Copyright 018 by Gary L. Pullman
Patients undergoing
medical or dental surgery are often restrained to prevent them from
causing injury to themselves during operations. Prisoners and mental
patients who express the intention of committing suicide are
restrained. Prisoners and students with behavioral disorders may be
restrained so they cannot hurt themselves or others. Although
restraints may occasionally be necessary, their use is sometimes
questionable, as these 10 controversial restraint devices indicate.
10 Dental Papoose Board
While acknowledging the
“Papoose Board” restraining device is controversial, Dr. Brian
Martin, Children's Division Chief of Pediatric Dentistry at
Children's Hospital in Pittsburgh, Pennsylvania, said its use can
calm anxious children during dental procedures and prevent injury. In
a videotaped demonstration of the device's use, a boy lies supine on
the board, which is laid atop the horizontal dentist's chair. Placing
the boy's arms along his sides, Martin secures a Velcro-equipped
strap around each of his wrists. Bands are then secured in place
across the boy's legs, across his torso, and over his shoulders.
The device, which is used
across the United States, is said to have caused cuts and bruises to
a California patient and brain damage to a Texas patient. Some
contend it has also caused children to experience post-traumatic
stress disorder. Martin agreed that, used incorrectly, the device can
limit a child's breathing ability or restrict the circulation of
blood to the limbs. Before the device is used, he said, dentists must
assess “a child’s developmental level, dental attitudes and
temperament.” Martin, who always obtains parental consent before
using the device, recommended dentists and parents agree on the
child's “treatment plan.” (LINK 1)
9 Nursing Home Restraints
A Monash University study
indicated that five restrained residents of “aged-care homes” in
New South Wales, Victoria and Queensland, Australia, died between
2000 and 2013. Four of them had dementia. According to Professor
Joseph Ibrahim, who headed the study, the patients choked to death
when they were unable to “get enough air because their necks had
been compressed.” The restraints were used to prevent the patients
from injuring themselves in falls. Both Ibrahim and Graeme Samuel,
who heads Alzheimer's Australia, agree the use of such devices is
rarely necessary, and Ibrahim suggests a debate should occur
concerning the practice. “Do you want to be restrained when you're
80 and have dementia, or would you rather be able to walk freely and
if you fall you fall?” he asked. (LINK 2)
8 Hospital Restraints
In
a 1992 public health notification addressed to “Hospital
Administrators, Directors of Nursing, and Directors of Emergency Room
Services,” the US Food and Drug Administration (FDA) warned of
“potential hazards associated with the use of physical patient
restraint devices.” As a result of using such devices, the warning
continued, “reports of death and injury . . . increased” in 1991.
Each year, no fewer than 100 deaths or injuries associated with
restraint devices occur, and many others likely go “unreported.”
Such
“incidents” as fractures, burns, and strangulations are due to
the improper employment of the devices, unnecessary use of the
restraints, improperly “applying the devices,” and “inadequate
monitoring” of restrained patients.
To
prevent such deaths and injuries, the FDA recommends developing clear
policies, obtaining patient consent, displaying and following
manufacturers' directions, providing in-service training, documenting
the use of the device, “recording the length of time for
treatment,” and following state and federal laws. (LINK 3)
Vincent Staggs, of
Children's Mercy Hospital and the University of Missouri-Kansas City,
who led a study of the use of hospital restraint devices wrote, in an
article published by Journal of General
Internal Medicine,
that such devices should be used less frequently than they are
presently employed, since their employment can cause “agitation,
confusion, adverse psychological effects and pressure ulcers,” and
even strangulation and death. To reduce the frequency of the use of
the devices, he recommended hospitals staff more registered nurses on
each shift. (LINK 4)
7 Correctional Restraint
Chair
Hooded and bound,
shirtless, to a restraint chair with straps secured to his ankles,
wrists, and neck, 17-year-old Dylan Voller sat isolated in a hallway
for two hours. A former guard at the juvenile facility at which
Voller was incarcerated said he's witnessed the youth strapped in the
chair on multiple occasions. He said he couldn't imagine the need to
resort to such a practice.
A videotape of Voller
strapped in the chair generated criticism from the public and
government officials alike. Although the Northern Territory,
Queensland, government authorized the use of the chair in May, 2016,
Attorney General John Elferink introduced the youth justice amendment
bill to “clarify” the use of “mechanical restraints” in
Northern Territory correctional facilities. Adam Giles, Chief
Minister of the Northern Territory, admitted the use of the restraint
chair “didn’t look good on television” and prohibited its
continued use and that of “spit hoods,” pending a “review” of
the issue. (LINK 5)
6 Foot Restraint Device
Suffering from an anxiety
attack brought on by smoking crack cocaine, Bobbi O'Shea called 911.
Vancouver, Canada, police responded not by having her transported to
a hospital, but by taking her to jail. When she was uncooperative,
she was restrained by having her bound feet tethered “under a jail
door.” She sued the police and was awarded $9,000 in general
damages, although Provincial Court Judge Laura Bakan ruled the police
were justified in restraining her.
However, the judge found
authorities' failure to communicate that O'Shea was suffering from
anxiety, depression, asthma, and a cold unnecessarily allowed the
situation to escalate to the point such restraint was required. In
addition, the judge faulted the police for not taking O'Shea to a
nurse as soon as they'd arrested her, as policy requires. O'Shea said
she suffers from post-traumatic stress disorder. (LINK 6)
5 Disability Classroom
Restraints
Restraint and
Seclusion: Hear Our Stories, a
documentary film by Dan Habib, of the Institute on Disability
at the University of New Hampshire, identifies the use and
consequences of disability classroom restraints. Citing The
President's New Freedom Commission on Mental Health, the film points
out that restraint and seclusion can cause “serious injury or
death” and renew the trauma of victims of “abuse, loss of
dignity, and other psychological harm.”
According to the testimony
of those who appear in the film, in addition to being subjected to
stress, humiliation, bullying, and sexual abuse, many were restrained
at early ages, suffered bruises and abrasions, were “locked away in
hidden rooms,” or suffered various injuries, including head trauma.
(LINK 7)
4 Bus Seat Restraints
Lilibeth Gomez, age nine,
was killed when an Arlington County, Virginia, school bus collided
with a garbage truck. Her death reignited debate about whether such
vehicles should be equipped with seat restraints. Those who oppose
the idea say the size and design of school buses make seat restraints
unnecessary. Compartmentalization, resulting from the placement of
seats “close together” and “with padding and high backs to
absorb the energy of a crash,” is sufficient protection, opponents
maintain. Statistics show the “fatality rate for school buses is
less than 1/7 that of regular passenger vehicles.” The National
Transportation Safety Board, “which investigates accidents,”
found compartmentalization isn't always enough to protect school bus
passengers, but the National Highway Traffic Safety Administration,
“which sets rules on vehicle safety,” has yet to act on whether
bus seat restraints should be required.
There's also uncertainty
as to whether two-point seat belts or three-point seat restraints
should be installed. The former, which “cross a passenger's lap,”
could increase the “risk of abdominal, spinal and head injuries,”
while the latter, “which stretch across the chest,” are
incompatible with the design of older buses. California requires the
installation of three-point seat restraints on new buses, but some
question whether students will use them or would do so correctly and
whether the restraints “would fit smaller children properly.”
(LINK 8)
3 Children's Car Seat
Restraints
By age three, children's
cognitive and motor skills have advanced to the point that toddlers
can unbuckle their car seats, which more than triples their “risk
for serious injury.” The age at which children were observed to
unbuckle their car seats by themselves for the first time ranges
between 12 months and 6.5 years. Forty-three percent of the “children
who unbuckled . . . did so while the car was in motion.” Boys
unbuckled their car seats more often than girls did. Lilia Reyes,
clinical fellow of pediatrics at Yale University, suggested
additional research should be conducted to determine the safest type
of restraint device for young passengers. (LINK 9)
2 WRAP System
Attempts to “deescalate”
situations involving defiant juvenile detainees verbally does not
always work. When such efforts fail, staff at the Yell County
Juvenile Detention Center in Danville, Arkansas, rely in the WRAP
system. Sometimes, a juvenile is restrained for hours, seated on the
floor, wearing a mask decorated with a “cartoonish, dehumanizing
cross-eyed effigy,” a leather strap connecting shoulders to legs,
and hands shackled behind the back.
Critics, including State
Juvenile Ombudsman Scott Tanner, who tested the restraint device,
called it “torture.” He concluded the WRAP system “caused
difficulty breathing and increased anxiety.” In addition, he said,
the device poses the potential for head injury and “violates state
standards, which say any placement of juveniles must be therapeutic
and not punitive.” Its employment, he cautioned the detention
center, could represent a “significant liability.”
The Arkansas Department of
Human Services and the Division of Youth Services ordered Yell County
to stop using the device, but it's still employed “across the
state,” many other facilities regarding it as “necessary tool”
in controlling “unruly children” who may hurt themselves or
others. (LINK 10)
1 Restraint Mitts
“Bulky,” thumbless
restraint mitts prevent two or more of the middle fingers of the hand
from bending. Their use in hospitals and nursing homes prevents
confused patients or patients who suffer from Alzheimer's or mental
illness from removing “catheters, intravenous lines, and gastro
feeding tubes,” preventing injury or death. Although the use of the
mitts remains controversial, as does the use, in general, of other
types of restraint devices, health care professionals consider their
use necessary at times to prevent disoriented or disturbed patients
from performing acts that would harm them. (LINK 11)
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