We manage violent patients with assistance from security, as well as law enforcement. We had a patient brought in by sheriff's deputies, and he was nice as pie -- I think his complaint was drug abuse. Once the officers left, he took off his "nice" mask and started to tear up our psych room -- there is only a stretcher in there, but he managed to cut his foot on the stretcher, put a huge hole in the wall, and bleed all over the place. We can lock the psych room from the outside, and we did, while calling the police. I have never seen police cars slide sideways into our parking lot before.
They came in with tasers, and suddenly the pt. was docile again -- he laid on the floor and said, "Don't tase me! Don't tase me!" (I guess he'd been tased before?
) After our doc sutured his foot, that patient went off to jail. We weren't about to go in and try to put him in restraints, or anything like that -- he was a huge guy. We put our safety first and locked that room door.
If a patient is in handcuffs in our ED, they are under the watch of law enforcement, and that is their business. We rarely have to use 4-point restraints, thank goodness, but we have a time or two, and we follow policy protocol closely in those cases as far as monitory and assessment. Most of our security guys are great, but a couple ... I think I could take 'em. Seriously. Thankfully law enforcement is quick to respond to us. (Probably because we feed them Sunday brunch every other week. LOL)
And yes, chemical restraints from time to time -- some docs love the Haldol/Ativan cocktail, other choose Geodon. (My complaint with Geodon -- it takes a minute or two to reconstitute! What a pain. It's not really ever a med you don't need quickly, you know??)