Behavioral Emergencies – Prehospital – Restraints

Also See: North Coast EMS Patient Restraints policy #6036Sedation (Chemical Restraint) policy #6552Combative Patient policy #6035, and Patient Refusal of Service policy #2312.

Restraints should be used as a last resort.

Prehospital personnel must consider that aggressive or violent behavior may be a symptom of medical conditions such as head trauma, alcohol, drug related problems, metabolic disorders, stress and psychiatric disorders. ALS treatment guidelines shall be followed for those conditions that require intervention.

If the individual continues to resist evaluation, treatment or transportation, all reasonable measures including police assistance and/or appropriate use of physical restraint should be used in order to evaluate, treat and transport the individual. At no time should EMS personnel place themselves in physical danger.
Restraints are to be used only when necessary, in situations where the individual is potentially violent and is exhibiting behavior that is potentially dangerous to self and/or others, and:

  • the individual is under arrest and the law enforcement officer permits restraints, or
  • the individual is under a 5150 hold and 5150 documentation is transported with the individual, or
  • unable rather than unwilling to follow directions.- i.e. confused, delirious, disoriented or extremely restless. The individual may be grabbing, pulling or tugging tubes, line or other therapeutic devices.

Restraints shall not be applied to individuals who are unwilling rather than unable to follow directions unless Law Enforcement, Emergency Department or Mental Health personnel are available and willing to participate in restraint application.

The method of restraint used shall not restrict the ability to protect the individual’s airway or compromise neurological or vascular status and must allow for adequate monitoring of vital signs.

Restraint devices applied by law enforcement require the officer’s continued presence to ensure patient and scene management control.

  • When possible, the law enforcement officer will accompany the patient in the ambulance.
  • If the law enforcement officer is unable to accompany the patient in the ambulance, the officer must follow the transport vehicle, driving in tandem over a pre-determined route and with established radio communication (may be conducted though dispatch if direct communications are not possible.)

Restraint equipment applied by law enforcement must provide sufficient slack in the restraint device to allow the individual to take full tidal volume breaths.

Restraint equipment applied by prehospital personnel must be either padded leather or synthetic restraints (i.e. posey, Velcro, or seatbelt type) and must allow for quick release. The following devices shall NOT be applied by EMS prehospital care personnel:

  • Hard plastic ties or any restraint device requiring a key to remove
  • Backboard, scoop-stretcher or flat used as a “sandwich” restraint
  • Restraint of an individual’s hands and feet behind the individual
  • Methods or materials applied in a manner that could cause vascular or neurological compromise

Individuals shall not be transported restrained and in a prone position.

Documentation on the Patient Care Record shall include the following:

  • Reason for application of restraints (describe specifics of behavior)
  • Which agency applied the restraints and under what authority
  • Information and data regarding the monitoring of circulation to the restrained extremities
  • Information and data regarding the monitoring of cardiac and respiratory status while restrained

Serial assessment of patient circulatory, cardiac, and respiratory status must be repeated at least every ten minutes and include patient status upon transfer of care to hospital staff or other care provider.

WIC 5008 (m):  “Emergency” means a situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place, or for it to become unavoidable prior to treatment.