ABSTRACTS
Characteristics and Outcomes of Prehospital Encounters for Patients with Behavioral Emergencies Receiving Physical Restraints and/or SedationAuthor: Dan D. Cohen, B Journalism, Paramedic | | Associate Authors: Faith Applewhite, BA, NRP, Remle P. Crowe, PhD, NREMT, Benjamin B. Currie, AAS, NRP, Terri King, MS, NRP, Christopher Lance, BS, LP, Michael Lozano Jr., MD, MSHI, Juan P. Mejias, AAS, FPC, Alison Treichel, MPH, Joseph Zalkin, BSHS-EMC, Scott S. Bourn, PhD, RN
Introduction Public discourse has focused on sentinel negative outcomes of patients who received prehospital sedation and/or restraint, yet little is known regarding the safety of these practices and hospital outcomes on a large scale. Objective To describe outcomes for patients with behavioral health emergencies (BHE) who received prehospital restraint and/or sedation. Methods Using the 2021 ESO Research Collaborative database, we conducted a retrospective analysis of adults ≥ 18 years with BHE encountered by advanced life support EMS units on 9-1-1 calls. We calculated the proportion of patients who received physical restraint and/or emergent intramuscular sedation (ketamine, benzodiazepine, or antipsychotics). Our primary outcomes were emergency department disposition, length of stay (LOS), and diagnoses. We calculated frequencies/percentages and medians with interquartile ranges (IQR). Results Of the 785,678 patients experiencing BHE encountered by 1,887 agencies, 3.6% (28,354) received prehospital sedation (n = 10,499), restraint (n = 9,916), or both (n = 7,939). Among those receiving restraint/sedation, median age was 34 (IQR: 26–46) years and 40% (n = 11,173) were female. Over half were White (55%, n = 14,820), 27% (n = 7,117) were Black, and 16% (n = 4,237) were Hispanic. Most (97%, n = 27,556) were transported. Linked ED data was available for 36% (n = 9,785). Of those with ED disposition, 63% (n = 6,160) were discharged from the ED with a median LOS of 7.7 hours (IQR: 4.5–12.9), 20% were admitted, 11% were transferred to other facilities, and 0.02% (n = 6) patients died in the ED. The top three ED diagnosis categories for those discharged were alcohol-related disorders (F10: 17%, n = 947), signs/symptoms involving an emotional state (R45: 10%, n = 552), and other stimulant-related disorders (F15: 9%, n = 506). Conclusion A small proportion of EMS patients with BHE received restraint and/or sedation. A high number of patients discharged from the ED and low mortality suggests the safety of these practices. Limitations include lack of data on cause of mortality and inability to obtain status on complications once admitted or transferred.
|
