Racial and Ethnic Disparities in Prehospital Restraint Use and Sedation

Emergency medical service clinicians routinely encounter patients experiencing behavioral health emergencies, yet limited data describe the prehospital use of physical restraints or sedatives. Systemic racism and challenges in access to behavioral health care may contribute to disparities in restraint and sedation use among minoritized groups. This study examined whether race and ethnicity were associated with prehospital use of physical restraints and/or sedation among patients with behavioral health emergencies.

Using the 2022 ESO Data Collaborative consisting of ∼12,000,000 emergency medical service healthcare encounters, this study estimated the associations between race and ethnicity (non-Hispanic White, Black/African American, Hispanic any race, Asian, or American Indian/Alaskan Native) and physical restraint and/or sedation use (yes, no) among patients aged ≥15 years who had an emergency medical service encounter for a behavioral health emergency. AOR estimates with 95% CIs are presented.

Approximately 7.1% (n=3,799) of behavioral health encounters involved any restraint or sedation use. All racial and ethnic minoritized groups were more likely to receive physical restraints (AOR range=1.62-2.72, p<0.05) than non-Hispanic White patients, whereas Black/African American, Hispanic, and American Indian/Alaskan Native patients were more likely to be sedated with antipsychotics or benzodiazepines (AOR range=1.27-3.21, p<0.05). Black/African American patients were also more likely than non-Hispanic White patients to be concurrently restrained and sedated (AOR=1.30, 95% CI=1.09, 1.55).

Disparities in restraint and sedation use may perpetuate poor psychiatric outcomes for racially and ethnically minoritized groups, particularly Black/African American patients, in a system that already hinders their access to mental health treatment.