For combative patients, which restraint protocol step is recommended?

For combative patients, which restraint protocol step is recommended?

• A. Complete primary survey/ABC's and apply NRB 15 L/min when using restraints
• B. Complete primary survey/ABC's; apply NRB 15 L/min when using restraints; if AMS, rule out treatable causes and apply restraints; GCS <15, apply restraints
• C. Apply restraints immediately before assessing airway
• D. Restrain only after moving to stretcher

Answer: (B)

The key idea is to manage safety and airway first while preparing for restraint, with oxygen on hand and attention to reversible causes of altered mental status. The recommended approach is to complete the primary survey with ABCs, provide oxygen via a nonrebreather at 15 L/min when restraints are used, and actively evaluate for treatable causes of AMS. If the patient’s level of consciousness is decreased (GCS less than 15), restraints should be applied to protect both the patient and responders, but only after ensuring airway and breathing are being supported and potential reversible issues are considered. This sequence prevents airway compromise during restraint and reduces the risk of deterioration due to hypoxia or other treatable conditions. Restraining before assessing airway or delaying restraint until after moving to the stretcher would miss these critical safety and airway steps.

The key idea is to manage safety and airway first while preparing for restraint, with oxygen on hand and attention to reversible causes of altered mental status. The recommended approach is to complete the primary survey with ABCs, provide oxygen via a nonrebreather at 15 L/min when restraints are used, and actively evaluate for treatable causes of AMS. If the patient’s level of consciousness is decreased (GCS less than 15), restraints should be applied to protect both the patient and responders, but only after ensuring airway and breathing are being supported and potential reversible issues are considered. This sequence prevents airway compromise during restraint and reduces the risk of deterioration due to hypoxia or other treatable conditions. Restraining before assessing airway or delaying restraint until after moving to the stretcher would miss these critical safety and airway steps.