Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Not Sedated – Restrained


This week the Normal Sinus Rhythm blog is doing our Jeff Foxworthy bit of the Blue Collar Comedy Tour. I apologize for being late in posting my contribution, especially since I was up all night writing on a different topic between calls.

Well, I don’t consider anyone to be much of a paramedic/EMT, unless one is a Jack of all trades. Part of that is the ability to keep a patient from harming himself and from harming crew members and still transport the patient to the hospital. This is the amateur wrestler/rodeo clown part of EMS, so:

You might be an amateur wrestler/rodeo clown if:

You laugh at the prospect of having to ride something for only 8 seconds to be considered a success – unless were talking about your spouse and the spouse doesn’t get a say in defining “success.”

You are so familiar with using cable ties as handcuffs that the police ask you to help if you are on scene.

When you arrive at the ED, the ED staff give medications to sedate the patient, because your ALS service is not allowed to.

You need to call OLMC (On Line Medical Command) to request permission to sedate violent patients who are currently fighting with you and with your coworkers.

You have asked the local hospital for a more lively variety in the hold music on the medical command line.

While waiting for the medical command doctor to come to the phone, you like to listen to some western music on your iPod, while you wrestle with the PCP poster boy.

You are able to control the patient’s face, so that nobody will be bitten or be spit on, without even thinking about it.

When the patient frees an arm, or leg, you start making noise to divert his attention, just long enough for everyone to readjust their grips.

If you get knocked down by a patient, you bounce back up as if nothing happened.

You use triangle bandages much more often as single point restraints, than as arm slings.

Your knotting skills approach those of a sailor.

You order lunch to match the body fluid stains from the last patient, because patient wrestling and BSI are only compatible in the imagination of an administrator.

With the continuous presence of video cameras, you are able to get fight films of the usual violent patients, so you can study their moves – Deborah Peel can’t move to her right, but likes to move things even farther to the left.

It isn’t that we have so many violent patients, but that we spend so much time wrestling with the ones we do have, that we get a lot of experience.

You prefer to wear a championship belt, rather than an EMS patch.

You want to set up ring ropes in some residences.

You have actually contacted Michael Buffer to come work as a dispatcher – he’s just holding out for more money and a reality TV show focusing on his dispatching.

You have only a benzodiazepine, or two, available to chemically restrain patients.

And some IV/IM Benadryl. 🙂

Your sarcasm is more potent than the drugs you carry.

You would like to have some nice quiet heroin over doses just so you can rest a bit.

You naturally take the head and grab some 2″ catheters, so you can start an EJ. It is easier to control the head than the arm, the IV absorption is much more predictable and potent than IM absorption.

You approach all sleeping/unconscious people with the expectation that they may suddenly become violent – even your kids.

You end up discussing last nights game, while you are wrestling with the patient – it isn’t as if he’s going to care.

You have had to release joint locks, because the patient was not even being slowed down and you didn’t really want to break his arm.

When you arrive at the ED, they give medications that cause the patient to stop fighting. Unlike the medications you are allowed to use homeopathically outside of the hospital.

Your medical director is less concerned about the underlying disease process and the restraint-related metabolic stimulus, than about the possibility that his poorly supervised medics will do something wrong.

You are on a first name basis with the emergency response psychiatrists in the county.

Your medical director is worried about the possibility of irreversible shock from Zebra Syndrome, when the patient is given only an appropriate dose of a benzodiazepine by injection. Said medical director still believes that it is only through the prevention of appropriate prehospital care that this Unicorn Reaction has been averted.

The FDA Black Box on droperidol (Inapsine) and the FDA Alert about haloperidol (Haldol) mean more to the medical director than delivering good patient care.

If you were to get your hands on a syringe of droperidol, your medical director would insist that you follow the Dear Doctor letter to the letter – pretreatment 12 lead ECG of the violent patient followed by continuous 12 leads during treatment. Riiiiggghhhttt!

There is no consideration of using atypical antipsychotic medication, at least not outside of the hospital, where it might be most useful.

The Rock is really just easing his way into EMS from pro wrestling, to acting, to the wild and woolly world of patient rasslin’.

Sorry, just not in a funny mood today, but the other NSR people are much more humorous, so go read their stuff. A lot of this could be avoided with the proper training, oversight, carrying the right drugs, and having standing orders for them. Of course, this is much more entertaining than a sedated patient protecting his own airway and maintaining good vital signs.



  1. You may not have been in a funny mood but I laughed anyway. Sometimes those days on the box are too close together. Excellent post monsieur!points well made.

  2. …and in true Rodeo clown form:You’ll take a shot so your partner (or a nurse) doesn’t have to.

  3. Gertrude,Thank you.ParaCynic, As only a rodeo clown (or a parent) would understand.