restraint?!

• Implementation of Restraint is likely the most “potentially-litigious” activity that ANY emergency responder will ever engage in. If they don’t know how to do it “right,” they can KILL their patients. If they don’t know how to do it “right,” they can end up suffering the HELL that is LITIGATION (“criminal” charges such as “Involuntary Manslaughter,” and the like – AND/OR “civil” charges such as “Medical Negligence,” “Wrongful Death,” and the like).
  Thus, Restraint Protocols DESERVE “serious” and THOROUGH attention!

• There are MANY TYPES of Patients who Require Restraint!
  MANY more Patient-Types than 99.9% of providers (99.9% of Medical Directors) realize.

• Different TYPES of Patients require Different TYPES (methods) of Restraint.
  
  • If you provide only ONE TYPE of “Patient Restraint Protocol,” you damn your service to inappropriately or inadequately restraining all the OTHER types of Patients who Require Restraint.
    
  • If you provide only ONE TYPE of “Patient Restraint Protocol,” you damn your service to the high likelihood of causing patient deaths, and suffering litigation.

• And, again: Unlike almost ALL other Emergency Medical Care Procedures, Patient Restraint is NOT sufficiently addressed or explained elsewhere. Thus, any “Definitive” Patient Restraint Protocol requires in-depth direction within it.

However! In addition to the FOUR “Generic Patient-Type Restraint-Method” Protocols,
an “Introduction to Patient Restraint Protocols” is required, as well as
a “Documentation Guideline” for Patient Restraint situations … AND,
there is ONE “special” restraint-related situation that strongly requires its OWN attention.

For example:
PART ONE is an “Introduction to Patient Restraint”

• The REASONS for Patient Restraint – ALL of Them.
• The BASIC PRINCIPLES Common to ALL Patient Restraint Methods.
• Identification of WHO – “Legally” – CAN be Restrained.
• And, Quick (yet Vital) Coverage of Issues such as:
  • “REASONABLE FORCE”
  • “HUMANE” RESTRAINT
  • LEAST RESTRICTIVE MEANS OF CONTROL
  • CONTRAINDICATION of PRONE RESTRAINT
  • MISCELLANEOUS RESTRAINT-RELATED TERMS

PART SEVEN is the “Documentation Guidelines for Every Restraint Application” …

• Something required to facilitate accurate and adequate documentation of every patient restraint application – AND to PROTECT Care Providers, Medical Directors, and Services in a COURT OF LAW.

5) PRINTING the PROTOCOLS:

• I don’t know how to “code” my Internet Pages so that they will PRINT PAGE NUMBERS on each page. If you know how to program your printer to print them, DO THAT before printing them. If not, copy and paste each protocol “page” to a document file on your computer, and format it with page numbers. OR, remember to write page numbers on your “Master Copy,” BEFORE reproducing it.

• Assuming you will print your “Master Copy” on WHITE PAPER, I placed WHITE INDENTS
  on these pages. On the Internet page, they will look like this:
  A white “rectangle” where an “indent” occurs.
  On a white page of paper, they will be invisible!
  (Both this line, and the line above, were indented with a rectangle of the same color/pattern of the Internet background I use. So, these indent rectangles are invisible here – as the WHITE ones will be on WHITE paper!)

• I did NOT put REFERENCES in these protocols. The references for ALL patient restraint information and practices addressed by these protocols are included within my two restraint articles. If something doesn’t sound “right” to you, go the related article to find the reference.

At Last! Here They Are – Safe & Effective
EMERGENCY PATIENT
RESTRAINT PROTOCOLS:

Well … They aren’t completely “HERE” yet. Most of them are still “Under Construction.”

But, as of January 21, 2003, I’ve at least posted ROUGH DRAFTS for each! Sooooo … If there is NOT a construction icon at the top of the page, the page is relatively “finished.” If there IS a construction icon at the top of the page, it is ONLY ROUGH DRAFT form.

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

• 2) Restraint Protocol for EVERY Unconscious Patient

• 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
  (This is a REFERENCE TOOL that accompanies the protocols.)

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