2. • Section 6(4) of the Mental Capacity Act states
that someone is using restraint if they:
– use force – or threaten to use force – to make
someone do something that they are resisting, or
– restrict a person’s freedom of movement,
whether they are resisting or not
4. • The authority to restrain a client is allowed if
the following conditions are satisfied:
– the patient lacks capacity in relation to the matter
in question
– the member of staff reasonably believes that it is
necessary to restrain in order to prevent harm to
the client
5. – Requiring treatment by legal order (e.g. MHA
1983 amended 2007)
– Requiring life saving or urgent treatment
– Needing to be maintained in secure settings
6. Practical Application
• This guidance ONLY applies to patients who
would otherwise not have been sedated or
intubated for medical or surgical reasons and
exclude patients with:
– With low or fluctuating GCS
– With head trauma
– Who need airway protection
– Who need ventilatory support
– etc
7. • Therefore restraint may be considered in the
following circumstances, where the patient is:
– Displaying behaviour that is putting themselves at
risk of harm
– Displaying behaviour that is putting others at a
risk of harm
8. Position statement on the
involvement of anaesthetists in
restraint teams
Royal College of Psychiatrists
Royal College of Anaesthetists
17/1/2014
9. This policy guides the use of anaesthetists as
part of a response team to provide:
• physical,
• mechanical and/or
• pharmacological restraint
of acutely agitated or aggressive patients with
mental health issues outside of the operating
theatre/intensive care environment.
10. • Following consultation with The Royal College
of Psychiatrists, the College would wish to
emphasise the following principles relating to
the involvement of anaesthetists in these
difficult scenarios:
11. • Anaesthetists should only act as part of a multidisciplinary
response team incorporating mental health care
professionals including a psychiatrist Trainee
• Anaesthetists should not routinely be involved in initiating
pharmacological restraint - referred to as ‘rapid
tranquillisation’
• If the urgency of the clinical situation dictates they must
only act within their competence and, whenever possible,
after consultation with a consultant anaesthetist
12. • Anaesthetists should receive appropriate
locally delivered training to safely fulfill their
role as part of the response team
• When rapid tranquillisation is deemed
appropriate the minimum intervention
possible should be used as guided by the local
protocol
13. • Equipment for ventilatory support and the full
range of resuscitation equipment must be
immediately available along with trained
assistance for the anaesthetist
• Careful consideration must be given to post
sedation management including:
– the venue for recovery of the patient,
– adequacy of monitoring and
– availability of nursing care with appropriate airway
management skills
14. • Organisations should ensure that there are
processes in place for post incident reflection
and de-briefing to ensure that individual and
team learning is maximised
15. • The College does not support under any
circumstances the use of rapid tranquillisation
to manage violence or aggression in visitors or
other individuals on hospital premises.
18. • Such restraints should only be employed
under the strict control of written policies that
have been developed, agreed and
implemented after:
– clinical, legal, and managerial input, and which
must take account of relevant legislation such as
the Mental Capacity Act 2005 and the Adults with
Incapacity Act (Scotland) 2000.
19. • Council of the AAGBI does not believe that
trainees in anaesthesia should be involved in
pharmacological restraint:
– except in extraordinary circumstances and
– after consultation with a consultant anaesthetist,
– should refer any requests for pharmacological
restraint to a supervising consultant anaesthetist.
23. • Intubation is not always the answer
– Asses the patient yourself
– Be familiar with and follow your local guideline
– Get your consultant involved early
– If there is disparity in assessment, get the consultants
to assess and decide if there is time
– Consider alternatives for sedation as in the above
protocol if indicated
24. Let common sense prevail
• Regain control of the situation
• Ensure the patient is safe
