No experience with it, but downloaded this piece a long time ago...
THE WET-SHEET-PACK LETTER
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My favorite restraint is 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 paralyzingly 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).
Often panic has already set in, but the worst has yet to come.
Since the patient is now rigid he 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 out and strap him very tightly to a hospital-type bed when he 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 re-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 re-immersion to break the monotony, the patient’s power to resist is often broken.
The roller towels that you asked about are rarely seen in the US, but are common in England. Essentially each towel is several hundred feet long by about one foot wide. When utilized 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.
Fearsome as her pack sounds, one of the institutions that I worked in often used much more stringent packs on its troublesome patients. Instructions and observations follow:
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 minimizes insulation).
• depending upon orders, insert urethral catheter or put on rubber pants, sealed at legs and waist with waterproof 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 llft 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 center 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 soaktub rollers to expel any trapped air. Quickly re-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 localized 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 minimize 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 diaper. 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 corsetlike device, with rust-free metal 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-like devices and temporary straps. Once properly applied the patient is held in absolute rigidity. If the feet are not going to be held enpointe (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):
• left leg 4
• right leg 4
• left foot 1
• right foot 1
• left arm & hand 3
• right arm & hand 3
• neck 2
• head 3
• crotch 2
• trunk 6
• between legs 4
• legs together 4
• entire torso 11
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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 re-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 re-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 re-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 re-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 immobilized. 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 catheterized then the question of eliminations 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 and 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, re-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.