YOU, THE VIOLENT PSYCH, AND THE RESTRAINTS.......

[letmesleep]

How do you restrain a Pt that is combative to the point of wanting to kill you and possibly rape your partner? there is some discussion in FIREDOC'S thread (FREAK OUT) about this issue and I'm wondering what YOU do. I don't care what psych scenario you want to base your answer on ie: paranoid schizo, OD, pissed off/ spoiled brat teeny.....what ever you choose. Can you effectively restrain this Pt face down, or not? How often do you pull out the chemicals? do you carry leathers and/or soft restraints?

play ball!!!

[p3medic]

Handcuffs, chemical, and transition to soft restraints if possible. They may end up face down during the process, but as soon as they are cuffed, they are rolled over.

[dougd]

Since my service only carries leathers, that pretty much dictates my restraint options. Most psych's I deal with are coming out of an ER and going to a dedicated behavioral center or the psych wing of another hospital, so if the hospital has them in soft restraints already I'll continue to use those as long as they are effective. If my partner and I can't get the leathers on, we call for backup - either another squad or law enforcement... or both.

[mobey]

I usually use triangulars to fasten the hands to the siderails, then straps across the thighs and chest, that usually does the trick.

Luckily I don't have to deal with this scenario much.

[itku2er]

I call the cops that is their job to get beat up not mine.

[Happiness]

I make sure the cops are there they do the original take down. Then the restraints are installed to the pt. and off we go with a few ff and cops to the hospital.. We have both leather and soft and depending on what kind of phyc this is dictates which kind i use.

[jsadin]

Definitely get the blue canaries on scene to help ASAP. NEVER restrain someone face down! Damn hard to protect the airway in that position. No hog tying or spine board sandwich ether. We carry a pretty decent set of heavy nylon restraints in one rig and soft restraints in the other. I've used the nylon ones only once, but they worked well. More than once I've had PD handcuff my patient to the board and then I've strapped them down snugly. Spitters get a NRB.

[TennesseeEMT]

I'd call law enforcement and let them take care of it

[Mateo_1387]

To the OP, this is a good topic to discuss !

I think it really depends on the call as to how to handle the violent psych patient.

First and foremost is that I have a goal everyday, and that is to go home alive.

That being said, if I have a patient that is threatening to kill me and rape my partner, then I am leaving the scene, and the police department can take care of the person. If someone can look at me and verbally threaten my partner and I, then they should be safe enough to go with the police.

Now, lets say you have a drunk patient that is wanting to fight. The people around say that they downed a bunch of pills. Would you still fight and restrain the patient? I probably would not. Again, if I have a patient that is going to fight the living daylights out of me, then I will probably let the police department handle the patient. The police will be able to take the patient to a hospital to get treatment based on the scenario above. The fact is that if a patient is going to fight, you will have a very difficult time treating them and your life is in danger. You might ask, well what happens if the person dies because you did not treat them because of the pills they took? First you have to ask this, how do you know if they really took pills? Patients do lie. Is it worth risking your health over someone wanting to fight, when they could just be lying to you? You can always follow the police to the hospital if something does happen to the patient. The pills may take some time before they metabolize in the body, so them riding with the police because of they decide not to cooperate may be fine. If the patient does become worse off, you can always follow until it happens.

Then there will be those times that you have a strong inclination that the patient has a serious medical related problem and is fighting with you. Some examples could be hypoglycemia, head injury, hypoxia, hypovolemia, electrolyte imbalances, neurotransmitter imbalances. The head injury example, it probably would not be wrong to restrain your patient. Using physical force can be an option, but you should be careful when doing so. This would be a good case to restrain the patient chemically. For the hypoglycemic, it may not be a bad idea to restrain long enough for the patient to get tired, and then start your IV glucose, or maybe even glucagon. This is of course dependent on the situation.

Not all psychiatric patients need to be treated by EMS. There should be a call for judgment with these patients. A schizophrenic patient may need psychiatric treatment, but when he threatens your partner, acts very violent, and uncontrollable, this may very well be a police issue. This may mean that the PD takes the patient to a hospital, or maybe this mean that they hold the patient down, and you give a medication for chemical restraints so that you may treat other medical conditions the patient has.

You have a patient who has a head injury and he fights your efforts to help him and you come to the quick decision to restrain the patient. You would want to use a chemical restraint in conjunction with a physical restraint. After you administer a chemical restraint to chill out the patient, I would recommend you place physical restraints at each extremity. When you tie the restraints, you need the restraint around the extremity as close to the tie off point as you can. Tying the patient's extremity as close to the tie off point as possible makes it very difficult for them to move that extremity under straps and such. Tie one arm in an L shape above the head, and the other arm towards the lower extremities. The arm placement gives less power to the patient to use core muscles to aid in escaping. It is ideal to place the patient on a backboard and restrain, this way you can move the patient easily. When you place restraints on a stretcher, in order to move the patient you have to remove the restraints, which could lead to problems. While on the backboard, strap down the torso, the hips, the thighs and the lower legs. Taping the head down may be necessary if the patient bangs their head against the backboard. Make sure that the pockets are empty because there is the possibility they can reach in and use something to their advantage. Of course, hopefully if a patient is able to use reasoning that they can escape by reaching into their pocket for a tool, then police probably should be transporting. Also when you are working on a take down, make sure everyone involved knows what they are to do in the take down.

[letmesleep]

So far some interesting and very professional responses. I will admit that i have done the LBB sandwich (back in the day), as well as prone/ tied/ and the head of the stretcher at a slight incline (that guy pissed me off), prone and supine both, at times i have even broke out the ATIVAN.

so lets bump it up a notch, to those who DON'T believe that the prone position is worth the risk let me ask you this, How do you suffocate a Pt in this position? We have sooo many devices out there to assist us with monitoring CAPnagraphy/ SAO2/ EKG. besides the obvious ways to monitor the Pt like talking to them. Is it the belief that if a Pt is placed in the prone position that their face would be smashed into the stretcher there fore sealing their fate? wouldn't some common sense tell us to secure their head with their face to the side?

For those of you who would simply defer to the PD, what if you have a medical Pt that is combative? PD isn't going to be the best thing for them now, you are! so tell me how you would restrain them, what are your "PROTOCOLS"?

That word is so darn evil sometimes.............