Ambulance personnel use of coercion and use of safety belts in Norway.

BACKGROUND: Providing health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance transport patients are fastened to the stretcher with safety straps. However, patients who wriggle out of, or unfasten, their safety straps pose a threat to him/herself and escorting personnel in the ambulance compartment in case of an accident. To prevent harm, ambulance personnel sometimes restrain the patient or unfasten their own seatbelts to keep the patient safe on the stretcher. The prevalence of coercive measures, and the relationship between the use of mechanical restraints comparable to coercion and seatbelt use, are scarcely investigated. Use of coercion normally requires a specific statutory basis. However, coercive measures needed to ensure safety in a moving vehicle while providing healthcare is hardly discussed in the literature. The aim of this study is to explore the use of coercion in ambulance services, the use of safety belts among escorts in situations where they need to keep the patient calm during transportation, and to analyse the relationship between safety belt non-compliance and coercion in these situations. METHODS: This is a retrospective, cross-sectional study using a self-administered, online survey aiming to investigate the use of coercion and use of seatbelts during ambulance transport. Approximately 3,400 ambulance personnel from all 18 Health Trusts in Norway were invited to participate between Oct 2021 and Nov 2022. Descriptive analyses were used to describe the sample and the prevalence of findings, while multiple linear regressions were used to investigate associations. RESULTS: Altogether, 681 (20%) ambulance personnel completed the survey where 488 (72.4%) stated that they had used coercion during the last six months and 375 (55.7%) had experienced ambulance personnel or escorting personnel working with unfastened seatbelts during transport. The majority of respondents experienced coercion as being unpleasant and more negative feelings were associated with less use of seatbelts. CONCLUSIONS: Coercion seems to be used by ambulance personnel frequently. For the study participants, keeping the patient securely fastened was prioritized above escorting personnel's traffic safety, despite feeling uncomfortable doing so. Because coercive measures have negative consequences for patients, is associated with negative feelings for health personnel, and is not discussed ethically and legally in relation to the prehospital context, there is an urgent need for more research on the topic, and for legal preparatory work to address the unique perspectives of the prehospital context in which traffic safety also is an important factor.

Coercion in the ambulance setting. / Bruk av tvang under ambulansetransport.

BACKGROUND: Patients who resist medical assistance can undo the safety straps on the ambulance stretcher. Ambulance personnel have been known to make use of blankets, bandages and Velcro straps to restrain patients in transit. This study aims to establish how often this type of coercion is used. MATERIAL AND METHOD: In 2021, approximately 400 ambulance service personnel in the county of Innlandet were invited by email to take part in an online survey about the use of coercion vis-à-vis patients who resist medical assistance. RESULTS: We received 85 responses, and 62 respondents (72.9 %) stated that they had used coercion. Of these, 38 (44.7 %) had restrained the arms/legs of patients using blankets, bandages or Velcro straps in order to keep them safe while in transit. A total of 36 respondents (42.4 %) had observed other personnel travelling in an ambulance without a fastened seatbelt in order to maintain patient safety during transit. INTERPRETATION: The results clearly show that ambulance personnel regularly use coercion when patients who resist their help are transported by ambulance. There is a need to discuss how such ambulance services can be provided in a safe, secure and caring way.