Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting
Abstract Objective Emergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use pre...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13016 |
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| author | Ashley A. Foster Kenshata Watkins Tarak K. Trivedi Marisol Cruz‐Romero Sara A. Leibovich Rajesh K. Daftary Aaron E. Kornblith Jacqueline Grupp‐Phelan Karl A. Sporer Colleen Kellison Nicolaus W. Glomb |
| author_facet | Ashley A. Foster Kenshata Watkins Tarak K. Trivedi Marisol Cruz‐Romero Sara A. Leibovich Rajesh K. Daftary Aaron E. Kornblith Jacqueline Grupp‐Phelan Karl A. Sporer Colleen Kellison Nicolaus W. Glomb |
| author_sort | Ashley A. Foster |
| collection | DOAJ |
| description | Abstract Objective Emergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use prevalence and primary impressions among children with MBH emergencies. Methods This is a retrospective cross‐sectional study of children with MBH emergencies evaluated by Alameda County (ALCO), California EMS from January 1, 2012 to December 31, 2018. Patient demographics and clinical variables were collected from the EMS records including sex, age at time of encounter, year of encounter, transport destination, medication use, and primary impression(s). The primary outcome was the use of physical restraints. Descriptive statistics were used to characterize the primary outcome and associated demographic and diagnostic features, as well as temporal use patterns. Sex and age were compared between restrained and non‐restrained youth using chi‐square analysis. Results Over the 7‐year study period, ALCO EMS transported 9775 children with MBH emergencies. Of these transports, 1205 (12.3%) were physically restrained. Most children restrained had the primary impression of “behavioral/psychiatric crisis” (51.1%), “psychiatric crisis” (27.4%), and “behavioral–other” (12.4%) and the remaining children (9.1%) had a non‐psychiatric/behavioral health primary impression. Over time, there was no statistically significant change in either number of children with MBH emergencies transported or physical restraint rate. Conclusions More than 1 in 8 children with MBH emergencies are being physically restrained during EMS transport. Restraint rate did not substantially change over time. Further studies to understand existing restraint rates and EMS resources available to address acute agitation in children are needed to inform quality and care enhancing initiatives. |
| format | Article |
| id | doaj-art-489edfa8361946aba470db34ad64dadc |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-489edfa8361946aba470db34ad64dadc2025-08-20T02:17:39ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-08-0144n/an/a10.1002/emp2.13016Physical restraint use in children with mental and behavioral health emergencies in the prehospital settingAshley A. Foster0Kenshata Watkins1Tarak K. Trivedi2Marisol Cruz‐Romero3Sara A. Leibovich4Rajesh K. Daftary5Aaron E. Kornblith6Jacqueline Grupp‐Phelan7Karl A. Sporer8Colleen Kellison9Nicolaus W. Glomb10Department of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California Los AngelesCaliforniaUSADepartment of Behavioral Health University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSADepartment of Emergency Medicine University of California San FranciscoCaliforniaUSAAbstract Objective Emergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use prevalence and primary impressions among children with MBH emergencies. Methods This is a retrospective cross‐sectional study of children with MBH emergencies evaluated by Alameda County (ALCO), California EMS from January 1, 2012 to December 31, 2018. Patient demographics and clinical variables were collected from the EMS records including sex, age at time of encounter, year of encounter, transport destination, medication use, and primary impression(s). The primary outcome was the use of physical restraints. Descriptive statistics were used to characterize the primary outcome and associated demographic and diagnostic features, as well as temporal use patterns. Sex and age were compared between restrained and non‐restrained youth using chi‐square analysis. Results Over the 7‐year study period, ALCO EMS transported 9775 children with MBH emergencies. Of these transports, 1205 (12.3%) were physically restrained. Most children restrained had the primary impression of “behavioral/psychiatric crisis” (51.1%), “psychiatric crisis” (27.4%), and “behavioral–other” (12.4%) and the remaining children (9.1%) had a non‐psychiatric/behavioral health primary impression. Over time, there was no statistically significant change in either number of children with MBH emergencies transported or physical restraint rate. Conclusions More than 1 in 8 children with MBH emergencies are being physically restrained during EMS transport. Restraint rate did not substantially change over time. Further studies to understand existing restraint rates and EMS resources available to address acute agitation in children are needed to inform quality and care enhancing initiatives.https://doi.org/10.1002/emp2.13016adolescentchildemergency medical servicesmental health servicesphysicalrestraint |
| spellingShingle | Ashley A. Foster Kenshata Watkins Tarak K. Trivedi Marisol Cruz‐Romero Sara A. Leibovich Rajesh K. Daftary Aaron E. Kornblith Jacqueline Grupp‐Phelan Karl A. Sporer Colleen Kellison Nicolaus W. Glomb Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting Journal of the American College of Emergency Physicians Open adolescent child emergency medical services mental health services physical restraint |
| title | Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| title_full | Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| title_fullStr | Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| title_full_unstemmed | Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| title_short | Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| title_sort | physical restraint use in children with mental and behavioral health emergencies in the prehospital setting |
| topic | adolescent child emergency medical services mental health services physical restraint |
| url | https://doi.org/10.1002/emp2.13016 |
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