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Injuries sustained by patients with behavioral disturbances brought to an emergency department in police custody

Introduction

Although it is widely recognized that physical restraint of violent persons can result in death or serious injury, formal reports documenting the incidence or rate of such injuries are lacking. The rate and nature of injuries for emotionally disturbed patients brought in police custody to a major urban emergency department (ED) were therefore recorded.

Methods

All medical records of persons brought by police to the public hospital ED for a large metropolitan county (population 2.5 million) are electronically marked for subsequent rapid searches. Excluding those arriving following commission of a crime or for evaluation of medical conditions or sexual assaults, all patients brought with the transport assistance of paramedic crews to the ED in police custody for psychiatric evaluation as an emotionally disturbed person from 12 December 1999 through 31 August 2003 were studied. Patients were classified specifically as 'agitated' if they were described as violent, psychotic, aggressive, combative, hostile, threatening, homicidal or dangerous.

Results

Of the total 24,895 police custody visits, 17,733 met the inclusion criteria for receiving psychiatric evaluation as emotionally disturbed persons. Of these, 10,173 (57%) could be classified as agitated. A potentially lethal weapon was confiscated in 447 cases. Of the 17,733 studied, 511 (3.3%) sustained injuries – 398 (78%) of which were self-inflicted stab wounds, wrist lacerations and hangings. Mace exposure resulted in 34 minor injuries, while none were attributable to conductive electrical devices. Overall, the rate of self-inflicted injuries over 3 years and 9 months was 2.2% (n = 398) while it was 0.6% (n = 113) for those inflicted by others. Only four of these patients (approximately one per year) required admission to a surgical service. Of note, 29% of injuries sustained by agitated patients were not self-inflicted, compared with 13.6% in nonagitated patients (70/238 vs 37/273, P = 0.0001).

Conclusion

With the assistance of transporting paramedics, police officers were able to restrain violent, emotionally disturbed patients with a very low risk of serious injury.

References

  1. 1.

    Morrison A, et al.: Death of a psychiatric patient during physical restraint. Med Sci Law 2001, 41: 46-50.

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Metzger, J., Maher, P., Wainscott, M. et al. Injuries sustained by patients with behavioral disturbances brought to an emergency department in police custody. Crit Care 12, P351 (2008). https://doi.org/10.1186/cc6572

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Keywords

  • Emergency Department
  • Psychiatric Evaluation
  • Stab Wound
  • Physical Restraint
  • Hospital Emergency Department