Strategies for safely managing agitated patients were discussed at the latest instalment of the Grand Rounds at Weill Cornell Medicine-Qatar (WCM-Q). 

WCM-Q welcomed Dr Rana Biary, who explained how to safely identify and restrain patients who arrive at hospitals in an advanced state of agitation, posing a risk to themselves and to healthcare providers. Dr Biary is assistant professor and director of the medical toxicology fellowship at New York University.

In an emergency department you may encounter patients who are agitated to the point of violence. They might be screaming at you, cursing, spitting, punching, kicking or grabbing at you. To protect them, yourself and others, it is crucial to know how to restrain them quickly and safely.’

Dr Biary used role play to show how to properly restrain an agitated patient, which she explained requires at least five people. Care should be taken not to apply pressure to a patient’s neck and they should never be restrained in a position that prevents them from breathing, she said. Once an agitated patient has been safely restrained, an appropriate sedative can be administered to allow treatment to begin.

Dr Biary said that the key to safely managing agitated patients was not related to knowing general self-defence techniques, and that being physically larger and stronger than the patient is not necessarily an advantage. Instead, healthcare workers should find safety in numbers and follow their training.

There are many examples of very fit, strong doctors being injured because they thought they could handle a patient alone. That is dangerous and wrong. The way to safely manage an agitated patient is to follow your training: first call for help, then approach the patient with as many people as possible, know the techniques for restraining a patient without causing injury to anyone and know which type of sedative should be used.’

The presentation also discussed how to identify and manage hyperthermia (elevated body temperature), which is common among agitated patients, especially if they are under the influence of narcotics. The lecture was accredited locally by the Qatar Council for Healthcare Practitioners-Accreditation Department (QCHP-AD) and internationally by the Accreditation Council for Continuing Medical Education (ACCME).

For more information about the Grand Rounds at WCM-Q, visit their website at qatar-weill.cornell.edu.