RegionsHospitalEmergencyMedical

ServicesYear2000EMSGuidelines
PatientRestraint
INTRODUCTION:
Patientshavetherighttorefusetreatmentand/ortransportifthey
areoflegalageandarecompetent.Competenceisdefinedasthe
capacityorabilitytounderstandthenatureandeffectsofones
actsordecisions.Apersonisconsideredtobecompetentuntil
provenotherwise.Therearesituations,however,inwhichthe
interestsofthegeneralpublicoutweighanindividualsrightto
liberty:
1.
2.
3.

Theindividualisthreateningselfharmorsuicide.
Theindividualpresentsathreattothecommunitybecauseofa
contagiousdiseaseorotherphysicaldangerousness.
Theindividualpresentsaspecificthreattoinnocentthirdparties.
Certainmedical,traumaticandpsychologicalconditionscancause
incompetenceandbehaviorthatinterfereswiththeabilityofEMS
personneltocareforthepatient,orthatthreatensthephysicalwell
beingandsafetyofthepatientorothers.Theseconditionsinclude,
butarenotlimitedto:drugs,metabolicdisturbances,central
nervoussysteminjuryorinsult,infections,hypo/hypertension,
hypo/hyperthermia,hypoxia,psychologicaldisorders,poisonsand
toxins.Minnesotalaw(609.06)authorizestheuseof"reasonable
forceuponortowardthepersonofanotherwithouttheothers
consentwhenthefollowingcircumstancesexistortheactor
reasonablybelievesthemtoexist:whenusedtorestrainamentally

illormentallydefectivepersonfromselfinjuryorinjuryto
anotherorwhenusedbyonewithauthoritytodosotocompel
compliancewithreasonablerequirementsforthepersonscontrol,
conductortreatment."IfanEMSproviderfeelsuncomfortable
withanypatient,evenwhentheyhavenotbeenactively
combative,theproviderhastherightanddutytoprovidethe
patientandotherswiththesecurityofpatientrestraint.Verbal
threatsarealegitimatereasonforrestraint.Thefollowingisa
guidelinefortheuseofrestraintsintheprehospitalcaresetting.It
isnotintendedtodictatepoliceactionthatmaybenecessaryto
subduesomeone.
INDICATIONS:
1.
2.
3.
4.

1.
2.
3.
4.
5.

Behaviororthreatsthatcreateorimplyadangertothepatientor
others
Safeandcontrolledaccessformedicalprocedures
Changeinbehaviorthatresultsfromimprovementordeterioration
ofpatientcondition,i.e.hypoglycemia,overdose,intubation
Involuntaryevaluationortreatmentofincompetentcombative
patients
PRECAUTIONS:
Beawareofitemsatthesceneormedicalequipmentthatmay
becomeaweapon.
Assurethatthesceneissafebeforeapproachingthepatient.
Patientsthatareactivelyseizingshouldneverberestrained.
Thepatientshouldberestrainedinthepronepositiononlyasalast
resortandonlywithcontinuousmonitoring.Thispositionmay
interferewiththepatientsabilitytobreathe.
Restrainingapatientshandsandfeettogetherbehindthepatient
(hogtying)isnotallowed.Theonlyexceptionisaprisoneror
suspectinthecustodyoflawenforcementorprisonauthorities.

GENERALRESTRAINTPROCEDURES:
1.
2.
3.
4.

5.
6.
7.
8.

9.
10.

11.

Makeeveryattemptnottoaggravateorworsenpreexisting
injuriesormedicalconditions.
Attemptfirsttocontrolthepatientwithverbalcounseling.
Theleastrestrictivemeansofcontrolshouldbeemployed.
Only"reasonableforce"maybeusedwhenapplyingphysical
control.Thisisgenerallydefinedastheuseofforceequalto,or
minimallygreaterthan,theamountofforcebeingexertedbythe
resistingpatient.
Restraintsshouldnotinterferewiththeassessmentortreatmentof
thepatientsABCs.
Thedecisiontorestrainapatientshouldusuallybemadepriorto
transport.
Donotremoverestraintsonceappliedunlessthepatientseizes.If
circulationbecomescompromised,thebenefitofremovingthe
restraintsmustbeweighedagainstcrewsafety.
EMSdoesnotapplyhandcuffsorhardplasticties(flexcuffs),but
ifalreadyinplaceandcirculationisadequate,maybelefton.
Handcuffsmustbedoublelockedtopreventinadvertent
tightening,andshouldallowonelittlefingertofitbetweenthe
handcuffandthewrist.Assurethatakeyisavailableduring
transport.
Restraintsshouldbeindividualizedandaffordasmuchdignityto
thepatientasthesituationallows.Attempttoaccommodatepatient
comfortorspecialneedswheneverpossible.
Ensurethatenoughhelpisavailabletoinsurepatientandprovider
safetyduringtherestraintprocess.Optimally,fivepeopleshould
beavailabletoapplyfullbodyrestraint(oneforeachlimbandone
forrestraintapplication).Communicatetherestraintplantoall
help.
Assurethatthepatientsclothingandpersonalbelongingshave
beensearchedforweaponspriortotransport.

12.

Anemergencytransportholdmustbeobtainedandcompleted
wheneverapatientistransportedagainsttheirwillfortheabove
mentionedreasons.
ADVANCEDLIFESUPPORTCARE:

1.

Forcombativebehaviorthatiscompromisingtheabilitytoprovide
patientcare,consultwithmedicalcontrolforsedationmedication
orders.
PEDIATRICCONSIDERATIONS:

1.

Alwaysattempttoinvolveparentswhenrestrainingchildren.
PREGNANCYCONSIDERATIONS:

1.

Pregnantwomenshouldberestrainedinasemirecliningorleft
lateralrecumbentposition.
DOCUMENTATIONREQUIREMENTS:

1.
2.

Anemergencyexisted
Theneedfortreatmentwasexplainedtothepatient(regardlessof
competence)
Thepatientrefusedtreatmentorwasunabletoconsenttotreatment
Evidenceofthepatientsincompetencetorefusetreatment
Failuresoflessrestrictivemethodsofcontrol(suchasverbal
counsel)
Therestraintswereusedforthesafetyofthepatientorothers
Thereasonsforrestraintwereexplainedtothepatient(regardless
ofcompetence)
Thetype/methodofrestraintusedandwhichlimbswererestrained
Injuriesthatoccurduringtherestraintprocedure
Whichagencyplacedtherestraints
ContinuouslyassessCMS(distaltotherestraints)andthepatients
abilitytobreathe
SPECIALNOTES:

3.
4.
5.
6.
7.
8.
9.
10.
11.

1.

TheuseofSaO2monitoringmaybeusefulinassessingdistal
circulation,butdoesnottaketheplaceofCMSchecks.