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Restraints: Physical

Clinical Indications: Last update 02/2009

    Any patient who may harm himself, herself, or others may be gently restrained to prevent injury to the patient or crew. This restraint must be in a humane manner and used only as a last resort. Other means to prevent injury to the patient or crew must be attempted first. These efforts could include reality orientation, distraction techniques, or other less restrictive therapeutic means. Physical or chemical restraint should be a last resort technique. Police officer should be on scene when useing restraints for combative patients.

Procedure:

    1. Attempt less restrictive means of managing the patient.

    2. Request law enforcement assistance.

    3. Ensure that there are sufficient personnel available to physically restrain the patient safely.

    4. Restrain the patient in a lateral or supine position. No devices such as backboards, splints, or other devices will be on top of the patient. The patient will never be restrained in the prone position.

    5. The patient must be under constant observation by the EMS crew at all times. This includes direct visualization of the patient as well as cardiac and pulse oximetry monitoring whenever possible

    6. The extremities that are restrained will have a circulation check at least every 5 minutes. The first of these checks should occur as soon after placement of the restraints as possible. This MUST be documented on the PCR.

    7. Documentation on/with the patient care report (PCR) should include the reason for the use of restraints, the type of restraints used, and the time restraints were placed. Use of the Restraint Checklist is highly recommended.

    8. If the above actions are unsuccessful, or if the patient is resisting the restraints, consider administering medications per protocol. (Chemical restraint may be considered earlier.)

    9. If a patient is restrained by law enforcement personnel with handcuffs or other devices EMS personnel can not remove, a law enforcement officer must accompany the patient to the hospital in the transporting EMS vehicle.

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the local EMS System.

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