Yesterday as I bit into a cherry and suddenly became aware half of my lower fifth molar was missing (the dentist told me this fact, just now). This first world problem of mine did however make me reflect on some of the work our clients have undertaken where emergency dental treatment has been sanctioned by court order as it was deemed a threat to the person's life.
Soft restraints are used widely and across many sectors, our system used by trainers across many disciplines has been through various processes of accreditation including awarding body certification and more recently through national standards by our trainers working in Psychiatric care.
A secure transport service we support identified they had a middle age gentleman patient who urgently required major dental surgery to remove all of his teeth. His current dental condition was life-threatening and the patient flatly refused to give authorisation to medical staff for the procedure. The prospective patient had been combative previously and there was a serious concern that should staff have to manage these behaviours, especially in transit and for a prolonged period of time, the likelihood of injury would be high. The risks of assault, musco-skeletal damage / manual handling injuries to staff were of concern. along, along with the risks of positional asphyxia to the patient and the obvious restraint related injuries often acquired during a struggle.
Several training sessions and RAMS were conducted in conjunction with the surgical team, including one scenario where they restrained one of the surgeons, using the Softcuffs and elements of the Soft restraint kit. On the well-rehearsed day of the operation, the patient was IM medicated to calm him and he agreed to the Softcuffs being applied. The cuffs were kept on for the whole period and even after returning to his residence. Two officers from the secure transport company remained with the patient for 24 hours and when it was thought appropriate, the Soft restraints were removed, which was about an hour after he had returned to the residence.
Although the anaesthetist was confident the patient wouldn't awake during the procedure, based on the risk assesssment, it was deemed safer to have the Softcuffs in place. This allowed the patient to have all his teeth removed, reducing the associated risk of death from his condition. The surgeons confirmed this was a necessary life-saving procedure and the whole procedure was considered successful by the medical and care team. The patient fully recovered from the procedure and it was fed back to us that it was reassuring to have the use of the Softcuffs, even though there was no struggle or need to use them as a tool to prevent movement.
It was agreed that metal cuffs would only have exacerbated the situation and added further risk, whereas using manual holds alone or, relying on staff to have to reacted should the patient have awoken and presented as combative simply wasn't considered safe as part of the planning process.
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