This recent Northern Territory coroners inquest report into the death of a young woman from a pulmonary embolism during hospital care for acute mental health condition highlights the risks of sedation and restraint. She had risk factors for thrombosis and was subjected to multiple episodes of chemical and mechanical restraint leading up to a final admission to Alice Springs Hospital ICU where she was intubated and anaesthetised for aeromedical transfer to Darwin for higher level forensic mental health care. This final period of heavy sedation was unnecessarily prolonged due to lack of bed availability in Darwin hospital. After intubation in Alice Springs ICU , it took over 24 hrs until she arrived, still intubated and heavily sedated, at Darwin hospital ICU. She actually never awoke from this period of sedation and died 4 days later , still intubated and sedated. This highlights one of the risks of psychiatric aeromedical retrieval and transfer in that bed availability may inadvertently prolong the period of sedation and restraint for acutely disturbed patients and thereby also increase the risk of medical complications such as thrombosis and aspiration pneumonia. This must be reassessed constantly and all efforts made to reduce the duration of sedation and restraint as much as reasonably possible.
The Surviving Sedation guidelines have been updated to reflect this risk and need to assess and mitigate such risk.
References:
Takuto Ishida, Takeshi Katagiri, Hiroyuki Uchida, Hiroyoshi Takeuchi, Hitoshi Sakurai, Koichiro Watanabe, Masaru Mimura,
Incidence of Deep Vein Thrombosis in Restrained Psychiatric Patients,
Psychosomatics,
Volume 55, Issue 1,
2014,
Pages 69-75,
ISSN 0033-3182,
https://doi.org/10.1016/j.psym.2013.04.001
Michitaka Funayama, Taketo Takata,
Psychiatric inpatients subjected to physical restraint have a higher risk of deep vein thrombosis and aspiration pneumonia,
General Hospital Psychiatry,
Volume 62,
2020,
Pages 1-5,
ISSN 0163-8343,
https://doi.org/10.1016/j.genhosppsych.2019.11.003.
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 