Compassionate Restraint in the ED

Abstract

Emergency medicine physicians are often tasked with caring for agitated and violent patients. Such incidents may be well controlled with verbal de-escalation and medication administration. However, these situations can escalate, posing risks to healthcare providers as well as the patients themselves. The initial approach in the management of a violent or agitated patient should include attempts at verbal de-escalation and then pharmacologic interventions before using physical restraints. Methods for applying safe and effective physical restraints should focus on shielding the healthcare team from harm, as well as preventing patients from harming themselves. Frequent monitoring, including cardiovascular monitoring and monitoring of restrained extremities, is crucial. Careful and compassionate use of physical restraints enables physicians to provide effective care while maximizing everyone’s safety.