A 25-year-old male patient is brought to the emergency department (ED) for violent, agitated behavior. The patient was handcuffed by law enforcement who suspect drug intoxication or psychiatric disease. The patient is yelling, spitting, and uncooperative with emergency personnel. What is the MOST compelling justification for placing this patient in four-point restraints?
Allow the placement of an intravenous line and blood draw for diagnostic testing.
+Ensure safety of patient and ED personnel.
+Facilitate transfer for psychiatric evaluation.
+Minimize impact of behavior on other sick patients nearby.
+Permit a medical screening exam to be performed.
The patient described represents a clear danger to himself and others. The rule of “safety first” must take precedence. Physical restraints, when placed carefully and humanely, assure patient and provider safety as well as facilitate further workup. Alternatives include the use of sedation drugs: the so-called medical restraint. The patient’s undifferentiated behavior abnormality will likely require laboratory testing, a careful physical examination, and possible psychiatric consultation. The impact on other patients can best be managed by relocating to a more secluded area of the department.