Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The issue of tie-downs in the emergency department

Elizabeth L. Mitchell, MD
Physician
October 21, 2020
542 Shares
Share
Tweet
Share

During a typically busy Saturday evening shift in the emergency department (ED), I am summoned to the trauma room for a “tie-down,” an agitated patient needing restraints. I find the entrance choked with police officers and push my way through to see the patient.  Once there, I see a large, young appearing Black man lying on his back, his hands cuffed tightly together on his stomach, a netted hood over his face to stop the possibility of biting or spitting. I bend close enough to him so he can see me and softly tell him my name and ask him his. He looks away, refusing to meet my eyes, tears forming at the corners of his own. Everything about this feels wrong.

For all the decades I have worked as an emergency physician, I have cared for patients who arrive agitated, psychotic, intoxicated on drugs or alcohol, or delirious, risking harm to themselves and others and delaying their diagnostic workups and treatment. Routinely they are treated with chemical sedation, physical restraints, or both, with the intention to remove the physical restraints as quickly as is deemed safe. Neither of these modalities is free from risk, but over the time that I have done this job, the process has been made safer. Each restrained patient has a designated sitter, and vitals and mental status are continuously monitored. Even with careful precautions, however, the use of restraints has the potential for significant harm to the patient. And the experience of being restrained is not only physically dangerous but psychologically damaging as well. It has been our practice to use restraints judiciously but using de-escalation techniques to avoid restraining a patient takes both an experienced provider and a significant time commitment. In the ED, both of these are in short supply, and physical and chemical restraints often seem the most expeditious route to a safe environment.

On this night, however, standing in the trauma room with this patient, I am acutely aware of the potential injustice of restraining him. He is volatile but not out of control. The murder of George Floyd and the Black Lives Matter movement weighs on the room. It is not just because the patient has been yelling at the police to shoot him, but rather it is the fact that he is a young Black man, restrained and surrounded by police. I wonder what justified his being restrained in the first place. Was he doing something that put him or others at a significant risk of injury, or was he simply reacting to the police presence? Is there a bias towards restraining and bringing in agitated Black men just as there is in arresting and imprisoning them?

Restrained patients generally fall into 2 major groups: young men, often under the influence of drugs or alcohol, and older patients who may be suffering from delirium, trauma, or dementia.  Many of the young male patients I see in restraints are Black. Tonight, as the staff waits for my direction, I feel a new discomfort. How can I continue to be complicit in the restraining of people who have been restrained physically, economically, and psychologically for centuries? When I see this man lying on the bed angry, frustrated, and vulnerable, I see a history of Black Americans enslaved, shackled in irons, or running for their lives to get to freedom only to be wrestled to the ground and tied by slave catchers- the southern states first police force.

It is time we change the way we think about agitated patients in the ED.  We need more education and guidance for emergency department personnel who care for these patients. The use of restraints may be necessary for many situations, but we should be approaching each patient with attempts at de-escalation without the use of chemical or physical restraints when possible. I watch this young man and think about what it would feel like to be surrounded by police to fear for your life, to feel the bondage of centuries of repression as your hands are squeezed tight by handcuffs, and you are physically controlled by others. Perhaps I have been complicit all along, but there is time for me to change.

Elizabeth L. Mitchell is an emergency physician.

Image credit: Shutterstock.com

Prev

2 stories that remind us to find joy and creativity in our new normal

October 21, 2020 Kevin 0
…
Next

Why we’ll never eradicate malignancy in medical training

October 21, 2020 Kevin 4
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
2 stories that remind us to find joy and creativity in our new normal
Next Post >
Why we’ll never eradicate malignancy in medical training

Related Posts

  • Solving the problem of non-emergent care in the emergency department

    Michael Kirsch, MD
  • Violence in the emergency department puts patients and physicians at risk

    Vidor E. Friedman, MD
  • Solving the low-acuity emergency department problem

    Dillon Mercado
  • A place for music in the emergency department

    Thomas Scary
  • Here’s the secret to emergency department efficiency

    Phillip Stephens, DHSc, PA-C
  • Don’t blame doctors for outrageous emergency department prices

    Peter Ubel, MD

More in Physician

  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Practicing medicine with conviction

    Arthur Lazarus, MD, MBA
  • The power of memory in shaping human identity

    Emily F. Peters and Sandeep Jauhar, MD, PhD
  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • The erosion of patient care

    Laura de la Torre, MD
  • Navigating adulthood in the digital age

    Eleanor Menzin, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Everyday dangers unknowingly impacting our health

      Tami Burdick | Conditions
    • A shop teacher’s daughter on transforming patient safety

      Barbara L. Olson, RN | Conditions
    • What happened to the chemical pathologist?

      Martin C. Young, MD | Conditions
    • Utilizing AI may reduce maternal and infant mortality

      Matt Eakins, MD | Tech
    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Study Pinpoints Growing Use of Cannabis to Manage Menopause Symptoms
  • 'This Case Could Spell the Beginning of the End': What We Heard This Week
  • Who Polices Hospitals Merging Across Markets?

Meeting Coverage

  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Study Pinpoints Growing Use of Cannabis to Manage Menopause Symptoms
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Everyday dangers unknowingly impacting our health

      Tami Burdick | Conditions
    • A shop teacher’s daughter on transforming patient safety

      Barbara L. Olson, RN | Conditions
    • What happened to the chemical pathologist?

      Martin C. Young, MD | Conditions
    • Utilizing AI may reduce maternal and infant mortality

      Matt Eakins, MD | Tech
    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...