This page is STILL under CONSTRUCTION!
Until this "blurb" is REMOVED, this page remains a "rough draft" version, and its contents should NOT NECESSARILY be implemented as currently written. However! Protocol-writers with a strong understanding of the information contained within the articles, "All Tied Up & No Place To Go" and "Restraint Asphyxia – Silent Killer," should be able to use this "ROUGH" information to build their own protocol. If you have "time" to delay your protocol writing, PLZ check back here periodically, to see if MY version of this protocol has been completed!

Minor Resistive Confusion (or only "Resistively Confused")
describes someone who's acts of confused resistance are performed with a degree of strength that requires only one or two providers to safely and effectively overcome. The confused individual may be agitated due to fear or anger (or both), but is merely withdrawing from others, avoiding contact with others by pushing them away, or non-specifically "striking out" at others in a defensive manner. An individual exhibiting Minor Resistive Confusion is not acting in a manner likely to cause "serious" harm to himself or others. Someone only Resistively Confused is not acting in a manner that suggests a purposeful INTENT to harm himself or others. When others discontinue contact with him, a Resistively Confused individual will discontinue attempting to harm others.

"RESISTIVELY CONFUSED PATIENTS" may be stumbling about in a "frightening" manner, actively withdrawing from contact with others. They are confused, but reasonably COOPERATIVE with gentle hands-on direction to sit or lie down. They are confused, but reasonably COOPERATIVE with gentle hands-on restriction from grasping at others/things around them, or pushing others/things away from them.
If gentle hands-on contact results in ANY CONFUSED PATIENT becoming Combative, or Violently Resistive to assessment and/or treatment, they should be treated according to the "VIOLENTLY CONFUSED or COMBATIVE PATIENT RESTRAINT" protocol.

Any Mildly-to-Moderately Confused Patient can reasonably be anticipated to BECOME Strongly Resistive to care procedures that are uncomfortable. (Such as IV access.) Thus, should uncomfortable treatment procedures be required in order to provide appropriate care for their illness or injury, Mildly-to-Moderately Confused Patients require Medical Restraint.

CONFUSED TRAUMA PATIENTS With a Mechanism Of Injury
REQUIRING SPINAL IMMOBILIZATION:

1. Provide Spinal Immobilization in the "Normal" Manner.
   If – at any time – the patient becomes Strongly Resistive to normal spinal immobilization procedures, they should be treated according to the "STRONGLY RESISTIVE or COMBATIVE PATIENT RESTRAINT" protocol.

2. Restrain ONE Wrist If possible, restraint the wrist of an
   UNINJURED arm to a T-anchor point ABOVE The Patient's Head.
   The other arm will be used for blood pressure measurement and IV access, and remain unrestrained. By anchoring the restrained wrist above the patient's head, the patient's ability to inappropriately remove his IV (without intervention) is minimized.
   If the nature of an arm injury prohibits blood pressure measurement and/or IV access being safely accomplished using the "injured" arm: "Splint" and Restrain the Injured Arm at the patient's side, leaving the Uninjured Arm free of restraint.

3. Have your Partner MANUALLY Restrain the Unrestrained Arm, while you perform blood pressure measurement and IV access. After these procedures are accomplished, discontinue manual restraint and transport.

   Restrain BOTH Wrists ONLY if

   • The patient becomes Strongly Resistive to continued care, and begins to "strike out" with the unrestrained arm, in an effort to push-away care providers.
   • The patient's attempts to bring the unrestrained arm above his head and inappropriately remove his IV are PERSISTENT.
   • The patient PERSISTENTLY utilizes the unrestrained hand to attempt removal of other restraints.
   
   If required, Restrain the Second Wrist at the Patient's Side.

CONFUSED PATIENTS With Non-Spinal MOI or a Medical Illness:

APPROPRIATE, SAFE & EFFECTIVE, RESTRAINT PROTOCOLS:

• 1) Introduction to Patient Restraint Universal Reasons For,
  and Basic Principles Regarding, SAFE Patient Restraint

• 2) Restraint Protocol for EVERY Unconscious Patient

• 4) Violently Confused or Combative Patient Restraint Protocol

• 5) Response When Forceful-Prone-Restraint (or Hobble Restraint)
  is Employed Prior To Your Arrival

• 6) Spinal Immobilization Protocol for the
  Violently Confused or Combative Trauma Patient

• 7) Documentation Guidelines for Every Restraint Application

• "Quick Look" On-Scene Restraint Reference Card

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"