J Emerg Med. 2026 Apr 30;87:14-30. doi: 10.1016/j.jemermed.2026.04.022. Online ahead of print.
ABSTRACT
BACKGROUND: Undifferentiated agitation in older adults is common in the prehospital setting, and in transitions from emergency medical services (EMS) to emergency department care. Restraints are commonly used in the management of agitation, although there is little evidence to inform the development of best practices.
OBJECTIVES: To explore paramedic experiences and determine perceptions on issues when managing older adults with agitation and using restraints in EMS.
METHODS: We conducted a descriptive cross-sectional survey of paramedics in Alberta, Canada, with a mix of multiple choice and open-ended questions that were interpreted using descriptive statistics and a qualitative thematic analysis, respectively.
RESULTS: Paramedics (n = 162) reported that older adults were commonly restrained due to risk of harm to self (81.5%) or others (76.5%), combative behavior (73.5%), or resistance to care (58.0%). Most paramedics believed that restraints were effective in facilitating care (76.9%) and had not resulted in adverse events (72.8%). Only 44.5% believed they had the necessary training to provide restraint alternatives, however, 93.6% agreed they have de-escalated situations without restraints, and 80.0% felt capable of using non-restraint-based agitation management strategies. Nearly half endorsed having suffered physical injury from patient agitation (48.1%). The mean total moral injury score was 20.9 ± 6.8 (range 9-35), indicating a relatively high level of moral injury.
CONCLUSION: Restraints are frequently used by EMS for the management of agitation among older adults, especially when there was a perceived risk of harm. Physical and moral injury is high among paramedics, as well as insufficient training regarding restraint alternatives.
PMID:42235087 | DOI:10.1016/j.jemermed.2026.04.022
