3 Patient restraint errors EMS needs to avoid

Avoid harm and potential litigation by not making these errors with a violent patient at an emotionally charged scene

Editor's note: Steve Whitehead, an EMS1 columnist and a firefighter paramedic for the South Metro, Colo., Fire Rescue Authority, presents a few restraint errors to avoid, courtesy of his blog, TheEMTspot.com.

Updated July 23, 2015

1. Don't scream, "calm down"
I'm not sure why there always seems to be one guy (yes, it's usually a guy) who thinks it will be helpful to scream, "calm down!" at the patient. This never, never, never works. Really.

Resist the urge to be the calm down guy. It's usually the guy screaming "calm down" who needs to calm down the most.

Instead of doing this, just speak in a calm voice to the patient, even during a take-down. Find the person who's the coolest cucumber in your group and place him or her near the head to just keep a dialogue going. "We're trying to help you. We don't want to hurt you. Just relax for us. It's OK. We're not going to hurt you. We just need to secure you down."

This ongoing narrative will also sound much more professional if a bystander starts rolling cell phone video in the middle of your wrestling match. Let everyone hear a friendly, calm narrative instead of a shouting match.

5 Tips for Provider Safety
The most dangerous patients are those who are disinhibited: the intoxicated, the hypoglycemic, the head injured.
Never let your patients get between you and the door.
Listen to your gut; if you are uneasy with a patient, you should be. Back off until you get help or stay out of harm's reach.
Most patients act out due to fear. Mitigate that by explaining what is happening and why. Give your patients a chance to ask questions about what is happening.

Have a plan, in advance, with your partner about the actions you will take if a patient becomes violent. Being on the same page with your partner ahead of time could very well save your life.


Source: By Thom Dunn, associate professor of psychological science at the University of Northern Colorado, field paramedic with Denver Paramedics, clinical psychologist at Denver Health Medical Center.

2. Don't give the patient ideas
I'm amazed by people who warn other team members of things the patient might do. Like, "Look out, he might spit." Or, "Careful, don't let him bite you." Or even, "That left wrist strap looks loose." All of those things can be considered coaching for the patient.

It never seems to fail, as soon as someone warns about spitting, the patient starts spitting. Don't give the patient any ideas.

If you're worried they might do something, watch out for it and try to mitigate the possibility, but don't shout it out.

3. Don't use arm locks, leg locks, face down restraint, hog tie or sandwich restraint techniques
I'm not real fond of techniques that are designed to force the patient to comply through pain. Even for police officers who are trained in pain compliance moves, these techniques require skill and ongoing training.

Even then, they still tend to be hit and miss. If you cause the patient pain, they are likely to fight harder. Then you apply more pain and they fight harder and then they get injured and you have to explain it to the doc at the ER, or worse.

Also, keep people face up. For a whole bunch of good reasons, just keep 'em face up. With those guidelines in mind, go get it done. If you meet the take-down challenge with plenty of resources, a good plan and a calm team, everything should go just fine.

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