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But, some of these patients aren't thinking rationally, and can't be talked down. Some of them are fighting from the moment you or the cops walk through the door. They're going to end up physically restrained, and chemical restraint means you can minimise the number of times they have to get TASERed, maybe avoid them getting pepper sprayed. And it means when they're tied down to the stretcher they're not thrashing around, screaming, getting all tachycardic, and maybe sensitising their myocardium to any drugs of abuse they have circulating around.
During the evolution of paramedicine, a great deal of both curriculum and skill set was in a state of constant flux. Permissible skills evolved in many cases at the local level, and were based upon the preferences of physician advisers and medical directors. Treatments would go in and out of fashion, and sometimes, back in again. The use of certain drugs, Bretylium for example, illustrate this. In some respects, the development seemed almost faddish. Technologies also evolved and changed, and as medical equipment manufacturers quickly learned, the pre-hospital environment was not the same as the hospital environment; equipment standards which worked fine in hospitals could not cope well with the less controlled pre-hospital environment. Physicians began to take more interest in paramedics from a research perspective as well. By about 1990, most of the 'trendiness' in pre-hospital emergency care had begun to disappear, and was replaced by outcome-based research; the gold standard for the rest of medicine. This research began to drive the evolution of the practice of both paramedics and the emergency physicians who oversaw their work; changes to procedures and protocols began to occur only after significant outcome-based research demonstrated their need. Such changes affected everything from simple procedures, such as CPR , to changes in drug protocols. As the profession of paramedicine grew, some of its members actually went on to become not just research participants, but researchers in their own right, with their own projects and journal publications.