Comparison of emergency physicians' and juris doctors' opinions on emergency department patient restraints usage.

OBJECTIVES: Emergency physicians (EPs) and Juris Doctors (JDs) often disagree on the correct use of restraints for emergency department (ED) patients. The objective of the study was to compare EPs and JDs propensity to restrain patients given various scenarios. The study hypothesis was that EPs and JDs would agree on when to restrain emergency patients. METHODS: This was a prospective cross-sectional study. Twenty-two EPs and 27 JDs were asked to complete the Video Assessment of Propensity to use Emergency Restraints Scale (VAPERS). The VAPERS scale consists of 17 scenarios utilizing actors who were videotaped to produce a scale. Results obtained include overall likelihood to restrain and likelihood to restrain specific subgroups of patients such as those who are a danger to themselves, a danger to others, medically unstable, trauma patients, altered patients, belligerent patients, agitated patients, calm patients, and patients with normal mental status. A two-way mixed model average intraclass correlation coefficient (ICC) was used to determine scale reliability. Unpaired t-tests with confidence intervals (CI) were used to compare the two professions on VAPERS results and on individual scenarios. RESULTS: Overall, EPs were more likely to restrain patients than JDs (46% vs 37%), although this did not reach statistical significance. The statistically significant EP-JD disagreement, with EPs more likely to restrain patients, occurred if the patients were calm. Common themes in the differences emerged from evaluation of the two groups' comments. CONCLUSIONS: EPs and JDs disagree on restraint use. These EP-JD differences were statistically significant in patients who were calm.

Medical Control Decisions: When Does a Neonate Become a Separate Patient?

Patient refusal for care or transport is a common request to medical control physicians, and it is an especially challenging decision in the case of minors. Parents or guardians are able to refuse medical care for a minor if there is not an imminent threat of harm to the minor. However, if a minor patient is presumed to be in need of emergent medical care to prevent harm, medical personnel have the right to treat the minor, even if the parent or guardian objects. If the minor patient is a fetus or a neonate, it is not always clear when they are considered to be a separate patient. Apparently, there is no over-riding general rule or law and, consequently, Emergency Medical Services (EMS) protocols vary greatly from state to state. This case report describes one patient case that involved some of these unclear legal areas and how it fit with local EMS protocols. The legal question arose when a pregnant patient delivered her baby, but the umbilical cord was not cut. Are the mother's rights violated by cutting the umbilical cord if she objects to the procedure? How is the medical control physician to decide when to go beyond established EMS protocols to ensure that the safest and most ethical care is provided to a patient in the field? Does the care of the infant or the mother take precedence? Continued analyses of cases are required to ensure that protocols and guidelines are protecting both patients and providers.Venegas A, Ann Maggiore W, Wells R, Baker R, Watts S. Medical control decisions: when does a neonate become a separate patient? Prehosp Disaster Med. 2019;34(2):224-225.