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Restraints and Restraint

Walker, Graham MD

doi: 10.1097/
    restraint, chokehold

    I have been grabbed.

    I have been spat on.

    I have been punched.

    I have been kicked.

    I have been bitten.

    I have had feces kicked at me.

    I have had urinals—full ones, mind you—thrown at me.

    I have been called every rotten name you can think of. (My patients can be creative.)

    My life has been threatened by patients carrying weapons.

    I do not carry a weapon on me.

    Lucky for me, I have not been hurt in any of these instances. Others in our field have not been so lucky.

    Lucky for me, I had co-workers (nurses, doctors, security) in all of these instances to help protect me and to restrain:

    The patient who was drunk.

    The patient who was high.

    The patient who was psychotic.

    The patient who was angry.

    The patient who was in pain.

    The patient who was under arrest.

    The patient who was lying.

    The patient who was hungry.

    In all these instances, we were able to restrain the patient, usually through a combination of chemical sedatives and physical restraints.

    Occasionally, someone sustained a minor injury while helping to protect me: a thigh contusion, a sprained wrist, a concussion. Luckily, nothing more. Others in our field have not been so lucky.

    Restraining a patient has been identified as such a high-risk procedure in medical care (for the patient and provider) that it comes with the most powerful of physician and nurse requirements: paperwork. Here I am, a physician with nine years of schooling, four years of training in emergency medicine, and almost 10 years of attending experience, and I have to attest that the restraints I'm using are properly and safely placed. I must explain why exactly I've decided to order restraints.

    If something went wrong—the patient had a seizure, aspirated, or said, “I can't breathe”—I can't really think of any person more qualified to respond than an emergency physician. If there were a bad outcome—or god forbid a death—the case would be closely scrutinized by no less than 100 people, I'd imagine, including my peers and people who know nothing about me, nothing about the specifics of the case, nothing about emergency medicine at all.

    So, please, someone, anyone, explain to me why my restraint requires paperwork, reassessment, documentation, and constant attention in my hospital, but seemingly none of that is required when an officer of the law kneels on a Black man's neck for eight minutes and 46 seconds?

    Why is it taking the death of George Floyd—and Manuel Ellis and Eric Garner before him, as well as countless others—for us to realize that restraint (particularly restraint of the neck) can kill people, and it is only now starting to be banned?

    Eric Garner died in July 2014. The Eric Garner Anti-Chokehold Act was passed by the New York State Assembly in June. June 2020. Why is it that doctors and nurses can manage to restrain a patient with Velcro, not a knee on the neck or a chokehold to the throat, but police need to use lethal force?

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    Dr. Walkeris an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc (, a medical calculator for clinical scores, equations, and risk stratifications, which also has an app (, and The NNT (, a number-needed-to-treat tool to communicate benefit and harm. Follow him on Twitter@grahamwalker, and read his past columns at

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