Employing freedom-restraining measures correctly can prevent fatal consequences

Being confined to bed can have fatal consequences. Incorrect fastening of restraints and inadequate monitoring led to the death of 19 people in care. Andrea M. Berzianovich and her colleagues, forensic medicine specialists from Munich and Vienna, investigated these fatalities in patients subjected to freedom-restraining measures (Dtsch Arztebl 2012; 109(3) 27).

The authors analyzed a total of 26 cases of death while the individual was physically restrained. Three died of natural causes, and one committed suicide. One nursing-home patient died of strangulation after wriggling through a correctly applied abdominal strap. In 19 of the remaining 22 cases death by strangulation, chest compression, or dangling in the head-down position was due to incorrect fastening of restraining straps.

The authors recommend that all alternative avenues should be explored before resorting to freedom-restraining measures. If physical restraint is the only feasible option, the straps must be fastened strictly according to the manufacturer's instructions and the patient must be closely monitored. Freedom-restraining measures are employed primarily in the care of the elderly, to enable medical treatment to be carried out in people who are at risk of falling or exhibit behavioral disorders or motor unrest.