McDowall Jared, Makkink Andrew William, Jarman Kelton
Netcare Education, Faculty of Emergency and Critical Care, Johannesburg, Gauteng, South Africa.
Department of Emergency Medical Care, University of Johannesburg, Doornfontein, Gauteng, South Africa.
Afr J Emerg Med. 2023 Sep;13(3):157-165. doi: 10.1016/j.afjem.2023.03.006. Epub 2023 Jun 9.
Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS.
We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results.
The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department.
The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.
精神运动性激越和攻击性行为（AAB）有可能在任何医疗环境中发生，包括紧急医疗服务（EMS）所服务的环境。本综述旨在研究院前环境中对患者进行身体约束的现有文献，并确定相关指南及其有效性、对患者和医护人员的安全性，以及EMS使用身体约束时的相关策略。
我们采用了由阿克西和奥马利描述、并经苏查雷夫和马卡卢索扩充的方法框架进行本综述。几个步骤指导了综述过程：确定研究问题、纳入标准、信息来源（CINAHL、Medline、Cochrane和Scopus）、检索、筛选和数据收集、伦理批准、整理、总结和报告结果。
在本综述中，感兴趣的人群是院前接受身体约束的患者，然而，与规模较大的急诊科相比，针对这一人群的研究较少。
无行为能力患者知情同意的局限性可能与既往和未来研究缺乏前瞻性实际研究有关。未来的研究应聚焦于院前环境中的患者管理、不良事件、从业者风险、政策和教育。
