Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting

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

doi:10.1002/emp2.13016

Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting

J Am Coll Emerg Physicians Open. 2023 Aug 16;4(4):e13016. doi: 10.1002/emp2.13016. eCollection 2023 Aug.

Affiliations

¹ Department of Emergency Medicine University of California San Francisco California USA.
² Department of Emergency Medicine University of California Los Angeles California USA.
³ Department of Behavioral Health University of California San Francisco California USA.

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.

Keywords: adolescent; child; emergency medical services; mental health services; physical; restraint.