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Using restraints on involuntary patients

Editor's note: The family of an autistic teenager who died a year ago after jumping out of a moving ambulance has filed a lawsuit against the hospital and the hospital's ambulance service. Editorial Advisor Art Hsieh says he remembers his EMT instructor 'telling us that by the very nature of (involuntary) patients, that the use of soft restraints was absolutely necessary."

This type of story is reported a few times a year, and raises the question about the use of restraints during the transport of an involuntary patient.

I recall my EMT instructor telling us that by the very nature of these types of patients, that the use of soft restraints was absolutely necessary. Over the years that bit of advice has proven to be helpful.

The vast majority of the time the patient, though unhappy, was cooperative with the restraints. A few had thrown a few choice words at me. I gladly would trade that than to see a patient dash out the back of the unit unexpectedly.

I remember one patient who had been very quiet, even meek during the transfer completely became unglued as we left the hospital grounds. I'm not sure if I would have been able to control the patient if he wasn't restrained onto the gurney.

Keep a few principles in mind:
1) This is still a patient, even if he or she is being involuntarily held for evaluation and care. That means you still treat the patient with the same level of care and respect as with any other patient.

2) Part of the respect is explaining, in simple and direct terms, that you will be using restraints to help manage the transfer. It truly is for their safety (as well as yours).

3) Even soft restraints can cause injury if improperly applied. Worse, they may be ineffective. Make sure you know how to use them correctly.

4) Once applied, check for sensory, motor and circulation in the extremities. The restraints should NOT be uncomfortable.

5) Finally, like emergent situations, make sure you have enough people to assist in the restraining process. Do not attempt the procedure by yourself.

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