When used correctly, crowd control officers have a good margin of safety and generally do not cause any permanent damage. In addition to the debate on the active substances themselves, there were some concerns about the safety of delivery vehicles, in particular methylisobutylketone (MIBK). Although chronic exposure to MIBK has been linked to neurological and respiratory effects, there is no evidence to support the theory that acute exposure to the low levels that occur with CS spraying poses the same problems. The combustible compounds used as the first vehicles have been largely replaced by water-soluble and less toxic vehicles. Despite all the controversy surrounding chemical control officers, they offer a less dangerous method of restraint than other life-threatening alternatives such as firearms. Since some officers can be deployed remotely, they provide the law enforcement officer with a method of control without direct contact with a potentially violent person. There were 16 reported data collection approaches that formed implicit definition domains based on an outcome data collection approach. An example of coding an outcome collection approach is presented (in Box 3) for the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) (approach in seven studies). The wording of the RAI-SED elements used was reported in two studies, however, all studies that applied the RAI-MDS were coded using the wording of the original tool, unless otherwise stated in the study. It was assumed that the data collection approaches reflect the same codes contained in the headings “Restriction Method”, “Resident Attitude is Restricted” and “Resident Ability to Withdraw/Control” as in the explicit definitions of physical restriction.
Only the number in the individual bubbles differed. Chemical restraint is the intentional use of drugs to suppress, calm or restrain a person. Chemical restrictions have been used to restrict a patient`s freedom of movement, usually in acute, emergency or psychiatric settings. Chemical restrictions are often prescribed for what health care workers describe as dangerous, uncontrolled, aggressive, or violent behavior. This chapter describes a theoretical approach to the assessment and treatment of behavioural disorders that takes into account the context in which behavioural disorders occur, including physiological and environmental events, previous environmental stimuli, and behavioural consequences. Information on the epidemiology, etiology, assessment and treatment of agitation and aggression in the elderly will be reviewed. First, a discussion on definition issues is presented. Chemical restrictions are incredibly dangerous. The use of powerful psychotropic drugs poses a clear risk to a person`s physical and mental health and should only be used when absolutely necessary. Chemical restrictions, on the other hand, are used when there is no clear medical purpose. Since users are older and often already taking more than five drugs, the risk of harm is significantly increased. According to the FDA, unnecessary use of antipsychotics kills 15,000 nursing home patients each year.
Safe and effective chemical restraint for a large number of people is a greater challenge than the restraint of the individual. The goal of retaining large numbers is to control the crowd by encouraging dispersal into smaller, less threatening numbers. The funds used are expected to have almost immediate effects in low concentrations. The remedy must be so harmful that exposed people are quickly aware of their exposure. It should also be harmful enough for exposed individuals to be motivated to leave the area promptly or to follow other orders from law enforcement officers. Violation by the officer of the crowd, bystanders and law enforcement officers should be minimal. The effects of exposure should be short-lived and easily reversible. The agent must have a short half-life and be easily degraded to minimize pollution.
Some agents meet these criteria and their use is explained in this article. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) established a resident`s right to be free from physical or chemical restrictions in nursing homes when used for disciplinary or convenience purposes and when it is not necessary to treat the resident`s medical symptoms. Lack of cooperation, agitation, hiking or socialization are not sufficient reasons to justify the use of restraint (Agens, 2010). The data collection approach was not described in sufficient detail to be coded in 13 studies, for example “The use of restrictions was determined by the RA at the time of resident assessment” [42]. Studies were excluded if (a) they were published in a language other than English, (b) data on the use of restrictions were reported for one year before the year 2000, (c) the publication was a letter, newsprint, journal article, commentary, legal document, ethics article, systematic review, case study, a study, a study, which reported only qualitative data, a poster summary or thesis, and (d) the prevalence of psychotropic drugs or other drugs was described without justifying the intention to suspend or reduce restrictions. Chemical retention methods have been used throughout history. Early forms included drifting clouds of arsenic smoke used by Hunyadi in 1456, arsenic projectiles used by the bishop of Munster`s soldiers in 1672, and the use of hypnotics by the Danes against King Duncan I in the eleventh century. Even in these early times, weather and wind conditions were estimated, so the offensive should not be affected by the means used. Despite the evidence for these remedies, the best historical account of chemicals used as a means of restraint or for war dates back to the First World War. Modern chemical mass control agents were first used by the French in 1912, when Paris police used ethyl bromomacetate (EBA) against violent offenders. In the first months of World War I, the French dropped chlorobenzylide grenades (CS: tear gas) against the German army.
In addition to CS, world War I also introduced chlorine and mustard gas, resulting in significant morbidity and mortality, and leading to the development of precursors to modern personal protective equipment and operational equipment used by law enforcement agencies. Coding implicit definitions of chemical constraints according to the outcome data collection approach resulted in three themes. These covered the themes of “method of restraint”, “declared intent” and the “duration, frequency or number” of restraint (see Figure 5). Other topics identified for implicit definitions of physical stress were either inapplicable or non-existent for chemical stresses. A resident`s ability to relax their physical strain was reflected in the results of one study. This study reported results for “liberal” chains, which they defined as “corrected for the ability to loosen and include pedals,” while “conservative” results were described as “corrected for the ability to loosen and exclude pedals” [38]. Compared to the consensus definition on physical restraint, there is relatively no clear definition of chemical restraint in long-term care. Definitions of chemical restrictions included “classes of drugs”, e.g. psychotropic drugs, hypnotics, etc.
However, without a consensus definition of the classes of drugs considered as chemical restraints, there is no consistency. Some definitions described the intent of these drugs, including controlling behaviour or organizational convenience. Since these drugs often have approved clinical indications, it is important to consider the reason for the prescription or use when defining chemical restraint. It was found that the current consensus definition of physical restraint encompasses many of the areas of physical restraint found in explicit definitions in the literature. However, the measurement approaches used do not reflect this definition. The consensus definition included the domains of a physical device, a stated intent, and the resident`s ability to suppress or control. Rarely, however, have measurement approaches been used that reflected the intent of the restraint or the resident`s ability to remove or control it. Contrary to the explicit definition of “duration”, many data collection approaches have indicated the “duration” of the data collection period for physical limitations as well as the “frequency” of use during that period, for example, “the daily use of physical limitations in the last 7 days” [44]. Whether restraint was “on request or according to standard procedures” was also part of the data collection approach in one study: “We also asked whether physical restrictions were used for this resident as needed or as a standard procedure” [35]. Reservations or statements about when a device or method was not considered a limitation have been included in a number of explicit definitions.
