RESTRAINT USE
ALL LEVELS
Indications:
To provide guidelines on the use of restraints in the field or during transport for patients who are violent or potentially violent or pose a danger to themselves or others. (e.g. to prevent the dislodgement of medical devices or to protect a patient who is confused or disoriented and unable to follow instructions for his/her safety).
Definitions:
Physical Restraint – means a device approved by this service that is used to limit mobility or immobilize a patient in order to protect the patient, crew or others.
Chemical restraint – Means a medication given with the intent to control behavior through sedation.
If the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility
Precautions:
As a general rule, if a patient needs to be restrained, it should be the responsibility of law enforcement to do so. Use physical restraint only if necessary for protection of EMS providers or the patient. If restraint of the patient is necessary, do not attempt to restrain until you have sufficient resources. A minimum of four people is necessary to assure adequate protection to the rescuers and the patient during the restraint process. If restraints have been applied, do not release until transfer at the hospital. Patients must not be restrained in a prone (face down) position or transported as such.
Policy:
1. Physical restraint must be humane and used only as a last resort. Verbal de-escalation must be attempted first.
2. Restraints applied by law enforcement must allow EMS the ability to assess the patient and provide the patient sufficient slack to take full tidal volume breaths.
1. If hand cuffs were applied by law enforcement, EMS must have the ability to remove them if needed in an emergent situation and an officer must accompany the patient.
3. Physical restraints applied by EMS personnel must be either the soft wrist restraints supplied by the department or transport agency or restraints fashioned out of sheets. Physical restraints must allow the patient to take full tidal volume breaths.
4. Justification of restraint use must be documented in the PCR
5. Any patient who is restrained should be placed on oxygen and monitored through pulse oximetry and end tidal CO2 at a minimum, whenever possible.
6. Any restrained limb should be evaluated for adequate distal perfusion every 15 minutes
7. Consider chemical restraint as an alternative in patients incapable of making informed consent and are at risk for injury from physically being restrained. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.
ALL LEVELS
Indications:
To provide guidelines on the use of restraints in the field or during transport for patients who are violent or potentially violent or pose a danger to themselves or others. (e.g. to prevent the dislodgement of medical devices or to protect a patient who is confused or disoriented and unable to follow instructions for his/her safety).
Definitions:
Physical Restraint – means a device approved by this service that is used to limit mobility or immobilize a patient in order to protect the patient, crew or others.
Chemical restraint – Means a medication given with the intent to control behavior through sedation.
If the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility
Precautions:
As a general rule, if a patient needs to be restrained, it should be the responsibility of law enforcement to do so. Use physical restraint only if necessary for protection of EMS providers or the patient. If restraint of the patient is necessary, do not attempt to restrain until you have sufficient resources. A minimum of four people is necessary to assure adequate protection to the rescuers and the patient during the restraint process. If restraints have been applied, do not release until transfer at the hospital. Patients must not be restrained in a prone (face down) position or transported as such.
Policy:
1. Physical restraint must be humane and used only as a last resort. Verbal de-escalation must be attempted first.
2. Restraints applied by law enforcement must allow EMS the ability to assess the patient and provide the patient sufficient slack to take full tidal volume breaths.
1. If hand cuffs were applied by law enforcement, EMS must have the ability to remove them if needed in an emergent situation and an officer must accompany the patient.
3. Physical restraints applied by EMS personnel must be either the soft wrist restraints supplied by the department or transport agency or restraints fashioned out of sheets. Physical restraints must allow the patient to take full tidal volume breaths.
4. Justification of restraint use must be documented in the PCR
5. Any patient who is restrained should be placed on oxygen and monitored through pulse oximetry and end tidal CO2 at a minimum, whenever possible.
6. Any restrained limb should be evaluated for adequate distal perfusion every 15 minutes
7. Consider chemical restraint as an alternative in patients incapable of making informed consent and are at risk for injury from physically being restrained. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.