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Medical restraints are a subset of general physical restraint used for medical purposes. Unlike some other forms of restraint, medical restraints are designed to restrain their wearer without causing pain.
Physical restraint in mental health settings
When dealing with patient violence appropriate physical restraint may be neccessary and should be applied by trainewd personnel only
Safety and medical restraint
Many kinds of mild, safety-oriented medical restraints are widely accepted. For example, the use of bed rails is routine in many hospitals and other care facilities, as the restraint prevents patients from rolling out of bed accidentally. Newborns frequently wear mittens to prevent accidental scratching. Some wheelchair users use a belt or a tray to keep them from falling out of their wheelchairs. In fact, not using these kinds of restraints when needed can lead to legal liability for preventable injuries.
Medical restraints are generally used to prevent people with severe physical or mental disorders from harming themselves or others. A major goal of most medical restraints is to prevent injuries due to falls. Other medical restraints are intended to prevent a harmful behavior, such as hitting people.
Although medical restraints, used properly, can help prevent injury, they can also be dangerous. The U.S. Food and Drug Administration (FDA) estimated in 1992 that at least 100 deaths occur annually in the U.S. from their improper use in nursing homes, hospitals and private homes. Most of the deaths are due to strangulation. The agency has also received reports of broken bones, burns and other injuries related to improper use of restraints.
Because of the potential for abuse, the use of medical restraints is regulated in many jurisdictions.
Types of medical restraints
There are many types of medical restraint:
- Four-point restraints and fabric body holders and straitjackets are typically only used temporarily during psychiatric emergencies.
- Lap and wheelchair belts, or trays that clip across the front of a wheelchair so that the user can't fall out easily, may be used regularly by patients with neurological disorders which affect balance and movement.
- Safety vests and jackets can be placed on a patient like any other vest garment. They typically have a long strap at each end that can be tied behind a chair in order to prevent the patient from getting out of the chair, or to the sides of a bed to keep the patient in bed. Posey vests are commonly used with elderly patients who are at risk of serious injury from falling.
- Limb restraints are used to prevent activity in various limbs. They are wrapped around the wrists or ankles, and tied to the side of a bed, to prevent patients from harming themselves or others by preventing the patients from using their arms or legs.
- Mittens to prevent scratching are common for newborns, but may also be used on psychiatric patients.
- A Papoose board can be used for babies and young children.
- NVCI (Non-Violent Crisis Intervention) techniques from CPI (Crisis Prevention Institute) have physical restraint techniques that keep both the person(s) restraining and the person being restrained safe during the restraint. One technique featured is the two person sitting technique where the people restraining sit down next to the person being restrained and lock their arms around the person being restrained arms until the person being restrained is rational and calm.
Laws pertaining to medical restraints
Current United States law requires that most involuntary medical restraints may only be used when ordered by a physician. Such a physician's order, which is subject to renewal upon expiration if necessary, is valid only for a maximum of 24 hours.
- FDA press release: Patient Restraint Devices Can Be Dangerous
- emedicine.com article: Restraints, by Herbert Wigder, MD and Mary S Matthews, RN, BSN, JD
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