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36-year-old psych patient being transferred between facilities shocked her ambulance crew last year when she suddenly unbuckled herself, got off of the cot and exited the rear doors as the vehicle was traveling at freeway speed. She died instantly in front of her horrified husband, who was following in their car.

Nothing in any EMS text had prepared that crew for what their patient did. And nothing could have braced them for the anguish they endured as a result.

These are hard times for psych patients and their EMTs. We_re surrounded by people who spend their whole lives barely in balance. Throw in a depression, a foreclosure, a screwy election, an unpopular war, the loss of a job, and maybe a divorce as a result of it all, and they just plain lose it.„

Plenty of them end up in emergency departments (EDs) with no medical insurance. Hungry, thirsty, tired and uncomfortable, they suffer for hours while busy staffs try to find facilities that will take them.

Invariably, they_re transferred. And as complex as their situations are, they often get transferred by young EMTsƒthe least experienced and least educated caregivers of all.

If you need care and you have plenty of money, the U.S. is a good place to be. But if you_re broke, God help you. In a time of crumbling social services, everybody knows that EMSers are the last remaining go-to people.„

An ED physician and a former EMT have invented a simple device that could prevent a similar incident from ever happening again. It_s so simple, you_re going to kick yourself for not thinking of it. I sure did. (Think I hurt myself, too.)

Wayne Guerra, the physician, and Lincoln Gup, the EMT, were studying for master_s degrees at Denver University when they developed the idea.„

Guerra and Gup call their idea the BuckleGarde. It_s a rigid plastic sheath you slide onto the female end of a cot strap before you buckle it. Once in place, it protects that release button until you want it released. It_s tough enough to last 10 years in a busy system. You could park an ambulance on one. (OK, maybe a Toyota.)„

Here_s the idea. You carry two or three of these things with your restraints. When a patient gets your attention, you bring the guards out and slip them onto your buckles. A slick operator like you won_t even have to break eye contact. Nobody will even know what you_re doingƒunless they_re very observant and they understand the equipment.„

Who would possess those qualifications? Another EMT. In fact, the mere act of bringing out these devices could be used as a way of communicating to everybody on your team that your spider sense is tingling. Personally, I can_t think of any reason why you wouldn_t use them on anybody with known or suspected behavioral issues.

Make no mistake, this is not a substitute for a good restraint system and professional people who know how and when to use it. But it_s a great, simple step between the standard cot straps and your restraints. And it should keep people on your cot, where they belong. They won_t have a clue, unless they decide to split. If that happens, you_ll get some warning.

What do you do if you want to free one of these up? There are slots in the top and bottom surfaces of the device that will accommodate any automotive or household keyƒor, the blade on your trauma shears. Shove any of those implements through the slot over the red button and, presto, it_s open. If you do a good job of removing the contents of a patient_s pockets prior to transport, they_re going to stay put.

According to its inventors, the BuckleGarde is designed to work on several brands of cot straps.„

Two things you should know about (which aren_t necessarily disadvantages): Depending on what kind of straps you have, once you attach one of these, you may not be able to loosen the strap without unbuckling it. If not, be sure to plan accordingly. (You can easily tighten a strap with the guard in place.) And two, you can lose these things. So, store them zip-tied together. You_ll usually need _em as a set, anyway.

You can go online and purchase the BuckleGarde directly from the inventors, at„www.gardesystems.com.One runs $35, and a three-pack is $90.„JEMS

Thom Dickhas been involved in EMS for 38 years, 23 of them as a full-time EMT and paramedic in San Diego County. He_s currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at„boxcar414@aol.com.


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