Is Getting An MRI Of A Law Enforcement Custody Patient In Restraints Difficult? How Difficult Can Restraints

Is getting an MRI of a law enforcement custody patient in restraints difficult? How difficult can restraints make medical care in general? Taking blood pressure kinda stuff, not uh spinal tap sort of things.

Lets first talk about why we restrain people in a medical environment, then we’ll get into law enforcement restraining and MRI safe equipment. 

The number one thing to remember is that any restraint in a medical environment must be in the patient’s best interest, and removed when they are no longer needed to keep the patient or their caregivers safe. As medical professionals, we restrain people when their actions pose a risk to themselves or their caregivers, thus preventing them from receiving necessary care- be this a fall risk, self-harm, violence, or simple delirium. 

There are many options for restraining people, some of which include:

All four bed rails up: Its more trapping than most people give it credit for, and many hospitals won’t even let a patient choose to have all four rails up because it increases the risk a patient will fall trying to climb over them. Because of this, a “four rails up” restraint may require a sitter (someone who watches the patient 24/7) to decrease this risk.

A sitter: Not so much a restraint, but a way to avoid having to restrain the person. A hospital employee stays in the room with the patient and can prevent them from harming themselves or pulling out catheters, IV access, or taking off CPAP machines. 

Roll belts: Belts that go around the person’s waist in a bed or chair, that kind of remind them not to get up without help. Technically, they are designed so the patient can release the belts themselves, and aren’t charted as restraints for this reason. Usually used with chair and bed alarms for delirious or dementia patients who would accidentally harm themselves by trying to get up and falling.

Soft restraints: These are wrist and ankle restraints that prevent people from pulling out their IVs, ET tubes, and foley catheters. These are not designed so that patients can release them themselves (they have clips that attach to the bed that shouldn’t be reachable from where the patient is), but some patients are very determined. On the medical professional side of this, these need a doctor’s order every 12-24 hours and need to be charted on every two or so hours (depending on policy). The patient must also be given adequate opportunities to use the restroom/move around/perform hygiene activities/eat and be able to call for help if needed.

Violent restraints: These are for people who are actively threatening to harm themselves or others, and form whom no other form of restraint has worked. These are very, very difficult to get out of (not saying a very determined patient can’t, but they are designed to keep people attached to their bed). They typically need a doctor’s order every hour or two and need to be charted on as frequently. The patient must also be given all the opportunities listed above.

Chemical restraints: Now, if the reason the person is a threat to themselves or others is that they are having hallucinations/delusions/extreme anxiety/paranoia/confusion/delirium, it makes a lot more sense to treat that medically than it does to just tie them down. Anti-anxiety meds like lorazepam and antipsychotics like haloperidol are common choices for this, and can be given through an IV if available or injected into the muscle. These are considered restraints because they’re sedating, which limits a patient’s ability to interact with their world and care for themselves, but may relieve the symptoms.

If a patient is in restraints, the nurse’s life is both way harder and way easier. On one hand, they get to worry slightly less about the patient hurting themselves or pulling out their catheter. On the other, having a patient in restraints is a LOT of extra work (charting, activities of daily living that the patient is now totally dependent on caregivers for, and explaining to angry family members why grandma is in leathers. Not to mention, the nurse has to call for an order to continue the restraints as frequently as every two hours (less for pediatric patients)).

When someone is in restraints, it takes a lot longer to do basic care like get vitals, provide hygiene and pass meds if the patient is not cooperating (like, have you ever cleaned up a C-diff patient who was trying to punch/bite/smear poop on you while navigating four-point violent restraints that were also covered in poop? Because I have). Certain things, like drawing blood, may be impossible (have you ever tried putting a foley catheter into a confused 83 y/o female who is screaming and kicking you (in 3-point restraints, mind you) because she thinks you’re trying to r*pe her? Because I’ve also done that.)

Restraints are specifically designed not to cause injury, but you’d be surprised at how willing someone is to dislocate something to get out of them. Handcuffs have no padding, and could seriously injure someone that hellbent on getting free. Because of this, the only time someone would be in handcuffs in the hospital is if they are calm and cooperative (not pulling against the cuffs, which could injure them), and have a police/prison officer present in the room with them at all times. They too must be given all the same privileges that those in soft or violent restraints are. Should they begin pulling on the handcuffs and injuring themselves, they may be transferred to violent restraints.

As for MRIs, all hospitals with an MRI machine have MRI-safe equipment, including gurneys, IV poles, and restraint equipment. If someone is really squirming, though, the use of a chemical restraint may be necessary. In the case that someone is just under law enforcement custody and not actively violent, they do make MRI-safe handcuffs.