Chemical Restraint?

[croaker260]

Excellent comment, although it should be expanded upon that the 'proper' restraint or agent of choice should be benzodiazepines. Other hypnotics or sedatives (Haldol, etc) don't mitigate the massive sympathetic response that these patients are experiencing.

Excellent point Kev, Dont forget that Haldo can lower the SZ threshold , and increase heat production (when EPS occurs- Mopvement disorders). It seems to me from previous discussions with other providers that there is a bias against using benzos , presumably because they are "controlled" and haldol is not. We need to get away from the idea that haldol is safer than benzos, when in this setting it clearly is not.

[Paradude]

We use 5mg Valium mixed with 5 mg Haldol administered IM. (makes a milkl looking substance when mixed together) Then we administer 25 mg Benadryl IM separately. This is to avoid the extra-pyramidal effects of the Haldol. Works well! By the time we get them to the ER, they are lambs.

-Paradude-

[NREMT-Basic]

Whats great about the state team Im on now is that since we are responding the MCIs either on a state or federal level, we had lead sedation available at all times. On top of each one of our trailers is an elevated and reinforced "gunner's platform" which is almost always manned by a National Guardsman or State Police Trooper. Their job is to make their presence very well known as a patient is brought to us. There are usually several more NG's or LEO in our medical compound (a civlian MASH basically) with riot gear, shot guns, etc. I dont believe we do, but some MERT, DMAT teams employ snipers and their military escorts and MPs, . We also use MPs and state guard troops when we are out of state. We use versed and benedryl chemically and out med director has left that as a standing order for EDP care.

I guess this also brings about the question of EMS provider safety. Should we be allowed to carry something to defend ourselves with. Pepper spray not good for obvious reason and ASPs can get way too deadly in the hand of an amped up EMT or medic who is being attacked. What about kubatons, etc? I know this aspect has been discussed previously, but it seems that now more than ever we need to address defensive tactics. I have been attacked twice so far, both time by tweeks. Fortuately I had some empty hand techniques which helped to mitigate. Maybe someone would like to start a thread on EMS Self-defense...I think I remember reading about it here before but cant find the thread.

[akroeze]

According the the Ontario ALS Patient Care Standards:

Administer midazolam at an initial dose of 2-4mg IV/IM/IN. A subsequent dose of 2 mg IV/IM/IN may be given after 5 minutes if adequate sedation is not achieved and provided systolic BP >= 100mmHg. The patient's respiratory rate and effort should be monitored for respiratory depression. Maximum 2 doses.

OR

Administer diazepam at an initial dose of 5-10mg IV/IM. A subsequent dose of 5-10mg IV/IM may be given after 5 minutes if adequate sedation is not achieved and provided systolic BP >=100mmHg. The patient's respiratory rate and effort should be monitored for respiratory depression. Maximum of 2 doses.

Contact BHP if further doses are required.