Prehospital Chemical Restraint

[mariomike]

Read this in a police discussion,

paramedics in many jurisdictions have access to haloperidol, olanzapine and lorazepam for im/iv injection and sublingual administration for the olanzapine.

Regarding the use of chemical restraint - outside of hospitals - I was only familiar with non-chemical restraint.

We were equipped with Strait Jackets ( that's the correct spelling ), soft padded leather arm and leg restraints, and boards. Roller bandages and tape also.

Of course, the police also had handcuffs.

What I know of chemical restraint - outside of hospital - is anecdotal, and from reading.

It is apparently not without medical risk to patients, and legal risk to Paramedics who use it,

Lawyers console paramedic Peter Cichuniec after his sentence is read on Friday, March 1, 2024 in Brighton, Colo. Cichuniec was sentenced to five years in prison for the death of Elijah McClain in a rare prosecution of medical responders that has left officials rethinking how they treat people in police custody

And, financial risk for city taxpayers.

Dozens of deaths reveal risks of injecting sedatives into people restrained by police

Demetrio Jackson was desperate for medical help when the paramedics arrived. The 43-year-old was surrounded by police who arrested him after responding to a trespassing call in a Wisconsin parking lot. Officers had shocked him with a Taser and pinned him as he pleaded that he couldn’t breathe...

halifax.citynews.ca

 

[medicineman]

So, police aren't medically in charge of a patient - the paramedics and their medical control/directors are. Police are in control of the threat and security side of the care delivered, as well as preservation of evidence or direct supervision if the person is arrested. The paramedics also likely (should likely anyway) have standing orders/medical directives on what drugs they can use and what situations they can use them in, and if something doesn't quite fall within the algorithm, then they call the medical control/director for advice. There have been situations, especially in the US, where police have demanded a "chemical restraint", when in reality, they don't have that authority - they aren't licensed to make medical decisions, unless they're like a sworn peace officer/paramedic on a tactical unit - and negative outcomes resulted because EMS didn't do their due diligence first. They can make decisions to arrest and detain someone under the regional mental health acts, but not much else beyond their first aid training. They're not trained to know when one should or shouldn't use certain drugs, much less the potential side effects of inappropriate used or how to handle them...whereas a paramedic or any other health professional for that matter, needs to know those and be able to recognize if there's an issue resulting from doing so and either prevent or act accordingly.

If this case is the one I'm thinking of, the EMS crew concerned were acting on the police's instructions vs using their own medical judgement and directives, which is likely why things went the way they did. You're responsible for the care you deliver and need to take the extra few seconds to assess what's happening...what was it we were taught in emergency medicine, "Believe only half of what you hear and none of what you see" or vice versa? That's why scene size up and history are so important. Frig, even in controlled settings, I've gotten a completely different story from not only patients but also from family of what's happening than I get from RN's/first responders/cops...and taking the extra few seconds to ask the right questions the first time prevents badness from occurring. I think good medical directives for use of sedative and anti-psychotic medications are appropriate in EMS, as they prevent potential injuries and downstream effects of prolonged physical fights to subdue or arrest people in crisis...you just need to have the the training and good medical directives in place and the ability to call for help if things aren't fitting into the flow sheet right...and the right judgement which comes with good training and exposure.

$0.02 pre tax...

 

[Booter]

I haven’t really come across this- but what I have come across is a lack of control at calls where because no one is in charge and no one knows what to do, and wants to help, bad ideas take the reins- and they run the whole way because the right questions aren’t being asked,

“I can do x”
“Ok”
“Should I do X”
“If you can?”

Turns into

“ I was told to”

 

[mariomike]

According to Associated Press ( 2024 ),

The practice of giving sedatives to people detained by police has spread quietly across the nation over the last 15 years

I retired before that. I'm not familiar with chemical restraint, other than what I read .

Makes me wonder if the non-chemical way we did it for 35 years was the right, or wrong way. It was certainly the hard way.

Citing combativeness, paramedics administered sedatives, further slowing their breathing. Cardiac and respiratory arrest often occurred within minutes.

 

[lenaitch]

We had to do it a few times on fly-in FNTs in the late 1970s. On one I was involved in the drug was administered by an NP or RN and we had the get the subject sedate enough to bundle into an aircraft.

 

[mariomike]

We did inter-facility transfers where patients were chemically restrained by hospital staff prior to departure.