Restraints

[ffemt8978]

All right, let's talk about restraints. First of all, what is your procedure for applying them (do you have to get permission first, do you remove them, etc...) and what, if any, special requirements do you have to meet.
Secondly, what type do you have (soft, leather, tape, handcuffs, etc...)?

Our protocols are pretty specific about the use of restraints. We can use soft restraints (including duct tape, if necessary), but we can't use leathers or handcuffs. As a matter of fact, if we're transporting a patient in handcuffs, our protocols require a law enforcement officer to ride in the back with us. (It's amazing how many handcuffed patients are transported by law and not us. ). Also, our restraints our like our backboard and c-collars. Once they're applied, it requires a doctor to remove them.

 

[cbdemt]

ours are exactly the same. soft only, with medical direction, once they're on they stay on, all cuffs are accompanied by a cop.

 

[MMiz]

I dont believe we have a company policy.

We use soft restraints or bandaging tied around the arm for restraining on-scene. For transporting, our company does not provide restraints, they are provided by the hospital. We'll transport in leather or soft, not really a big deal there.

There is also no policy on removal. I've seen people remove them, but I would never do so.

 

[rescuecpt]

We're the same: soft restraints, contact to confirm permission, don't take them off. If handcuffs are involved PD has to ride along.

My personal favorite device (as I mentioned in another post) is a large FF or PO. They can be quite menacing, and if necessary they're great to hold the pt down while I call for permission to tape/tie.

 

[ffemt8978]

We don't need to call for permission to use restraints, but we better be able to articulate our reasons why we applied them.

 

[rescuecpt]

Theoretically, I don't HAVE to call for permission, but realistically, it's nice to be able to CYA with a Med ID# on the PCR.

 

[SafetyPro2]

LA County protocol limts EMS personnel to padded leather and soft restraints. We can't do any sort of "sandwich" restraint (strapping a backboard over the patient, etc.) and we can't restrain the patient's arms behind them or place them in a prone position. We also have to assess PMS in the restrained limb(s) and the patient's cardiac and respiratory status after application and every 15 minutes. The type of restraint, reason applied and PMS/cardiac/respiratory check need to be documented on the run form.

Law enforcement can restrain a patient for us with handcuffs, generally one or both wrists to the gurney. However, if they do so, they must ride in the back of the ambulance or follow the ambulance in their squad car in case the restraints need to be removed for any reason.

In practice, I've only seen the later done on my department.

On a related note, if a patient's in PD custody when we arrive, technically, the officer is their legal guardian and CAN make medical treatment decisions on their behalf like a parent with a child. In other words, PD can refuse to allow us to treat/transport a patient. We just document it as an AMA and have the officer sign the run form like anyone else refusing treatment. Doesn't happen very often (they don't want the liability), but has happened once or twice.

Now if we arrive before PD and initiate treatment, we have control, even if PD decides to place the patient in custody (they generally don't until after the transport's complete).

 

[ffemt8978]

My understanding of these type of situations is that if the subject is already in custody, the law enforcement agency is responsible for the bill, also. If the ambulance starts treatment first and then the patient is placed in custody, the patient is responsible for the bill.

Generally, I have seen law enforcement officers do everything in their power to have us start treatment before the patient is arrested.