RESTRAINT AND TRANSPORT / INVOLUNTARY
ALL LEVELS
DESIGNATION OF CONDITION
Emergency treatment applies to any age patient. Emergency treatment without consent implies that a life threat exists and patient is mentally incapable of making decisions on their own behalf. Reasonable force can be used, but only that force necessary to treat and transport the patient. Consider medication for sedation as the safer and more effective alternative to the risks of physical restraint. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.
EMPHASIS ON PATIENT CARE
Provider safety, transport decisions
1. Several attempts to gain consent for treatment and transport must be made prior to any attempts to subdue the patient.
2. If the patient meets the following criteria, the EMT may use reasonable force or sedation to treat and transport.
a. The patient words or actions indicate that he/she is mentally incapable of making decisions on their own behalf. Such as:
i. Displays inappropriate and erratic behavior
ii. Patient has inappropriate responses to questions.
iii. Evidence of significant drug or alcohol impairment.
iv. Disoriented to time, person, place, or event
v. Suicide attempt, or talking about attempting suicide or homicide.
b. A life-threat is suspected or present.
3. Use the following guidelines to secure and treat the patient.
a. Call for law enforcement assistance,
b. Have enough personnel to safely secure patient and assure that all personnel are in- formed of plans and are involved.
c. Adequately restrain the patient to stretcher or other device, as needed.
d. At least two EMTs should be present at all times if the patient is or suspected of being combative.
e. Keep bystanders and onlookers away from the patient as they may agitate the patient.
f. All resuscitative measures to sustain life may be executed.
g. Medical Control should be consulted if any questions arise.
h. Transportation to an appropriate health care facility.
4. Document all actions, statements, and responses to your questions that support your decision to treat the patient without consent.
The Non-Patient
For the purposes of refusal of treatment and/or transport there is a subgroup of individuals that constitute the “non-patient”. This is a small group and care should be taken in making the determination that the individual in fact meets the criteria for a “non-patient”. Non-patients still need documentation of their situation that lead to an EMS request and any relevant information concerning potential illness or injury. All demographics should be included. Seriously consider obtaining a formal informed consent refusal when any question of the individual’s actual patient status is present. “Non-patients” do not need to sign a refusal form, however.
Minors present a unique problem. They can’t consent to assessment and treatment just as they can’t refuse it. If they meet the criteria for a “non-patient” when time allows a good faith effort should be made to contact parents or guardians and inform them of their minor child’s status and wishes. The guidance of the parent or guardian should be followed.
A “non-patient” is one that declines all assessment and treatment and meets all of the following criteria:
1. Did not request EMS assistance or an ambulance
2. Presents with no current physical or psychological complaints
3. Has no symptoms, signs, or complaints of an active medical illness or a traumatic injury or evidence of the same
4. Is not impaired in anyway
Special notes:
“Lift assist” and similar calls for service where the potential for occult injury or illness is present should be carefully considered before being designated a “non-patient”. In an excellent study, patients who called for “lift assist” and similar calls had greater than a 20% need for emergency services within two weeks of the initial call. Look carefully for any sign of injury or illness and encourage assessment and treatment if it appears appropriate. In a similar manner consider getting an informed refusal if you suspect injury or illness in the face of the patient’s refusal of assessment and treatment. As usual, all refusals need to be well documented.
ALL LEVELS
DESIGNATION OF CONDITION
Emergency treatment applies to any age patient. Emergency treatment without consent implies that a life threat exists and patient is mentally incapable of making decisions on their own behalf. Reasonable force can be used, but only that force necessary to treat and transport the patient. Consider medication for sedation as the safer and more effective alternative to the risks of physical restraint. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.
EMPHASIS ON PATIENT CARE
Provider safety, transport decisions
1. Several attempts to gain consent for treatment and transport must be made prior to any attempts to subdue the patient.
2. If the patient meets the following criteria, the EMT may use reasonable force or sedation to treat and transport.
a. The patient words or actions indicate that he/she is mentally incapable of making decisions on their own behalf. Such as:
i. Displays inappropriate and erratic behavior
ii. Patient has inappropriate responses to questions.
iii. Evidence of significant drug or alcohol impairment.
iv. Disoriented to time, person, place, or event
v. Suicide attempt, or talking about attempting suicide or homicide.
b. A life-threat is suspected or present.
3. Use the following guidelines to secure and treat the patient.
a. Call for law enforcement assistance,
b. Have enough personnel to safely secure patient and assure that all personnel are in- formed of plans and are involved.
c. Adequately restrain the patient to stretcher or other device, as needed.
d. At least two EMTs should be present at all times if the patient is or suspected of being combative.
e. Keep bystanders and onlookers away from the patient as they may agitate the patient.
f. All resuscitative measures to sustain life may be executed.
g. Medical Control should be consulted if any questions arise.
h. Transportation to an appropriate health care facility.
4. Document all actions, statements, and responses to your questions that support your decision to treat the patient without consent.
The Non-Patient
For the purposes of refusal of treatment and/or transport there is a subgroup of individuals that constitute the “non-patient”. This is a small group and care should be taken in making the determination that the individual in fact meets the criteria for a “non-patient”. Non-patients still need documentation of their situation that lead to an EMS request and any relevant information concerning potential illness or injury. All demographics should be included. Seriously consider obtaining a formal informed consent refusal when any question of the individual’s actual patient status is present. “Non-patients” do not need to sign a refusal form, however.
Minors present a unique problem. They can’t consent to assessment and treatment just as they can’t refuse it. If they meet the criteria for a “non-patient” when time allows a good faith effort should be made to contact parents or guardians and inform them of their minor child’s status and wishes. The guidance of the parent or guardian should be followed.
A “non-patient” is one that declines all assessment and treatment and meets all of the following criteria:
1. Did not request EMS assistance or an ambulance
2. Presents with no current physical or psychological complaints
3. Has no symptoms, signs, or complaints of an active medical illness or a traumatic injury or evidence of the same
4. Is not impaired in anyway
Special notes:
“Lift assist” and similar calls for service where the potential for occult injury or illness is present should be carefully considered before being designated a “non-patient”. In an excellent study, patients who called for “lift assist” and similar calls had greater than a 20% need for emergency services within two weeks of the initial call. Look carefully for any sign of injury or illness and encourage assessment and treatment if it appears appropriate. In a similar manner consider getting an informed refusal if you suspect injury or illness in the face of the patient’s refusal of assessment and treatment. As usual, all refusals need to be well documented.