Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review

McDowall, Jared; Makkink, Andrew William; Jarman, Kristin H.

doi:10.1016/j.afjem.2023.03.006

Cited by 2 publications

(3 citation statements)

References 38 publications

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“…However, the expression “not easily removable” in the commonly used definition of PR [ 1 ] prompts confusion about which devices are appropriate. Lethal adverse effects of PR, such as death, occur in relation to the restraint device, restraint position, and immobility [ 47 , 48 ]. To reduce the fatal adverse effects caused by PR, it is necessary to develop a physiologically safe restraint device and position.…”

Section: Discussionmentioning

confidence: 99%

“…In the PR-related lawsuit analyzed in this study, adherence to guidelines emerged as the pivotal factor influencing the determination of whether the ‘duty of care’ was violated. Regular monitoring of care recipients who are either currently using or likely to use physical restraints is crucial for ensuring compliance with guidelines [ 36 , 48 ]. Specific monitoring measures were identified in our study (e.g., checking restrained body parts every two hours and periodically releasing restraints).…”

Section: Discussionmentioning

confidence: 99%

“…Documentation is also important [ 51 ]. When a conflict arises, health workers are burdened with proving that their practices were appropriate [ 36 , 48 ]. Even with diligent adherence to guidelines, health workers may face challenges in having their compliance recognized in a dispute without detailed documentation.…”

Section: Discussionmentioning

confidence: 99%

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Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

Jang,

Lee,

et al. 2024

BMC Nurs

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Background Physical restraint (PR) is used to ensure the safety of care recipients. However, this causes an ethical dilemma between the autonomy and dignity of the recipients and the provision of effective treatment by health workers. This study aimed to analyze legal and ethical situations related to the use of PR using written judgments. Methods This study uses a qualitative retrospective design. Qualitative content analysis was performed on South Korean written judgments. A total of 38 cases from 2015 to 2021 were categorized. The types of court decisions and ethical dilemma situations were examined according to the four principles of bioethics, and the courts’ judgments were compared. Results Written judgments related to PR were classified into three types according to the appropriateness of PR use, the presence or absence of duty of care, and legal negligence. Ethical dilemmas were categorized into three situations depending on whether the four principles of bioethics were followed. The courts’ decisions regarding the ethical dilemmas differed depending on the situational factors before and after the use of PR and the conflicting conditions of the ethical principles. Conclusions Health workers should consider legal and ethical requirements when determining whether to use PR to provide the care recipient with the necessary treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

Jang,

Lee,

et al. 2024

BMC Nurs

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Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies

Cummings,

Babcock,

Zhang

et al. 2024

Pediatr Emer Care

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Objectives The aims of the study are to characterize children with mental and behavioral health conditions (MBH) transported by emergency medical services (EMS) and examine differences in patient, emergency department (ED), and EMS transport characteristics based on restraint interventions during EMS transport. Methods This is a retrospective cohort study of EMS patients with MBH crises, aged 5–18, transported to 2 pediatric EDs over 9 years. Demographic and ED data were collected electronically; EMS data were extracted manually from prehospital care records. Field interventions studied included pharmacologic and mechanical restraints by EMS clinicians. Univariate analysis compared variables between patients who received EMS restraints and those who did not and multivariable logistic regression identified patient factors independently associated with EMS restraint use. Results Among 10,264 patients transported by EMS for MBH crises, 1400 encounters were randomly selected, with 768 records available. EMS restraint interventions were used in 73 (9.5%) patients: 5 (0.7%) received only pharmacologic restraints, 58 (7.6%) received only physical restraints, and 10 (1.3%) received both. Those who received EMS restraints were more likely to be younger (35.6% vs 19.6%, P = 0.001), male (71.2% vs 44.6%, P < 0.0001), and had longer scene times (13 vs 9 min). Restraint use was more common when patients were picked up from schools (30.1% vs 14.8%, P = 0.007). EMS-restrained patients were also more likely to receive physical (12.3% vs 2.3%, P < 0.0001), mechanical (15.1% vs 1.0%, P < 0.0001), or pharmacologic (24.7% vs 3.9%, P < 0.0001) restraints in the ED. Predictors of EMS restraint use were male sex (odds ratio, 3.00; 95% confidence interval, 1.74–5.17) and being picked up from schools (odds ratio, 2.08; 95% confidence interval, 1.13–3.81), whereas age group, race, and insurance type were not independent predictors. Conclusions Nearly 1 in 10 pediatric patients experiencing mental health crises and transported by EMS required restraint interventions in the field. Male patients, younger aged children, and those picked up from school represent a distinct and vulnerable population that could benefit from specialized prehospital care to manage agitation.

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Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review

Cited by 2 publications

References 38 publications

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies

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