POLICY STATEMENT:

The use of patient restraints should be held to a minimum and only used as a last resort to transport a patient who exhibits physical resistance to transport or violence towards EMS personnel. The purpose of restraints is not to arrest, but to protect the patient and others from his or her irrationality.

GOAL/PURPOSE:

To assure appropriate use of patient restraints in the pre-hospital setting.

POLICY/PROCEDURE:

A. The use of restraints is determined by the physical resistance to transport or violence towards EMS personnel by a patient who meets the criteria for implied consent and intentionally or unintentionally physically injure himself/herself or others.

B. Whenever possible, Medical Control is contacted for guidance and concurrence in determining the need for restraints. Unless patients possess an immediate threat to themselves or other persons, Medical Control should be contacted prior to the restraint.

C. Attempt voluntary application of restraints.

D. Notify law enforcement for assistance, if indicated.

E. If voluntary restraint is not possible, assemble adequate personnel. Ideally, this should include one person for each of the patient's limbs.

F. For Involuntary Restraint, do not spend much time bargaining with the patient. If the patient does not respond in a brief time to the request for voluntary restraint, then move quickly to apply involuntary restraint. Indecisiveness may agitate the patient even further.

G. EMS Personnel shall use all the force reasonably required to restrain the patient. "Reasonable force" depends on the degree of resistance on part of the patient. The force of restraint must equal the degree of combativeness. Legal claims of excessive force may be made for restraint beyond what is necessary.

H. Once the patient is on the stretcher, begin application of restraints. The patient should be gently grasped and placed on his/her back.

I. The gender of the pre-hospital personnel present when restraints are being applied should be considered in relation to the patient's problem (i.e., it is better to have same gender EMS crewmember present when a patient is out of control and needs restraint).

J. After application of restraints, the patients must at no time be left alone. Someone must be assigned to talk with the patient about the patient's feelings and explain the purpose of the restraints.

K. Restraints must periodically be checked for proper application (i.e., adequate circulation to limbs, with documentation written on the Patient Care Report Form that these periodic checks were conducted at least every five minutes).

L. A patient under arrest by a law enforcement agency must first be restrained with hand-cuffs. Restraint and/or transport of a patient to a hospital by EMS personnel who is under arrest but has not been restrained initially with hand-cuffs by law enforcement, ARE NOT TO BE RESTRAINED AND/OR TRANSPORTED BY EMS PERSONNEL until hand-cuffs have been applied.

M. Documentation Requirements

N. Avoiding Injury