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“Correct” Use of Restraints does Not Necessarily Prevent Death

August 8, 2010

Dr. Ronald Federici has argued that the restraint methods he recommends in his book are safe, when properly done. However, here is evidence that deaths have occurred from prone restraint methods, even when they were correctly used.

Click here to read the full text of this publication.

Review Paper: Adverse Effects Associated With Physical Restraint

Wanda K Mohr, PhD, RN, FAAN1, Theodore A Petti, MD, MPH2, Brian D Mohr, MD3

Can J Psychiatry 2003;48:330–337

The report states (see p. 3 of the PDF):

When scholars reviewed 63 cases of asphyxia death following restraint use in individuals ranging in age from 26 weeks to 98 years, they found that restraints had been properly applied in 57 cases (16). This finding suggests that restraints pose an inherent danger to patients even when proper techniques are used. [emphasis added] Although fatal positional asphyxia has been documented in adults, it has not been documented in children. However, it is probable that small size alone is a significant factor increasing children’s susceptibility to death by this mechanism.

So 57 out of the 68 deaths were cases where the restraint was “properly applied.” This is something for people to consider, when a therapist, licensed or otherwise recommends that parents use prone restraint procedures on their children. If they are this dangerous even under highly supervised conditions that were verified as “properly applied”, what does that say about parents who only had informal “training” from a therapist and are left alone to administer the procedure.

This same publication (p. 5) reports that serious psychological after-effects on children who have been restrained:

Likewise, children and adolescents who had been restrained during psychiatric hospitalization reported nightmares, intrusive thoughts, and avoidance responses resulting from their restraint experiences, as well as marked startle responses associated with being held in benign and nonthreatening situations. They also reported painful memories and fearfulness at seeing or hearing others being restrained and a mistrust of mental health professionals (6). Five years later, they continued to experience intrusive thoughts, recurrent nightmares, avoidance behaviours, startle responses, and mistrust (63).

The report also points out that when the patient is agitated prior to being restrained, that increases the risk factors for death due to asphyxiation.

They conclude:

There is a dearth of studies to support the efficacy or necessity
of restraining children and adolescents or to support setting
the boundaries or criteria to define conditions for restraint
across patient populations (89,94).

While the authors argue that sometimes restraining a patient is necessary, they urge the development of better standards and guidelines. Leaving parents who have no formal credentials alone with their children and advising them to perform a face-down, prone restraint procedure for extended periods of time after only an informal “training” from a mental health professional does not appear to be a good idea, to put it mildly. Federici recommends in his book that parents find a mental health professional with experience working in residential facilities, but the mere fact of having had experience is no guarantee that the person knows what he or she is doing since the literature reveals that many people working in such facilities did not have proper training.  Federici also cautions (see p. 112 in Help for the Hopeless Child) parents about not applying too much pressure or weight and to trust their instincts, but how much is too much and can non-credentialed parents really trust their so-called instincts? Can they really trust themselves to know or trust the person who trained them to know exactly what constitutes the correct amount of pressure? This does not seem to me to be an adequate precaution, in my opinion.

The above-cited report shows that even under the best conditions, prone restraints have killed people and there are many more reviews published within the past decade that show “benefits” from restraints are not empirically supported and that they often do more harm than good (contrary to the so-called “reviews” that have been posted online that refer to publications nearly 20 years old, some written by proponents of the now thoroughly debunked “therapy” for multiple personality disorder that employed restraint). Also note that this is the result of research and reviews in scholarly publication, not the “sensationalist” media reports opponents of restraints have been accused of.

The implicit message here would seem to me to be: Don’t try this at home.

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