NYS Protocol for Restraining Patients?

[WAS967 97]

Since when can we follow the facility docs orders? In NYC there's a whole procedure for following direction from a non-FDNY OLMC physician. I know in Westchester orders come from the physician at your destination hospital. If thats the case, anything the originating facility doc writes is just a waste of paper.

What if the originating facility is an ER where the doc IS your OLMC physician? And originating facility MD orders DO have bearing in some cases. DNR is the perfect example.

The guidance from OMH applies to in-patient restraint within Pysch facilities. I don't believe that it has any bearing on EMS operations as we're not governed by OMH and once we accept a patient they're not an in-patient anymore.

Are not the OMH rules mental health law or am I confusing the two?

[Bnechis 3,961]

Since when can we follow the facility docs orders? In NYC there's a whole procedure for following direction from a non-FDNY OLMC physician. I know in Westchester orders come from the physician at your destination hospital. If thats the case, anything the originating facility doc writes is just a waste of paper.

On interfacility transfers the orders almost always come from the sending MD. "Back in the day" we did this all the time.

[Guest alsfirefighter]

Regarding documentation, theoretically, could a provider take picture of the restraint without the face of the patient in the photo to document the restraint used to show in case of a court case that the restraints used were not excessive?

I don't think that would be prudent nor necessary. Make your documentation to be your picture. Picture or not anything can be painted in any light, only good documentation of what you did and what you checked and kept checking.

WAS. No disrespect...but your throwing me off by coming to the table with "I believe." I've never heard of that by the way and I've never seen a policy be in that much detail.

[helicopper 1,050]

Are not the OMH rules mental health law or am I confusing the two?

Two different animals!

[WAS967 97]

Interesting. Anyone have a link to the mental health laws pertaining to retraints?

ALS: That's why we're here discussing this. I've been told by staff at one agency (in this case Abbey so forgive me if I'm dating myself) one thing, and if that is incorrect then we clearly need to fix the perception. Keep in mind that the concept of PRN restraint orders (again for interfacility runs) is CURRENTLY being contested by some as well. (Not on here) Will be interesting to see what becomes of that.

In the end, when it comes to combative patients - safety first. And for whoever brought up the issue of prone positioning, here's a story out of NJ of related interest: http://www.ems1.com/ems-management/articles/924068-5-NJ-EMTs-suspended-in-death-of-man-tied-face-down/

[wierdid 2]

Im still wondering about what was meant about restraint prn's being illegal. At my service, we do quite a few psych transfers in which a restraint prn is given from hospitals in CT to facilities in NY. In such cases, the pt is automatically restrained before leaving that facility, where the man power and means are available to do so safely. Those pt's are always also PEC'd. I dont know how many people on this forum have ever tried to restrain a psych pt who is trying jump out the back of their ambulance at 55+ mph, but I assure you it is no cake walk. It is a safer idea for us to take the word of the MD and just restrain the pt initially, but only if they are involuntary and it is in the best interest of the pt's safety, and most importantly yours. And on a side note, a properly tied cravat is one hell of a good restraint, just know what you are doing first.

[WAS967 97]

Perhaps illegal is the wrong word? Maybe against policy, etc etc would be better? I just don't know. But what you said makes sense. If they need restraints, then restrain before transport. If they don't, then don't. If they take a turn on the way to the destination, stop and deal with the situation. Involve police if needed. So the magic question is - regardless of the legality of it - what is the point of getting a script for restraints? Is it required/necessary? Or are we covered by the state protocols?

I just checked the NYS DOH EMT-Basic curriculum and it mentions that EMTs should be able to demonstrate the proper techniques for safely restraining a patient. (Lesson 4-8 Behavioral Emergencies - Psychomotor Objectives - Page 268). Has ANYONE here been skill trained in ANY EMT class of ANY level to do this? My basic class didn't do it. My medic class didn't do it. None of the EMT classes I've taught LAB in did it. Food for thought.

(I literally had a provider tell me that since we're not trained to restrain, if the person wants to get out of the back, then you should let them. THAT just doesn't sound like a viable option in this day and age.)

Edited February 26, 2011 by WAS967

[Guest alsfirefighter]

WAS..first brother you are dating yourself..lol.

Second...I was just thinking about this..but in all actually aren't all patients not restrained...in some way under the "PRN" restraint category if they get froggy? Just sayin...