Effective: 08-12-24
Supersedes: 04-24-23
Purpose: The purpose of this policy is to provide guidance for the use of patient restraints in the field or during transport for patients who are violent, potentially violent, or who may harm themselves or others.
Massachusetts Statewide treatment protocols permit EMTs and Paramedics to restrain a patient that “presents an immediate or serious threat of bodily harm to him/herself or others”. In order to be the subject of a “Section 12” / application for involuntary hospitalization, the patient must be a “substantial threat to themselves or others”. Therefore, by definition- a patient with a Section 12 may be restrained as necessary for their safety, or that of the crew. Similar laws and regulations exist throughout our coverage area.
Policy
1. Adults and emancipated minors who are competent with the functional capacity to understand the nature and effects of their actions and / or decisions have the right to refuse treatment and / or transport. Certain medical, traumatic, and psychological conditions can cause incompetence and behavior that threatens the physical well-being and safety of the patient or others.
2. When restraints are necessary, such activity will be undertaken in a manner that protects the patient’s health and safely preserves his or her dignity, rights, and well-being. The safety of the patient, community, and responding personnel is of paramount concern when following this policy.
Restraint Guidelines
The following guidelines should assist prehospital personnel in the application of restraints and the monitoring of a restrained patient.
1. When possible, the Communication Center should be notified that a potential prehospital patient restraint situation exists and a Field Supervisor and other appropriate resources dispatched to the scene. Law enforcement officers, or hospital security (depending on location) should be involved in all cases when a patient poses a threat to EMS personnel or others. If law enforcement is not immediately available, EMS personnel should retreat to a safe place and await the arrival of law enforcement if possible.
2. EMS personnel should recognize that there is no duty to act when faced with violent behavior, whether that behavior is being directed at a caregiver, a patient or their family, or another member of the community at large.
3. Patient dignity should be maintained during restraint, and the method of restraint should be individualized to use the least restrictive method of restraint that protects the patient and EMS personnel from harm.
4. The goal of managing a patient exhibiting violent behavior is to prevent further harm to the patient and others by exercising only that force which is necessary to neutralize the aberrant behavior, without causing harm to the patient, EMS personnel, or bystanders.
Patient Restraint Procedure
1. Use the least restrictive method of restraint that assures the safety of the patient and others.
2. Use only soft restraints (leather restraints only if made with soft padding inside).
3. Remind law enforcement that for ambulance transport, patients who are handcuffed must have handcuffs in front (not behind) or to the stretcher and that the key must be readily available for removal; if needed.
4. Apply restraints in a way that allows for airway, breathing, and circulation assessment.
5. Never restrain a patient in a prone position or use equipment that forms a “sandwich” around the patient.
6. When possible, have a minimum of four (4) trained personnel coordinate the restraint effort and consider involving parents if patient is a child.
7. Secure the patient so that major sets of muscle groups cannot be used together, restraining the lower extremities to the stretcher first around the ankles and across the thighs with soft restraints and stretcher straps.
8. Restrain the patient’s torso and upper extremities with one arm up and one arm down with soft restraints and stretcher straps; do not impair circulation.
9. Consider cervical-spine immobilization to minimize violent head/body movements. Pad under patient’s head to prevent self-harm.
10. Secure backboard or scoop stretcher (if used) to ambulance stretcher.
11. Transport OB patients in a semi-reclining or left lateral position.
12. Monitor/record vital signs every 5 minutes, ensuring patient’s airway remains clear.
13. Consider placing a non-rebreather mask (use only at 15 lpm) or a face mask (NOT a P100/N95) on the spitting patient’s face.
14. Unless necessary for patient treatment, do not remove restraints until care is transferred at the receiving facility or condition has changes to necessitate removal.
15. Notify receiving facility and tell them that patient is restrained.
Documentation
Documentation should describe the reason for the restraint, time of application, types of restraints used, patient position, neurovascular evaluation of extremities, issues encountered during transport, other treatment rendered, and police and/or other agencies that assisted.