Re: Transporting restrained patients

February 15, 2001

Our policy is to remove handcuff prior to transport unless an officer will

ride in the unit with us. If the patient requires restraints and the

officer will not ride, we use soft restraints.

Steve Dralle

San , TX

[texasems-L] Transporting restrained patients

Transporting restrained patients can become a legally ticklish

situation for EMS responders. Please respond to this situation:

Local jail prisoner to be transported to local hospital. Patient c/o

chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

ambulance, but will follow behind in car and be at the hospital. EMS

crew given key to handcuffs in case patient needs to be released.

Prisoner is in jail for DWI. Not known to be violent. He is

fully alert and oriented.

Any problems here?

Bob Tarbet, LP

McGregor (Just down the road from the Texas whitehouse)

February 15, 2001

only with having the handcuff key; also, i have no qualms of stopping and

opening the door for the patient/prisoner who is violent -- he is not my

prisoner, therefore our officers stay real close to the ambulance

> [texasems-L] Transporting restrained patients

>

> Transporting restrained patients can become a legally ticklish

> situation for EMS responders. Please respond to this situation:

>

> Local jail prisoner to be transported to local hospital. Patient c/o

> chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

> ambulance, but will follow behind in car and be at the hospital. EMS

> crew given key to handcuffs in case patient needs to be released.

>

> Prisoner is in jail for DWI. Not known to be violent. He is

> fully alert and oriented.

>

> Any problems here?

>

> Bob Tarbet, LP

> McGregor (Just down the road from the Texas whitehouse)

>

February 15, 2001

I agree with the pt is just that my patient not my prisoner I will not

be responsible if the pt wants out I will not fight to keep him in the unit

I will inform PD of any situations that may occur during transport but wont

put myself in harms way. As for the pt being in handcuffs I have no problem

with that as long as you do have access to a key if needed. The way I look

at it is the hand cuffs are there to protect me.

Frieze EMT-P

League City EMS

Ph.(281)338-4873

Fax. (281)3327663

League City, Texas

[texasems-L] Transporting restrained patients

>

> Transporting restrained patients can become a legally ticklish

> situation for EMS responders. Please respond to this situation:

>

> Local jail prisoner to be transported to local hospital. Patient c/o

> chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

> ambulance, but will follow behind in car and be at the hospital. EMS

> crew given key to handcuffs in case patient needs to be released.

>

> Prisoner is in jail for DWI. Not known to be violent. He is

> fully alert and oriented.

>

> Any problems here?

>

> Bob Tarbet, LP

> McGregor (Just down the road from the Texas whitehouse)

>

February 15, 2001

So far all I have seen here are personal " opinions " . Seems we need a

" legal " statement. There are definitely Texas laws that pertain to law

enforcement officers " releasing " a restrained prisoner to non-law

enforcement personnel. Gene, ???

Greg Higgins LP

FWFD

February 15, 2001

Bob,

Our policy is not to transport with handcuffs on, unless the officer is in

the truck. If the won't ride with us, then no handcuffs. If the patient

wants out, we pull over and let him out.

[texasems-L] Transporting restrained patients

> Transporting restrained patients can become a legally ticklish

> situation for EMS responders. Please respond to this situation:

>

> Local jail prisoner to be transported to local hospital. Patient c/o

> chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

> ambulance, but will follow behind in car and be at the hospital. EMS

> crew given key to handcuffs in case patient needs to be released.

>

> Prisoner is in jail for DWI. Not known to be violent. He is

> fully alert and oriented.

>

> Any problems here?

>

> Bob Tarbet, LP

> McGregor (Just down the road from the Texas whitehouse)

>

February 15, 2001

I see some problems with transporting a prisoner without a law enforcement

escort. Medics are not sworn law enforcement officers normally, and so don't

have any of the rights and privileges that sworn officers have. In other

words, no right to restrain or prevent the " escape " of a patient.

I would always insist upon a LE person accompanying the patient. If that

were not possible, I would let them know that I would not attempt to restrain

the patient if s/he attempted to leave. If restraints are to be applied,

then they must be applied prior to the beginning of transport. If there's to

be a fight, then the time for it is prior to transport.

These matters are best addressed before the fact through policies and

procedures that have been worked out in advance between the services.

Failure to do this is common. It always astounds me when I encounter cases

where LE, EMS, and Fire have never sat down and worked out rules to be

followed in these cases. It's like Law Enforcement is from Mars, EMS is from

Venus, and Fire is from Saturn. And the mayors and city managers are from

Pluto.

So everyone should sit down and develop a policy and procedure manual to

cover these transports.

That said, I have some personal ideas and tricks that I will pass along. I

don't guarantee that these techniques will work in all instances; in fact NO

technique will work in every instance. The ideas expressed here are solely

for the purpose of provoking thought and the development of workable

solutions.

First, I won't accept patients in handcuffs, because a patient in handcuffs

cannot be freed in case of an accident or fire in the patient compartment.

Even if you have a handcuff key, you won't be able to use it in a crisis

situation. And when you get them to the ER and they're handcuffed to your

stretcher, you're attached to them until they can be freed and transferred to

LE people. In the meantime your dispatcher is telling you to clear for a

cardiac arrest three blocks away and you can't respond.

Second, I will not accept a patient in the " hogtie " position. This is a

recipe for demise of the patient and civil and criminal charges. Please

review the extensive data on the contraindications for this position.

Third, if the patient is in handcuffs, then I will convert the patient's

restraints to plastic ties which can readily be cut with paramedic shears or

knives. If your service doesn't carry plastic ties, then you should insist

that they do it. They are cheap and will save millions in damages if push

comes to shove. If your service won't provide them, then you can buy them

very cheaply and carry them yourselves. If your service won't allow you to

implement them, then you need to have a serious talk with your operations

manager and medical director.

The technique for transferring restraint from handcuffs to plastic ties is as

follows: If the patient will lie down on the stretcher or spineboard, place

a plastic tie around each wrist snugly but not tightly. Have the patient

restrained while the cuffs are taken off. Then place another plastic tie

through the one on each wrist and run that tie through either the handholds

on the board or the BOTTOM frame of the stretcher. (Hint: the sequence of

events here will depend upon the cooperation of the patient. Modify as

needed.) Arms may be crossed, or one arm restrained to the side and the

other over the head. Now the metal handcuffs have been replaced with plastic

ties, which can readily be cut. If the patient will not lie down, then s/he

must be immobilized through force of numbers. It can take as many as 5

rescuers per patient to effectively immobilize one who is fighting and that

may not be enough. If the requisite personpower is not available, then don't

go there. Rodney King could have easily been restrained with a 5-person

immobilization technique. Once you get their legs off the ground, then they

have no way of applying force.

I cannot emphasize enough the advantages that can be gained by practicing

these techniques in advance. Scenario play is extremely important, and

should be done at regular intervals. Don't find yourself facing a situation

that requires an orchestrated response without having practiced it. Would

you go into the SuperBowl without having practiced?

The same technique can be used with the ankles. Place a tie closely around

each ankle and then run another one through that one and run it through the

handholds of the long board, or the scoop, or on the frame of the stretcher.

If the patient continues to resist, or if difficulty is encountered in

placing the ties around the ankles, then place a CPR board or other rigid or

semi-rigid object, such as a traction splint or oxygen D cylinder on top of

the patient's knees and apply pressure. Sit on them if necessary. Apply

additional plastic ties around the legs just above the knees and run another

tie through them and fasten them to the stretcher or spineboard.

Always restrain your patients prior to beginning transport. I'm talking here

about patients in LE custody. If they're not in LE custody, then they should

be, or you should not be trying to restrain them. If a patient in LE custody

doesn't want to be restrained, the time for the fight is prior to tx, not

during, and when you have LE people there to run the show. If the LE

officer can't accompany you and wants to drive behind, then you've got to

have your patient restrained prior to tx. Otherwise, don't go there.

Once restrained, you must continually monitor circulation to the restrained

extremity and document it. Record skin color, temp, and pulses at regular

intervals. Also monitor pulse oxymetry and respirations.

I favor restraining patients with arms crossed and wrists secured to the

opposite side of the stretcher. Unless a spineboard is necessary, the

patient can be restrained with arms crossed and if they struggle, the head of

the stretcher can be raised, which will increase the pressure on their arms

and discourage movement. A NRB can be placed on the patient with O2 at 15

lpm, which will effectively prevent them from spitting and biting. Monitor

and record your oxymetry levels at all times. Watch your patient and employ

the basics at all times. If your patient vomits, then take immediate action.

Protect the airway at all times. Think in advance about how you would deal

with your patient if his mouth were suddenly full of vomit. Have a plan.

If your patient is on a spine board, the same rules apply, except that you

can't increase the pressure through raising the head.

I'm sure that there will be many questions and objections to these proposals.

I welcome them. There is simply no one solution to the problems encountered

with a violent patient who must be restrained. Please post your questions,

problems, and dislikes of these proposals. That way we'll learn. There are

probably a thousand other ways of dealing with these patients and the

problems they present. So please, lets hear and debate them. The problems

inherent with restraint of the uncooperative patient are many and troubling.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

February 15, 2001

I don't see any problems. what does chest pain have to do with being

handcuffed?

Eddie on, EMT-P

[texasems-L] Transporting restrained patients

> Transporting restrained patients can become a legally ticklish

> situation for EMS responders. Please respond to this situation:

>

> Local jail prisoner to be transported to local hospital. Patient c/o

> chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

> ambulance, but will follow behind in car and be at the hospital. EMS

> crew given key to handcuffs in case patient needs to be released.

>

> Prisoner is in jail for DWI. Not known to be violent. He is

> fully alert and oriented.

>

> Any problems here?

>

> Bob Tarbet, LP

> McGregor (Just down the road from the Texas whitehouse)

>

February 15, 2001

Our policy is that " prisoners " and/or " possible prisoners " (those persons

that haven't actually been placed under arrest, but have been restrained by

Police for 'protection') are ALWAYS accompanied by an officer in the rear of

the unit. If the officer won't go, then the patient must be released from

hand cuffs and restrained in a method that is conducive to good patient care

and designed for patient protection. That usually means leather restraints

designed for patients, or at least wide bands of sheets or cravats and

documented to death. We just don't do hand cuffs.

Tom

[texasems-L] Transporting restrained patients

Transporting restrained patients can become a legally ticklish

situation for EMS responders. Please respond to this situation:

Local jail prisoner to be transported to local hospital. Patient c/o

chest pains. Patient/prisoner in hand cuffs. Jailer will not ride in

ambulance, but will follow behind in car and be at the hospital. EMS

crew given key to handcuffs in case patient needs to be released.

Prisoner is in jail for DWI. Not known to be violent. He is

fully alert and oriented.

Any problems here?

Bob Tarbet, LP

McGregor (Just down the road from the Texas whitehouse)

February 16, 2001

Though I agree that you should not transport a Patient handcuffed to your

stretcher I see no problem with the Patients hands handcuffed together in

the front of their body. I have done a numerous amounts of emergency calls

(911) out of a TDC facility in Texas City and you had very little choice as

a medic the Pt. was going to be handcuffed. Granted a TDC officer rode

along on the call but always up front (not readily available to take the

cuffs off in an accident. I never had a problem with the cuffs I learned to

start IV's around them. If an emergency arose the Pt. could still be

removed from the unit with little to no extra effort. The handcuffs as well

as the seatbelts on the stretcher gave me a little extra protection just in

case the prisoner decided to become violent. (not that I was going to fight

him/her but by the time they could fight through the seatbelts with the

cuffs on I figure I could have my partner stop, I could get out and the

guard could be allowed to do his/her job) I don't see any problem with the

plastic ties but I do beg to different with you about not being able to use

the handcuff keys in a crises situation we are trained to function in crises

situations that is are job. (not necessarily taking handcuffs off but

functioning in a crises). You are exactly right about sitting down and

drawing up your own policy planning always is easier the flying by the seat

of your pants.

Frieze EMT-P

League City EMS

Ph.(281)338-4873

Fax. (281)3327663

League City, Texas

Re: [texasems-L] Transporting restrained patients

I see some problems with transporting a prisoner without a law enforcement

escort. Medics are not sworn law enforcement officers normally, and so

don't

have any of the rights and privileges that sworn officers have. In other

words, no right to restrain or prevent the " escape " of a patient.

I would always insist upon a LE person accompanying the patient. If that

were not possible, I would let them know that I would not attempt to

restrain

the patient if s/he attempted to leave. If restraints are to be applied,

then they must be applied prior to the beginning of transport. If there's

to

be a fight, then the time for it is prior to transport.

These matters are best addressed before the fact through policies and

procedures that have been worked out in advance between the services.

Failure to do this is common. It always astounds me when I encounter cases

where LE, EMS, and Fire have never sat down and worked out rules to be

followed in these cases. It's like Law Enforcement is from Mars, EMS is

from

Venus, and Fire is from Saturn. And the mayors and city managers are from

Pluto.

So everyone should sit down and develop a policy and procedure manual to

cover these transports.

That said, I have some personal ideas and tricks that I will pass along. I

don't guarantee that these techniques will work in all instances; in fact NO

technique will work in every instance. The ideas expressed here are solely

for the purpose of provoking thought and the development of workable

solutions.

First, I won't accept patients in handcuffs, because a patient in handcuffs

cannot be freed in case of an accident or fire in the patient compartment.

Even if you have a handcuff key, you won't be able to use it in a crisis

situation. And when you get them to the ER and they're handcuffed to your

stretcher, you're attached to them until they can be freed and transferred