CHEMICAL RESTRAINT OR SEDATION
In cases of excited delirium, extreme agitation, severe combativeness, and risks of self-harm or harm to care givers chemical restraint or sedation may be indicated. This is a huge decision and should be approached carefully and in good faith . The decision to sedate a patient should be based on sound medical grounds and is not a law enforcement decision. The patient needs to be transferred to the care of the paramedic and a full assessment performed to the limits allowed by the patient’s condition. An appropriate transport vehicle should be in route or otherwise available and the full complement of medications and equipment should be available to manage the patient, manage any adverse events, and monitor the patient.
Mental health crises can pose specific problems for chemical restraint interventions. Acute psychotic manic episodes or gross hallucination can be exacerbated by Ketamine and Midazolam may be the preferred medication. Some medical conditions should be cautiously approached when considering Ketamine including dangerous hypertension, acute cardiac disease, and sedating medications such as gross alcohol intoxication and other sedatives where the patient already has a depressed level of consciousness.
1. Determine that the patient is a danger to themselves or caregivers due to undifferentiated agitated delirium, severe agitation, severe combativeness, or other conditions amenable to chemical restraint for the patient’s well-being.
2. Be certain that medical indications exist for medication assisted restraint.
3. The patient must be transferred to the paramedic for medical care. The restraint of the patient for safety may require the additional help of law enforcement but this is not a law enforcement decision.
4. The patient needs a full assessment to the degree that the patient’s condition allows.
5. The patient must be transported to an emergency department for further care.
6. The use of soft restraints in any sedated patient (or in general in agitated patients) is allowable. The patient must be in a comfortable position where circulation and breathing are not compromised.
7. The LCFD Treatment Guidelines applicable to sedation follow:
In cases of excited delirium, extreme agitation, severe combativeness, and risks of self-harm or harm to care givers chemical restraint or sedation may be indicated. This is a huge decision and should be approached carefully and in good faith . The decision to sedate a patient should be based on sound medical grounds and is not a law enforcement decision. The patient needs to be transferred to the care of the paramedic and a full assessment performed to the limits allowed by the patient’s condition. An appropriate transport vehicle should be in route or otherwise available and the full complement of medications and equipment should be available to manage the patient, manage any adverse events, and monitor the patient.
Mental health crises can pose specific problems for chemical restraint interventions. Acute psychotic manic episodes or gross hallucination can be exacerbated by Ketamine and Midazolam may be the preferred medication. Some medical conditions should be cautiously approached when considering Ketamine including dangerous hypertension, acute cardiac disease, and sedating medications such as gross alcohol intoxication and other sedatives where the patient already has a depressed level of consciousness.
1. Determine that the patient is a danger to themselves or caregivers due to undifferentiated agitated delirium, severe agitation, severe combativeness, or other conditions amenable to chemical restraint for the patient’s well-being.
2. Be certain that medical indications exist for medication assisted restraint.
3. The patient must be transferred to the paramedic for medical care. The restraint of the patient for safety may require the additional help of law enforcement but this is not a law enforcement decision.
4. The patient needs a full assessment to the degree that the patient’s condition allows.
5. The patient must be transported to an emergency department for further care.
6. The use of soft restraints in any sedated patient (or in general in agitated patients) is allowable. The patient must be in a comfortable position where circulation and breathing are not compromised.
7. The LCFD Treatment Guidelines applicable to sedation follow: