1-11 RESTRAINTS

Violent, agitated or potentially violent patients who are medically unable to give consent should be restrained on the cot to prevent injury to the patient or paramedics.  If a patient is refusing treatment, but deemed to be at threat for loss of life or permanent impairment by the paramedic team, the appropriate police agency should be contacted, assist with restraints as needed and prepare an EM-1. Notify receiving hospital about the nature of the patient and the need to restrain so they can prepare for arrival. (Once restrained, the restraints should remain in place until the patient is seen by a physician in the emergency department.)

If police authorize use of restraints for transfer to Brown County Mental Health Center or jail but wishes to have EMS transfer for safety reasons contact medical control to determine whether there is a need for Emergency Department evaluation.

The following content will be considered the standard of care for the patient who needs physical restraint:

1. Protect patient, family, bystanders and EMS personnel from potential harm.  Obtain additional help as necessary.
2. Observe universal precautions.
3. Evaluate the situation to determine the need for police presence as above.
4. Assure clear airway, breathing, and circulatory status.
5. Complete the history and secondary physical assessment.
6. Assess the patient’s level of consciousness, level of activity, body language and affect.
7. Evaluate suicidal potential.
8. Attempt to rule out common physical causes for patient’s abnormal behavior and treat accordingly.
   1. hypoxia
   2. hypoglycemia or other metabolic disorders
   3. head trauma
   4. alcohol intoxication
   5. substance use/abuse
9. Maintain non-threatening attitude toward patient.
10. Contact your hospital base station physician for medical orders as needed.
11. Provide appropriate medical care as ordered.
12. Complete a run report, documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

Documentation must include:

• A description of the circumstances/behavior which precipitated the use of restraints
• A statement that the patient/significant others were informed of the reasons for the restraints and that their application was for the safety of the patient/bystanders or personnel and not as punishment for antisocial behavior.
• A statement that no other less restrictive measure appeared appropriate and/or other measures were tried and failed
• The time of application of the restraint device
• The position in which the patient was restrained and transported
• The type of restraint used

Guidelines for application by EMT’s include:

• Restraint equipment applied by EMS personnel must be padded, four point, soft restraints and allow for quick release.
• Restraints must be applied in such a manner that complete monitoring of vital signs is possible.
• Restraints must not cause vascular or neurological compromise.

EMT’s operating within the Brown County EMS System may NOT use:

• Hard plastic ties or any restraint device which requires a key to remove
• Backboard or scoop stretcher to “sandwich” the patient
• Restraints which secure the patient’s hands and feet behind the back (“hog-tie”)
• Any method or material applied in a manner that could cause vascular or neurological compromise.

For restraint devices applied by law enforcement officers:

• The restraints and position must provide sufficient slack in the device to allow the patient to straighten the abdomen and chest to take full tidal volume.
• An officer must be immediately available to the patient AT ALL TIMES at the scene as well as in the patient compartment of the transport vehicle.

A left lateral lying position should be used whenever possible.  The position of transport may not compromise respiratory or circulatory systems and must not interfere with necessary medical treatment. Patients should not be transported in a prone position.

Restrained extremities should be evaluated for pulse quality, capillary refill time, color, nerve and motor function every 15 minutes.  Restraints must be adjusted if compromise of any of these functions is discovered.

Document reasons for any deviation from protocol on an Incident Report form.