UMEM Educational Pearls

Category: EMS

Title: Arresting and Agitating Pitfalls in Patient Restraint

Keywords: cardiac arrest, chemical restraint, ketamine, agitation, delirium (PubMed Search)

Posted: 8/30/2023 by Ben Lawner, MS, DO
Click here to contact Ben Lawner, MS, DO

Patient restraint is a high risk, high liability encounter for all levels of emergency medical practitioners. Often, acutely agitated patients benefit from de-escalation. This can be difficult to achieve in a resource limited setting. McDowell et al (2023) performed a comprehensive review of patient restraint encounters. Their work describes risk factors linked to adverse outcomes. Specifically, highly agitated patients who are physically and chemically restrained can experience clinical deterioration. The review also highlighted risks to EMS clinicians as well such as: needle stick, physical inury, and downstream litigation. 

Bottom line: 

Patient restraint represents a high risk encounter. 

  • De-escalation is preferred vs. physical restraint 
  • Chemical restraint likely preferred vs. physicial restraint 
  • Restraint can worsen agitation and contribute to acidosis, positional asphyxia, cardiac arrest, and other untoward outcomes
  • DO NOT place restrained patients in the prone position 
  • Policies for restraint should be vetted, socialized, and regularly reviewed with all stakeholders 


McDowall J, Makkink AW, Jarman K. Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review. Afr J Emerg Med. 2023 Sep;13(3):157-165. doi: 10.1016/j.afjem.2023.03.006. Epub 2023 Jun 9. PMID: 37334175; PMCID: PMC10276259.