Combative Patient: The reality of using restraints in healthcare

For years I have attempted to raise awareness of the dangers involved with patient restraints. Oftentimes my pleas of reason fall upon deaf ears. Now, since the subject of violence is getting some real attention, the bandwagon is replete with new patient restraints classes/courses using police style (custody/control) systems, or martial arts (fighting/submission) techniques. Some are well-intentioned, but still dangerous for several reasons, mainly due to a lack of critical thinking skills for the end-user. 

This Chronicles post is one more attempt at providing a realistic view of what front-line staff face regarding this extremely dangerous, frequent type of event.

Before you watch the video, consider the following:

  • Empty-hand pain-compliance techniques only work on people who feel pain. 
  • Police have other tools (Taser, OC, Baton) for when empty- hand pain- compliance fails
  • The use of force in healthcare is usually reserved for restraints when performing a recognized form of medical treatment that was consented to. (See the actual MO State Statute below the video)
  • Patient restraint situations are the leading incident in which criminal assaults occur.
  • Restraint training receives the least amount of attention/hours
  • Custody is a police action
  • There is a huge difference between a person pulling away versus a person actively attacking

 

 

 

Questions:

  1. How often have you been a part of, or witnessed events like the ones you just watched?
  2. How frequently do police style empty-hand techniques fail?
  3. Is the healthcare provider supposed to deliver pain to obtain consent for medical treatment?
  4. How much training have you had in patient restraints?
  5. How often to patient restraint attempts turn into a “pile of bodies” that are able to use overwhelming numbers  (brute force) to get the patient into restraints?

 

Below is a screen shot of Missouri’s Statute covering the use of force in patient restraint. Here is the SOURCE

 

 

Pay particular attention to:

  4.  The use of physical force by an actor upon another person is justified when the actor is a physician or a person assisting at his or her direction; and

  (1)  The force is used for the purpose of administering a medically acceptable form of treatment which the actor reasonably believes to be adapted to promoting the physical or mental health of the patient; and

  (2)  The treatment is administered with the consent of the patient or, if the patient is a minor or an incompetent person, with the consent of the parent, guardian, or other person legally competent to consent on his or her behalf, or the treatment is administered in an emergency when the actor reasonably believes that no one competent to consent can be consulted and that a reasonable person, wishing to safeguard the welfare of the patient, would consent.

  5.  The use of physical force by an actor upon another person is justifiable when the actor acts under the reasonable belief that:

  (1)  Such other person is about to commit suicide or to inflict serious physical injury upon himself or herself; and

  (2)  The force used is necessary to thwart such result.

  6.  The defendant shall have the burden of injecting the issue of justification under this section.

 

Many agency polices regarding patient restraints contain a phrase about “If a patient is a danger to themselves or others.” The above statute says nothing about when the person is a danger to others. That would be another situation entirely, quite possibly falling under a self-defense statute.

A number of healthcare providers have found themselves unemployed, some in legal trouble, stemming from what was labeled a “patient restraint” situation. The use of force in medicine is a rabbit hole. Here are a few links to help you build critical thinking skills:

Pressure Points and Pain Compliance

First Touch

No such things as a combative patient