Why this is not done!

[spinnakr]

So again, I ask, the patient is restrained using LEO tactics by LEOs who are using LEO equipment. So, who is in charge of how the LEO's place the patient, or how they apply the LEO restraints?

If they truly refuse, and there's absolutely no way around it - in short, if the patient becomes a detainee first and foremost, then documentation is key. Write it in the narrative and maybe an incident report. Make sure the liability is on the LEO's side.

You could always try to convince the LEO to handcuff the patient to the cot instead of behind his/her back.

On the other hand I don't think there should ever be an absolutely no-dice situation like I described above. If you think it could kill or harm the patient, or otherwise impede in care, then be honest and upfront about explaining that to the officer. If the officer still refuses, ask to speak with his superior/OIC. It's YOUR patient.

 

[JPINFV]

If the LEO refuses, then the LEO can transport in his car and take full responsibility for the care of the patient. I'm not going to take responsibility for the police officer's actions that puts my patient at risk, especially for something as stupid as transporting a patient prone like that. If the patient wants to be transported prone, more power to him, however if he patient is being restrained with anything more than seatbelts, then it's going to be done supine. No questions asked. Do not pass go, do not collect $200.

 

[CAOX3]

As JP stated, its my way or the highway.

My truck my way, his car his way. Pretty simple.

 

[JPINFV]

Everyone should read the National Association of Emergency Medical Service Physicians (NAEMSP) position paper on the use of restraints.

http://www.naemsp.org/pdf/restraint.pdf

Transporting a patient restrained prone is so far from the standard of care it can't even be accepted as an appropriate deviation.

 

[mycrofft]

Unconscious pts die of positional asphyxia before we get a chance, too.

Postictal folks, pts with neuromuscular problems like MS, or just plain hit their heads and came to rest folded up.
Famous athlete Florence Griffith-Joyner died that way...postictally went face down into a pillow.
Anyone remember the "D-ring litter sandwich"?

Quiet, Sasha.

 

[dmc2007]

Well, most of us. Some might have had handcuff experience before... but hopefully from other jobs! (for the record, that was a joke).

No comment.

You bring up a very good point, though.

In class we were taught that if a patient is to be transported handcuffed, LE is coming with us.

 

[JPINFV]

Class!=field

 

[LondonMedic]

A better option would be to transfer the patient to restraints made for medical patients. All ambulances should have a set of leather restraints on them.

Or a haloperidol/lorazepam cocktail?

(But FFS, sods law states that the 'combatative drunk' punters you do end up restraining are going to be the hidden head injuries...)

 

[EMTinNEPA]

or the bedroom.

I just forgot everything else I read in this thread. Thanks, Sasha, now I have to start over.

 

[46Young]

This won't be a problem if you know the officer, but how do you go about explaining it to the LEO? (I'm not trying to be confrontational; I'm just curious).

Also, this is yet another reason why a backboard sandwich is an inappropriate means of restraint.

I would think that the officer would rather ride in the cruiser instead of being cursed at and spit on.

I never said backboard sandwich, rathe having one wrist cuffed to the frame of the cot.

 

[46Young]

That and we're not trained or get any practice in quickly removing handcuffs.

The cruiser rides right behind the bus. It takes less than 30 seconds to pull over and have the LEO jump in back if there's an issue. Anyway, how far is the pt going with an arm cuffed to the cot? No liability there regarding airway, since they're sitting fowler's/semi-fowlers or whatever. It works well for us, and is acceptable under our SOP's.

If the perp grabs the gun, where are you going to hide? I'll accept a 30 second delay in LEO assistance with a pt that is already restrained, should I need to remove the cuff for some reason vs getting shot.

 

[spinnakr]

I never said backboard sandwich, rathe having one wrist cuffed to the frame of the cot.

You misunderstood me. This part was a non-sequitur, and not directed at you!

 

[46Young]

So again, I ask, the patient is restrained using LEO tactics by LEOs who are using LEO equipment. So, who is in charge of how the LEO's place the patient, or how they apply the LEO restraints?

or let me be even more specific, if the LEO's handcuff the patient with their arms behind their back, are you within your rights to tell them to restrain them another way? you can ask, but what right to you have to tell a LEO how to restrain a person, when they are the experts in restraining, and have received many hours in how best to restrain someone for everyone's safety?

now, assuming they place this violently combative person in a prone position on the stretcher, and then straps the person down in hopes of limiting the patient's ability to swing and kick, what right do you have to tell the LEO anything else? after all, they are the experts in restraining, and have received many hours in how best to restrain someone for everyone's safety.

We all know EMS can ask for a LEO to do something to make out jobs easier, but if they refuse, then what position does that leave EMS in, esp when their actions are not done in the best interests of good patient care?

We have a good relationship with the county PD. Same with the NYPD back in the day. It's really simple. If the police restrain a pt in a way that is potentially dangerous for the pt, then we just don't transport until things are done to our satisfaction. If it's a combativeness issue, we'll drop some versed to smooth things over. Again, if the pt's wrist is secured to the cot's frame, where are they going, and how are they going to attack anyone?

I miss the NYPD ESU, they would secure a combative EDP in what looked like a heavy duty sack. It restrained well, and allowed some movement while inside, just that they couldn't take their arms or legs out to strike or kick.

 

[46Young]

If they truly refuse, and there's absolutely no way around it - in short, if the patient becomes a detainee first and foremost, then documentation is key. Write it in the narrative and maybe an incident report. Make sure the liability is on the LEO's side.

You could always try to convince the LEO to handcuff the patient to the cot instead of behind his/her back.

On the other hand I don't think there should ever be an absolutely no-dice situation like I described above. If you think it could kill or harm the patient, or otherwise impede in care, then be honest and upfront about explaining that to the officer. If the officer still refuses, ask to speak with his superior/OIC. It's YOUR patient.

Yes, crew and LEO safety at the scene takes precedence, but the position of the pt is a whole other matter.

 

[46Young]

When wrestling with a combative pt, they should be places supine at some point. One person holds the shoulders, another controls the head by turning it one direction or the other. The head follows the body, they can't go anywhere. One person on each leg. Externally rotate each leg, and they can no longer kick. Now you can isolate an arm or a delt for some vitamin V/vitamin A. This works well for the pt in the ED as well. It works way better than everyone wrestling with the pt in an uncoordinated fashion and getting f'ed up.

 

[JPINFV]

I would think that the officer would rather ride in the cruiser instead of being cursed at and spit on.

An NRB or isolation mask solves this.

 

[46Young]

You misunderstood me. This part was a non-sequitur, and not directed at you!

My bad XD

 

[46Young]

An NRB or isolation mask solves this.

But there's still the issue of a loaded gun within reach, and nowhere to take shelter.

 

[JPINFV]

4 point restraints....

 

[46Young]

4 point restraints....

Then why the bracelets? If I had the pt secured in that fashion then I wouldn't need an LEO after that point, anyway. I'd probably drop a lock on them while onscene since the extra hands are there, so I can chemically restrain them IV vs IM if necessary.