Patients who experience a behavioral emergency can be challenging for EMS providers to manage. Unlike a medical condition, the signs and symptoms of an impending change in status can be hidden right up to the point of catastrophe, as happened when a patient jumped out of an Arizona ambulance traveling at freeway speed.
Cases like this are reported at least annually in the United States and are the source of grief, headache and liability for EMS providers and their agencies. Last year there was a just as catastrophic incident when a psychiatric patient somehow got ahold of the steering wheel, causing the ambulance to crash.
Transportation is an intervention in field care. As with any other clinical procedure, it needs to be applied appropriately. As loathe as we might be to do it, patient restraints may be necessary when transporting behavioral or psychiatric patients who may appear docile and cooperative, yet still remain a danger to themselves or others. Restraining patients keeps them safe and allows the crew to slow the vehicle if the patient presents an imminent danger of self-harm or of attacking the crew.
Policies and procedures should be developed that authorize humane, respectful medical restraints for patients who may require them. Field providers should be comfortable speaking to patients about why restraints are applied and be familiar with their use. Clear, precise documentation ensures that all relevant information is recorded for later review.
While they are in our care, we are responsible for our patient’s safety at all times. Prudent interventions can help minimize the opportunity for unexpected, catastrophic outcomes.
