Frequently check patient because of possibility of suffocating while in a prone position.

(4) Place the middle of the roll diagonally across the patient's upper back and shoulder.

(5) Bring both ends of the sheet under the litter.

(6) Cross the ends of the sheet under the litter.

(7) Bring the ends of the sheet up and over the patient's other shoulder and other side of the patient's upper back and tie ends snugly in the middle of the patient's back with a square knot.

(8) Secure one of the patient's wrists to the litter parallel to the thighs using a wrist restraint.

(9) Secure the patient's other wrist overhead to the nearest litter-carrying handle using a wrist restraint.

(a) This method prevents the patient from pushing himself up from the litter.

(b) Also, it keeps the patient's arms and hands within confines of the litter.

NOTE: This procedure requires another person to assist. e. Bed Restraint.

(1) Fold sheet in half, lengthwise.

(2) Tuck sheet approximately 2 feet of one end under one side of mattress at patient's chest level.

NOTE: Ensure there is adequate sheet under the mattress in order to prevent the sheet from being easily pulled out.

(3) Bring the other end of the sheet over the patient's chest.

(4) Keeping the sheet over the patient's chest and arms, tuck the free end of sheet snugly under other side of mattress.

CAUTION: This restraint should in no way take the place of side rails and should be considered one of the lease effective methods of restraints.

NOTE: If further restriction is desired, sheets may be applied in the same manner at the level of the patient's abdomen, legs, knees, and/or ankles.

f. Field Expedient Restraints. Under field conditions, standard restraining devices may not be available. However, violent patients must be restrained. By utilizing materials commonly carried by the soldier in the field, patients can be effectively placed in field-expedient restraints. Field expedient restraints may be improvised from such items as two litters, rifle slings, web belts, bandoleers, and cravats (folded cloth). The field-expedient restraints should be replaced with regular restraining devices as soon as possible and should not be used for long periods of time. With any field-expedient restraint, the same considerations used in applying regular restraints must be followed.

(1) Mixed equipment. A variety of equipment (rifle slings, web belts, bandoleers, cravats, rope, and so forth) can be used to restrain a patient in the field. See figure 3-4 for an example.

(2) Double litters with litter strap. NOTE: Be sure to obtain adequate help to assist with the patient.

(a) Place the patient on the litter in the prone position and turn his head to one side.

(b) Place each of the patient's hands along his thigh and use wrist restraints to secure his hands to the litter.

(c) Place the other litter, carrying side down, on top of the patient.

(d) Bind litters together with two or more litter straps (figure 3-5).

Figure 3-5. Double litter restraint. g. Record and Report Action Taken.

(1) Record the date and time the restraint was applied.

(2) Record the type of restraint applied.

(3) State reason for the application of the restraint.

(4) State the patient's tolerance of the procedure.

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