Non-Hispanic Black individuals experiencing a mental health crisis are significantly more likely to be restrained or sedated by emergency medical service (EMS) personnel than are non-Hispanic White individuals, according to a report published yesterday in JAMA Open Network.
Diana Bongiorno, M.D., M.P.H., of Harvard Medical School, and colleagues noted that caring for patients with acute agitation is particularly challenging in the prehospital setting because EMS clinicians must consider safety on scene and within the enclosed space of an ambulance, often with limited resources. But, the researchers added, “Although restraints and/or sedation are needed in certain situations, there are notable risks associated with these interventions, including respiratory depression, hypoxia, physical trauma, and, rarely, cardiac arrest.”
The researchers used data from the 2021 ESO Data Collaborative—a database on EMS services—to analyze EMS encounters among patients ages 16 to 90 years having a behavioral health emergency from January 1 to December 31, 2021. The primary outcome was administration of any physical restraint and/or chemical sedation (defined as any antipsychotic medication, benzodiazepine, or ketamine).
The dataset included 661,307 encounters, of which 9.9% were with Hispanic patients, 20.2% non-Hispanic Black patients, 59.5% non-Hispanic White patients, 1.9% non-Hispanic other patients, and 8.6% patients of unknown race and ethnicity. Restraint and/or sedation was used in 7% (46,042) of the encounters.
After adjusting for demographic and community variables, non-Hispanic Black patients were 1.17 times more likely to experience any kind of restraint or sedation compared with non-Hispanic White patients; Black patients were also 1.31 times more likely to experience both restraint and sedation during an EMS encounter. Hispanic patients were 1.04 times as likely to experience physical restraint as non-Hispanic White patients but had no increased odds of chemical sedation or both restraint and sedation.
Bongiorno and colleagues said that future work should include investigation of EMS agency protocols for restraint or sedation use. “Our results also suggest a need for increased EMS training on behavioral health emergencies, and potentially consideration of expanded national prehospital education standards … that include de-escalation training,” they wrote.
For related information, see the Psychiatric News article “APA Resource Document Outlines Principles on Use of Seclusion, Restraint.”
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