Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies

Caroline Cummings; Lynn Babcock; Yin Zhang; Sang Hoon Lee; Hamilton Schwartz; Olga Semenova; Wendy J Pomerantz; Cincinnati Children's Prehospital Care Committee

doi:10.1097/PEC.0000000000003298

Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies

Pediatr Emerg Care. 2024 Nov 6. doi: 10.1097/PEC.0000000000003298. Online ahead of print.

Authors

Caroline Cummings¹, Lynn Babcock², Yin Zhang³, Sang Hoon Lee², Hamilton Schwartz², Olga Semenova², Wendy J Pomerantz²; Cincinnati Children's Prehospital Care Committee

Affiliations

¹ From the College of Medicine, University of Cincinnati, Cincinnati, OH.
² Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
³ Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

PMID: 39499148
DOI: 10.1097/PEC.0000000000003298

Abstract

Objectives: The aims of the study are to characterize children with mental and behavioral health conditions (MBH) transported by emergency medical services (EMS) and examine differences in patient, emergency department (ED), and EMS transport characteristics based on restraint interventions during EMS transport.

Methods: This is a retrospective cohort study of EMS patients with MBH crises, aged 5-18, transported to 2 pediatric EDs over 9 years. Demographic and ED data were collected electronically; EMS data were extracted manually from prehospital care records. Field interventions studied included pharmacologic and mechanical restraints by EMS clinicians. Univariate analysis compared variables between patients who received EMS restraints and those who did not and multivariable logistic regression identified patient factors independently associated with EMS restraint use.

Results: Among 10,264 patients transported by EMS for MBH crises, 1400 encounters were randomly selected, with 768 records available. EMS restraint interventions were used in 73 (9.5%) patients: 5 (0.7%) received only pharmacologic restraints, 58 (7.6%) received only physical restraints, and 10 (1.3%) received both. Those who received EMS restraints were more likely to be younger (35.6% vs 19.6%, P = 0.001), male (71.2% vs 44.6%, P < 0.0001), and had longer scene times (13 vs 9 min). Restraint use was more common when patients were picked up from schools (30.1% vs 14.8%, P = 0.007). EMS-restrained patients were also more likely to receive physical (12.3% vs 2.3%, P < 0.0001), mechanical (15.1% vs 1.0%, P < 0.0001), or pharmacologic (24.7% vs 3.9%, P < 0.0001) restraints in the ED. Predictors of EMS restraint use were male sex (odds ratio, 3.00; 95% confidence interval, 1.74-5.17) and being picked up from schools (odds ratio, 2.08; 95% confidence interval, 1.13-3.81), whereas age group, race, and insurance type were not independent predictors.

Conclusions: Nearly 1 in 10 pediatric patients experiencing mental health crises and transported by EMS required restraint interventions in the field. Male patients, younger aged children, and those picked up from school represent a distinct and vulnerable population that could benefit from specialized prehospital care to manage agitation.