Hospital Restraints - General This is an area of fantasy enactment which quite a few people find appealing. The degree to which it can be put into play depends on convincing role play and the availability of authentic looking equipment. As far as I can discover, there are three major suppliers of actual hospital restraints in the USA and none here in sunny Britain! Of course, many useful materials related to medical needs are available if you know where to look and have the nerve to go in and ask for them. The actual restraint of hospital patients has been frowned on for many years. However, more recently, the use of sedatives to make patients controllable and suppress the outward sign's of hysteria have also been criticised. In Europe, the French, in particular, have returned to using the straight jacket or 'camisole' to allow certain categories of patients to work off surplus energy or anger without harm to themselves or others. For people who want authenticity the HUMANE RESTRAINT and POSEY jackets are the ones sold to hundreds of hospitals and sanatorium's in the good old US of A. Sizes are generally large and if expertly applied can be escape proof. Humane Restraint straitjackets are in four sizes, made of #6 cotton duck, and sewn together with nylon thread. The sleeves have #7 grommets at the sleeve end. The sleeve strap and back straps are leather and can be removed to launder the 'jacket. An optional cotton crotch strap is available at extra cost. A Transport Jacket which encases the torso and arms in a strong, heavy-weight cotton sleeveless jacket, with a strap between the legs. Hook and loop closures combined with roller buckles fasten it up the back. Handles are sewn to each side. Not to be used as the primary form of restraint but over a straight jacket or if used with a waist/cuff belt it is a valuable addition to any collection. Table and/or Bed Restraints The HR leather restrainers are excellent quality and finish and it must be said that the prices charged reflect this. The various kinds of locks are of interest. The variety of uses they can be put to depends entirely on the imagination of the user. Lightweight webbing straps with Velcro closings have a variety of uses and can be tamper-proof if strategically placed. The Posey catalogue shows a range of easy knots which members of the nursing profession are expected to know. Special bed blankets, such as the SHERWOOD heavy canvas and the Posey restraint bed net are combined restraints and covers which some of us have found useful in imaginative domestic games. Splints, Braces and Surgical Bondage This is an area where personal preference and fantasy may run riot. Anyone who has been subjected to the rigorous efficiency of a surgical collar of corset may not be turned on by this kind of authentic equipment, but there are many people who are. The LAB-100 transport leg brace is listed as prevents the knee from bending. They can be locked at the knee to keep the joint straight or bent. They are currently being used in the USA on prisoners in place of leg irons to prevent escape, kicking, etc. Can you get a better recommendation? As it is very expensive and often custom made, it is not always easily available. However, there are sources of second hand supplies. In these places other authentic pieces like hospital beds and dentists chairs may be found, if you have the nerve to ask. Bandages This is an area for the true DIY enthusiast. Know how and experience are only gained by practical experience ( and possibly a good first aid course!). The human body is not as easy to wrap as a postal package. Naturally, care must be taken not to interrupt blood circulation. Types and widths of bandage give many different opportunities. Elastic bandages and even soft rubber strips can be used. It's mainly a matted of visual effect and personal taste. All types of soft wrapping can be efficient if properly applied. Cling film? The time it takes to release a mummification need to be considered just in case of an emergency situation. A pair of bandage (blunt ended) scissors is a wise investment. Plaster Bandage For really extreme and lengthy scenes this has been used to great psychological and physical effect. Know how about using it should be sought in advance and, like many other aspects of bondage, an experiment to discover how it feels before subjecting someone else to it is advisable. Knowing how to cut it off without causing damage is also essential before it has been put on!!!. Surgical Gadgets So far I have only been able to get access to a limited range of items and illustrations. My list currently includes vaginal specula (4 sizes). A proctoscope for the examination of the rectum. The scope is inserted and then the central core is removed leaving the hollow nozzle in place to enable examination. Vaginal dilators in 7 sizes. Various enema sets, single and double Bardex. That's the one which has a second bulb which is inflated outside the body giving a greater security of leakage from the rectum. Male and female (Foley) urinary catheters. Stirrups to get those legs up and apart with securing straps to prevent the patient lowering or closing his or her legs. I know that a range of clamps for penis, mouth, etc. certainly exist and I would be grateful for information on these from people who have access to them through their work. Waist belts The NTB-200 Nylon Transporter belt restrains wrists to waist. The wrist restraint is double secure. Velcro closures are used to wrap tightly around each wrist. Twin steel loops are then cinched by a sturdy nylon strap. The waist belt buckles in back with a plastic buckle that will not accidentally open. Mendota P.A.D.S These restraints are combinations of a locking 48" waist strap and locking leather wristlets. Three types are available. (A) Wrists restrained at the waist. No freedom of movement of the arms. (B) Wrist restrained about 12 inches from waist. (C) ADJUSTABLE RESTRAINT. The wrists can be snug at the waist or given up to 12 inches of freedom. Each arm can be individually adjusted. A very nice bit of kit. And now for a bit of bed time reading to get the old grey matter working The Wet Pack As many as 30 wet cotton sheets are individually wrapped about the limbs and body - as tightly as possible, so that only the breathing tube from the inflatable gag remains exposed. The sheets are then compacted and bound paralysingly tight using several long roller towels. Once these have been wrapped and pulled very tightly round the patient, mummy fashion from head to toe, it is quite impossible to move - not even to blink or twitch a toe (unless a foot has been left exposed so that it can be tickled, or if electrodes have been attached, 'below the waist'). Often panic has already set in, but the worst has yet to come. Since the patient is now rigid he or she can be picked up in an invalid hoist and lowered into a long water tank containing water, crushed ice - just as cold as I can make it. You probably cannot imagine the shock or agony as this ice-cold water seeps through the bindings and numbs the skin. It is of no consolation that I hoist him or her out and strap him or her very tightly to a hospital type bed when he or she has been sufficiently soaked. The muscle contractions due to struggling can reduce the cold but this soon results in unbearable heat, especially if the patient is further wrapped in heavy rubber sheets. The patient can be immersed and the cycle repeated whenever my assistant or I feel like it. By the morning, after a sleepless night and only cramp and the fear of immersion to break the monotony, the patient's power to resist is often broken (always?) The roller towels are common here in England. Essentially each towel is several hundred feet long by about one foot wide. When utilised for its intended purpose each towel is rolled up and sits in a wall-mounted dispenser. The user pulls a fresh section from the cabinet to dry his or her hands. The used portion rolls back up into the cabinet. The towel is a strong cotton weave without any nap - like heavy sheeting which is also used. Want to have a go? Instructions and observations: PREPARE PATIENT - shave all hair including legs, crotch and armpits. Do not shave the head unless specifically ordered to do so. - cleanse with enema. - wash body using strong detergent (degreasing body minimises insulation). - depending upon orders, insert urethral catheter or put on rubber pants, sealed at legs and waist with water-proof tape. - insert intravenous saline and nutrient drips as required. - insert ear plugs. - either: provide patient with mouth breathing tube or insert gag, seal mouth with waterproof tape and insert nostril tubes. Strap the patient to the corners of the frame (a strong rectangular metal frame approximately 10'6" x 2'6") using waterproof cuffs at ankles and wrists. Pull the straps, attaching the cuffs to the frame, as tight as possible. THE TANK Fill a hydro tank (approximately 11ft x 3ft x 3ft) with luke warm water (about 70 degrees Fahrenheit). Hoist the frame and patient into the water filled tank. Each end of the frame has one pivot at its centre which fits into a corresponding socket inside the tank. This arrangement allows the frame and patient to be rotated about the long axis like a barbecue spit. Disconnect the hoist. The frame is now free to rotate beneath the surface of the water. Ensure that the patient is breathing properly through the tubes(s) provided and that the tubes remain kink-free and open during the packing procedure. PACKING - STAGE 1 Take each folded sheet from the soak-tub and refold it appropriately for its purpose. Pass each sheet through the soak-tub rollers to expel any trapped air. Quickly immerse the sheet in the tub until needed. The purpose of preparing the sheets in this way, and applying the pack with the patient underwater, is to ensure that all air is excluded from the pack. Air acts as an insulator and tends to diminish the effectiveness of the pack. In addition, applying the pack in the tank is easier because the patient is relatively buoyant. Carefully wrap the sheets around each limb as tightly and smoothly as possible. Use cloth tapes to tightly tie each sheet in place prior to bandaging. After each sheet has been tied in place, use 6" cotton bandages to bind it even more tightly. Remove the tapes during the bandaging to avoid localised pressure. Bandaging the thickest part of the limb first tends to force the flesh to the thinner parts and make the limb a more uniform thickness and therefore easier to pack. Ensure that each turn of the bandage overlaps considerably with the last. It is important that the pressure be applied as evenly as possible to reduce the probability of pressure sores. Such extensive use of bandages may seem extravagant but it is important to anchor each sheet individually to ensure that no amount of prolonged wriggling can loosen the pack. The bandages are relatively cheap and can often be reused. It may seem like a lot of extra work but the patient isn't going to be unpacked frequently. This method actually takes less time overall than more frequent packing using less rigorous methods. To aid in the wrapping operation, rotate the frame and patient like a spit. This is a great improvement over manhandling the enormous combined weight of patient and wet-pack on a table. Include the hands and feet in the wrapping process, removing and replacing the cuffs one at a time. To help speed the process several hydro attendants should work at the same time on different body areas. The supervising nurse must ensure that all the bindings are tight enough and that the pressure is uniform. When binding the head, use pads over the eyes to minimise any cavities in the packing. After a couple of sheets have been wrapped around the torso use a short corset to compress the waist and control respiration if this is a level 4 pack or higher. In the case of a male patient fold the penis back toward the buttocks and hold it in position with pack sheets applied in the style of a nappy. Hold the sheets in place with a tightly strapped canvas waist belt and attached crotch strap designed to prevent erection. Once the limbs, trunk, crotch, neck and head are satisfactorily wrapped then stage 2 begins. PACKING - STAGE 2 Hoist the support-frame from the bottom of the tank so that the patient is supported by it. Remove the ankle cuffs and place sheets between the legs to fill any gaps. Securely wrap additional sheets around the legs and the trunk and fasten them in place again with bandages. At this stage stronger bandages should be used, made out of cotton sheeting. It is no longer necessary to bandage after every sheet. Splint the legs and body. The splint is a canvas corset like device, with metal rust-free stays, that laces up the back and extends from ankles to beneath armpits with adjustable shoulder straps. Fittings are provided for the level 4 head-harness and shoulder brace to be attached. Lace up the splint as tightly as possible, using heavy-duty buttonhook devices and temporary straps. Once properly applied the patient is held in absolute rigidity. If the feet are not going to be held en-pointe (level 5 and above) then the splint should be anchored by a strap across the soles of the feet. Release the wrist cuffs and remove the original frame altogether, leaving the water-logged patient supported by the "support-frame" - but still underwater. Put each arm into a splint. Each splint has a mitt for the hand. Tightly lace each arm splint from wrist to armpit. Strap the arms securely to the side of the body using the special canvas straps built into the side of the body splint, passing the straps through the loops in the arm splints. A level 5 pack or above may specify different arm positions. Use extra-large sheets to wrap the entire body, from the crown of the head to the tips of the toes, as a single unit. As with any other wrapping operation, pass each sheet at least 3 complete times around the patient (or limb) to ensure that it cannot be unwrapped by the patient. After the last sheets are added then again bandage the patient from head to toe. Overall a lot of sheets are used. They should be 100% cotton in order to absorb and retain the maximum amount of water and provide the minimum insulation. They are usually made from an extra-heavy white sheeting in various sizes but are generally larger than regular bed sheets. Although the number of sheets may vary from patient to patient, the following pack sheets might typically be used (not in the order of application): - legs 4 each - feet 1 each - arm & hand 3 each side - neck 2 - head 3 - crotch 2 - trunk 6 - between legs 4 - legs together 4 - entire torso 11 - Total 48 SECURITY BAG In a level 3 pack or above, canvas cinch straps should be used and the patient put in a heavy canvas security-bag. (Remember that the patient is still immersed in the tank and that the staff should ensure that there is no air in the security-bag before using it.) Tightly lace and strap the security-bag and then perform a final heavy bandaging to prevent any possibility of air entering the security-bag when the patient is raised out of the tank. The patient is then securely refastened to the support-frame with a number of canvas straps. In a level 5 and above, force the feet into an exaggerated en- pointe position using a ballet strap. HOIST PATIENT When the patient and frame are hoisted out of the tank, excess body-heated water drains off. As the water drains out of the pack no air can pass back through the pack-sheets to fill the voids previously filled by the water. Thus the patient not only feels the oppressive weight of the wet sheets, but will also feel the pack draw tighter as the sheets "shrink" to fill any gaps previously filled with water. It is rather similar to being vacuum packed. The canvas straps used to secure the patient to the frame should be retightened as any excess water drains from the pack. IMMERSION IN COLD TANK Move the hoisted frame and patient to the cold tank where the water is kept refrigerated. Gradually lower the patient into the tank. In order to ensure that all the warm water is removed from the pack, hoist the patient out and allow the pack to drain before immersion. Perform this process several times in quick succession. As the freezing water gradually passes through the pack you may hear the patient desperately trying to inhale more air through the breathing tubes as the cold water causes the oxygen requirement to shoot up. The patient will try to inhale all the air that it can as its metabolism increases to combat the cold. In a level 5 pack, or higher, a nurse may request that the air supply be reduced at such times. After the initial immersion cycles the patient is left to soak in the tank and the auto-immersion cycle is started. This is essentially a timer that causes the patient to be hoisted out of the tank and immersed automatically. The timer has a random setting that is most often used to avoid the patient being able to anticipate the next hoisting or immersion. The period between immersions may be long enough for the patient to become uncomfortably hot but maybe not. In this way the patient is left without any contact with the outside world for as much as a week at a time. The hell endured by such a patient is hard to imagine. Itching, cramps and fear of immersion are the only companions. The timer switch may also activate the white-noise speakers in the hydro room, which effectively mask any outside noise that the patient might otherwise hear. Since the white noise is very loud, staff should wear hearing protectors while in the room. The patient is protected by the ear plugs and layers of pack. OBSERVATIONS A wet-sheet-pack is clearly a fearsome method of discipline. The patient is transformed into an absolutely helpless and rigid mummy, without even the slightest hope of escape. Even the fingers, toes, jaw and eyelids are immobilised. Even shivering is reduced to a minimal level. The patient is usually reduced to a state of blind panic, but is not be able to communicate that panic to anyone or get any form of comfort. The patient is alone! The patient is being crushed and needs to move to relieve the screaming cramps in the limbs and body. The patient cannot possibly lie still any longer - but will! The patient has no idea when he or she will be released or how much time has passed. The patient knows beyond doubt that it has entered a living hell - if this can be called living. If the patient is not catheterised then the question of urination will eventually arise: "Can I hold back until I am released". "How long will I have to wait - just a few minutes, more?" Eventually the patient will succumb to the urge and be forced to urinate. Later the issue becomes defecation added by glycerine suppositories again the patient is eventually forced to succumb. In addition to the shame of fouling themselves and lying in their own waste they are concerned about what "treatment" may be meted out to them if they foul themselves and the tank so horribly. "When is this going to end?" "I must have been here for hours!" "Is it night or is it day?" "Have I been in here for 6 hours or 24 hours or 2 days or a week?" "Nobody told me how long this treatment would last - they implied it would only be a couple of hours, but I know its been longer than that!" "Are they ever going to release me?" "The cramps keep getting worse and my muscles feel as if they are being torn apart." "Are my arms turning blue?" "If only I could die." "Oh god, please let me out." But the patient is not released - the treatment continues. "Life" remains a living hell of alternating heat, cold, immersion, fear of drowning, claustrophobia, suffocation, cramps and unimaginable boredom. Nothing to do but lie there, nothing to hear, smell, control or feel except the cold. There is no way to know when the next immersion will come, or if it will come, and no way to judge the passing of time. A note from the "editor s", I may be contacted at: theinstitute@blueyonder.co.uk If you have any comments regarding this material please feel free to contact me. I am always happy to talk to anyone about possible mutual interests. If you have access to equipment or have any addresses where it can be obtained please let me know.