The use of chemical restraints reduces agitation in patients transported by emergency medical services

Abstract

Background: Agitated patients are the primary source of injury to patients and providers during ambulance transport.

Objective: Our primary hypothesis was that the addition of a chemical restraint agent (midazolam) to a restraint protocol would reduce agitation to a greater extent than a restraint protocol with physical restraint alone.

Methods: The local emergency medical services restraint protocol (RP) was implemented on October 1, 2006. It included a form for data collection about each restrained patient. On April 1, 2007, chemical restraint (CR) using midazolam in addition to physical restraints was made available through the RP, and paramedics were educated in its use. Transported patients were divided into pre-CR and post-CR. The post-CR group was split into those who received and those who did not receive midazolam. Agitation was measured on a validated agitation behavior scale with a parametric (Rasch) adjustment.

Results: There were 96 patients in the pre-CR group and 522 patients in the post-CR group. Forty-three percent of the pre-CR group and 49% of the post-CR group had a decrease in agitation during transport (NS). Of the 522 in the post-CR group, 110 were physically restrained and given midazolam (21%) and 412 were physically restrained without midazolam (79%). There was a significantly greater decrease in agitation scores (-17 ± 21 vs. -7 ± 17) in the subjects receiving midazolam compared to those who did not.

Conclusion: If available, CR is used in about 20% of restrained patients. When CR is used, there is a decrease in the subject's agitation.