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EMS Use of Restraints

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  • EMS Use of Restraints

    As a paramedic in an urban system I am trying to promote the city to allow us to carry handcuffs, as do many of the other urban systems around us, for example Boston EMS, and Worcester EMS. I am looking for opinions from law enforcement (police officers) on this topic. Does EMS in your community carry handcuffs? Do you feel that they should ? Do you send an officer to all EMS requests? I am looking for any opinion, it doesn't just have to be positive! I encourage all feedback! We, often do not get a crusier on all of our calls because they are just to busy to free a car !

    Also, do any of your police departments incooperate paramedics as part of the SWAT (or equivelant) team?
    Last edited by B_Lonardo; 11-08-2007, 09:33 AM.

  • #2
    *not Leo Yet*

    I think that all the trucks should have some flex cuffs just in case, but I don't really think that the normal EMT needs a pair of steel cuffs. If they are bad enough to cuff around here the police are usually already there. If they are combative might think about an EOD. I also believe that the EMT-B/drive should ALWAYS be allowed to carry a concealed handgun, but that pretty much never happens
    Let no one lose heart on account of this Philistine; your servant will go and fight him

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    • #3
      I'll throw my two cents since I am an EMT-IV and LEO....


      Restraints? Yes

      Cuffs? Not necessarily. There are other ways to restrain a patient.

      I will agree with Norman on one aspect, that if the call is possibly violence-related, LEO's are there in most cases. In some counties, LEO's roll with EMS on almost every call. In my county (Metro Nashville/Davidson Co), normally MNPD rolls with EMS on calls related to domestics, violent behavior, ETOH (or alcohol-related).

      Handgun for EMT's? No...whether you realize it or not (Norman), allowing an EMT to carry a firearm introduces that weapon to every call you go on. An otherwise unarmed person who becomes belligerent/violent for whatever reason (whether it be alcohol-related, behavioral, diabetic) now has access to a gun; and law enforcement may or may not be there to help you out. I just don't see EMS personnel staying proficient enough in use of force issues, handgun training, deadly-force training to warrant carrying it. Some may have a different opinion, but that's my take on it. The only time I've seen weapons on ambulances are in the middle-east, and normally they are assault rifles. Totally different circumstances involved though.

      I think pepper spray/mace would be ok and would be effective enough to incapacitate the indivudal and allow you to either (1) gain control or (2) escape to safety.
      I'm 10-8 like a shark in a sea of crime..

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      • #4
        Handcuffs?

        I've been medic for 7 years in an urban area. Been in plenty of fights and had more combative patients than I can count. Never have I needed handcuffs. 4 point restraints right to the stretcher or strapped to a back-board works fine.

        Why would you need handcuffs? If they're cuffed in the back than they can't be secured properly on a stretcher. If you're going to cuff with arms in front then they can still swing at you. I'd rather 4 point with one hand over their head. Works great.
        Last edited by bigeagle; 11-08-2007, 12:04 PM.
        "There is no hunting like the hunting of man, and those who have hunted armed men long enough and liked it, never care for anything else thereafter." Ernest Hemingway

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        • #5
          Ok, I work for the FDNY as an EMT, handcuffs no but soft restraints yes. We actually use triangular bandages as our soft restraints, and if the guys really that bad ESU will wrap em in a nice black burrito (that’s a nick name we call em). You don’t need soft restraints all of the time, I've had my shares of EDP's, drunks, and drugs, most of them aren’t all out fists flaring, but the few that are yea...def. The ones that are already arrested, PD has it covered. Usually if the call's that bad we wait for PD no matter what, you shouldn’t put your safety in jeopardy if you feel uncomfortable.
          Last edited by MrsPagan; 11-08-2007, 12:46 PM.
          Rookie

          Changed name, don't use this account anymore but will check if you need me to ans. questions.

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          • #6
            I am a police officer and EMT We try to send officers on all medic runs. Handcuffs = No and soft restraints = Yes. I agree with the above three posters.

            Comment


            • #7
              Originally posted by SgtScott31 View Post
              I'll throw my two cents since I am an EMT-IV and LEO....


              Restraints? Yes

              Cuffs? Not necessarily. There are other ways to restrain a patient.

              I will agree with Norman on one aspect, that if the call is possibly violence-related, LEO's are there in most cases. In some counties, LEO's roll with EMS on almost every call. In my county (Metro Nashville/Davidson Co), normally MNPD rolls with EMS on calls related to domestics, violent behavior, ETOH (or alcohol-related).

              Handgun for EMT's? No...whether you realize it or not (Norman), allowing an EMT to carry a firearm introduces that weapon to every call you go on. An otherwise unarmed person who becomes belligerent/violent for whatever reason (whether it be alcohol-related, behavioral, diabetic) now has access to a gun; and law enforcement may or may not be there to help you out. I just don't see EMS personnel staying proficient enough in use of force issues, handgun training, deadly-force training to warrant carrying it. Some may have a different opinion, but that's my take on it. The only time I've seen weapons on ambulances are in the middle-east, and normally they are assault rifles. Totally different circumstances involved though.

              I think pepper spray/mace would be ok and would be effective enough to incapacitate the indivudal and allow you to either (1) gain control or (2) escape to safety.
              I was not saying that handguns be required, only allowed if the EMT gets a CCW or the like. The reason I say that is I persoally know of medics getting shot at and etc. I think that pepper spray would present a major problem to future patients who may have allergies. That and the back of a bus is so small I would hate be in it after someone got sprayed.

              Sorry to the OP for getting off topic. I still think that a couple flex cuffs could come in handy. As mentioned though triangular bandage and KED/Long spine board FTW.
              Last edited by Norman; 11-08-2007, 03:30 PM. Reason: got off topic
              Let no one lose heart on account of this Philistine; your servant will go and fight him

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              • #8
                I am just reaffirming most of what I have read above. I am both a Paramedic and a Police Officer, and having been on both sides i would certainly encourage use of restraints where appropriate but not with steel handcuffs.

                As an EMT you are a caregiver and the patient's advocate. Steel on skin is never the choice you want to advocate for them if you have other options available. Cloth 4x4's and some kerlix can make instant soft restraints for you, and cost little or nothing. Get blood on them? So what, they are disposable. Plus you should already be carrying that in your supplies. I have done this multiple times and have yet to see anyone be able to tear loose unless you tie them to a sharp edge, but again some 4x4's or abd dressings would protect that.

                Most medical suppliers do offer cheap and disposable soft restraints. The padded leather ones will cost more but if cared for can still be used long after your grandkids retire.

                Other reasons to choose soft restraints include:

                - limb placement flexibility. You can usually choose length of the strap you are securing a limb with, handcuffs are as you get them. This can become important when trying to secure or maintain IV access, BP monitoring (Critical especcially in head injuries = combative), as well as some other medical assessments and treatments.

                - you can safely assess radial pulses without fear of pinching your fingers between their bones and the metal. not so with handcuffs.

                - people come in all sizes, soft restraints can be adjusted for that size. what if the person you hare securing is small and squirmy, or extremely large? Edema in extremities can change the size during some medical conditions as well, making your risk of compartment syndrome type injuries a possible risk. Soft retraints would allow for more expansion and can be more easily adjusted or just plain cut off if necessary. If you have to much pressure on the cuffs and you can't easily remove them after that sweeling has ocurred you could have issues there as well.

                - nerve and joint damage is more likely with metal cuffs than with soft restraints.

                - Metal cuffs will scrape the paint on your fancy cot

                - Metal cuffs you will need to carry a key and always have it available. Soft restraints can be removed by any medical personnel.

                I could list more, but I am hoping you will see where I am coming from. Again as a Paramedic with a lot of years of experience, I would really discourage the use of any kind of metal restraint. Even if just for the perception. Even as a cop I don't like to use handcuff's because people know that when they come out their freedom is being taken away. Your ability to build trust and enhance your care can be hampered just because you used the wrong tool. I again really throw out the idea of the Kerlix and 4x4's because none of those are going to set off alarm bells for most patients and you san use them effectively for most transports. If you need more, you can always consider chemically restraining them with the proper medical orders for sedation as well.

                Jon

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                • #9
                  Originally posted by wisened View Post
                  If you need more, you can always consider chemically restraining them with the proper medical orders for sedation as well.

                  Jon
                  Yet another good point.
                  "There is no hunting like the hunting of man, and those who have hunted armed men long enough and liked it, never care for anything else thereafter." Ernest Hemingway

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                  • #10
                    If ther person is in custody, then the only option if they are concious is to cuff them to the gurney. If unconcious then no.

                    If in custody, then an officer will escort the bus to the hospital.

                    Fierarm=No

                    Body armor=yes. (in an outer carrier).

                    Comment


                    • #11
                      Thank you to all who have responded thus far. Some very helpful feedback here. A couple of interesting things came up that I want to address. First, I am completely against EMS carrying firearms. I have heard talk of tasers (our police department recently outfitted each officer with a taser) I personally have not been involved in an incident where one has been used. My concern with EMS (myself included) carrying any weapon is the risk of being overcome and losing it to someone who is suicidal or otherwise psychologically ill. I believe someone already mentioned this above. The reason I am wanted to explore the topic of restraint is that some of the patients we encouter (as do all of you) are often under the infulence of very potent drugs (cocaine, PCP, etc. ) and can become quite strong, requiring lots of power to overcome. In my system, unless a weapon is know to be involved, we only send the rescue. Unlike some other similar systems, we don't routinely dispatch an engine to medical calls. So, unless its coded in the computer as a weapon involved, or something that is known to require an officer, its just us. Now, with that said, the PD is very good to us, and helps us out greatly when they are there, but often times they don't get sent. But all of you have been very helpful, and I appreciate the feedback. As to chemical restraint: Does anyone work in a system where you can use chemical restraint on psychological emergencies in the pre-hospital setting? I have heard that New Hamphsire allows for this, but to my knowledge the state of MA does not provide for this.

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                      • #12
                        Well my department issues us body armour because of a few techs that we're shot or confronted with a firearm, I think its a good thing, a bit to get used to. Actual firearm issued to us: No, absolutely not, there are so many dangers with us having one, you cant treat properly and worry about if the dude will snatch the weapon or worse. Techs. and medics are to treat and transport, officers are there for arrests and restraints other then soft restraints.
                        Not to mention we'd need additional training for how much force we are to use, etc. That's going a far way from what we are there to do, aid peoples injuries/illness' and such.
                        Rookie

                        Changed name, don't use this account anymore but will check if you need me to ans. questions.

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                        • #13
                          B_Lonardo,

                          When it comes to chemical restraint you primarily need your medical director to be on board with what you are potentially facing. As long as you can medically document a need for the medication administration then legally you should be able to administer the medication.

                          It comes down to articulable support. If you can legally and reasonably document a condition (i.e. combative to the point of self harm or harm to others) then you can have a documentable need for the medication. What meds you use can range greatly depending upon why the patient is in the state they are in.

                          For possible drug overdoses you are going to be a little more limited, as you do not want to overload the livers ability to process the medications. However, full sedation may not be necessary. Instead of diazepam (Valium) could you use lorazepam (Ativan). They won't go as deep into sleep but the calming effects may be all you need to bring their threat level down to a level you can manage with communication or a combination with restraints.

                          Remember that diphenhydramine (Benadryl) will also have a sedative side effect. It is not unusual for some people's significant aggressiveness from drug overdoses to be reduced with some Benadryl. Research has not resolved why this is, but it is theorized that it is a form of allergic reaction in the body. Similar to Dystonia reactions from some drugs that is also reversed by Benadryl.

                          For Cocaine overdoses you are probably going to be encouraged by a progressive doctor to consider a sedative. This will reduce the overall stress on the body. Prinzmetals Angina form constriction of blood vessels is not the first sign you should be looking for in possible cardiac complications and this will help keep you ahead of the curve.

                          In extreme cases, PCP for example it may not be out of line to consider a paralytic such as norcuronium, vecuronium or succinylcholine. Of course you combine that with a sedative. It may be safer to have to provide an airway for this patient than to have to fight them.

                          One of the things that we had to do was to get our money person to authorize the expense of Romazicon on the trucks so that we had a reversing agent for the sedatives. This way if something changed and we needed to wake the patient up we had the means to do so quickly and safely.

                          Once again it is all a matter of justifying the actions you want to take with sound medical knowledge and an ability to properly articulate how your actions were a benefit to your overall patient care.

                          Last but not least, when you are making your presentations for options, present them with areas of benefit to the hospitals and their staff as well. Remember that you are a gateway for this patient to enter into the entire healthcare continuum. If you proposals show benefit to the patient as they progress from the street to the ER to the floor and so on, then you will be more likely to have success in getting these tools in your arsenal. If you use them or present them as something that helps you but adds to what the hospital has to deal with then you are likely to be shut down.


                          Jon

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                          • #14
                            B- I hear your frustrations. I was a medic in one of your above mentioned services for a few years before becoming a cop. I learned quickly that EMS and scene safety is not always textbook, sh*T just happens. There were many times I wished I had a pair of handcuffs to use. I think that if there is a good deal of regulation when it comes to medics using handcuffs,along with some proper training, I dont see a huge deal with it. An example of this would be use the cuffs to get someone quickly restrained, and then change them over to soft restraints once it is safe to do so. Christ, medics are trusted with paralytics, which can easily kill someone, whats the big deal about handcuffs. No on the OC and a big no on the handgun option. As far as body armor, I wore it religiously everyshift as a medic. EMS means you may get into a bad situation, but the difference between you and the police in these cases is that you can turn around and run away (or wait), where as cops cannot.

                            Im not sure what the history of why and how Boston EMS started using cuffs, Worcester EMS does NOT carry them.

                            Good luck, stay safe
                            Smudge
                            ....Remember that courage and strength are naught without prudence, and that a momentary negligence may destroy the happiness of a lifetime. Do nothing in haste,look well to each step, and from the beginning think what may be the end. -E. Whymper

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                            • #15
                              I completely support paramedics having hand cuff's for safety reasons. There's no mention about using them on all patients (obviously), however it's better to be prepared against violent patients. I understand that 4-point restraints work. but if your walking a mobile drug addict down four flights of narrow stairs, being tied to a stretcher doesn't do that much good.
                              Work harder! Millions on welfare depend on you...

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