Physical Restraints

4.22 Physical Restraints

A restraint is defined as any mechanism that physically restricts a person's freedom of movement, physical activity, or normal access to his/her body. Restraints should be used only as a last resort because they have the potential to produce serious consequences, such as physical and psychological harm, loss of dignity, violation of the individual's rights, and even death. Justification for the restraints must be noted in the EMS Run Report.

Restraints should be used only when attempts at pharmacological, verbal, and family intervention have been deemed ineffective and when the patient is:

  • Attempting to inflict intentional harm on self or others.
  • Attempting to inflict bodily harm on EMS personnel.

Only a commercial soft restraint system should be used.

  1. The patient should be placed supine on a long spine board (or backboard). Never place a patient in the prone position.
    • Use of a long spine board provides the flexibility to easily move the patient should he/she vomit.
    • It also provides a safe means of transfer from the stretcher to the bed.
  2. Wrap the cuff pad around each limb.
    • Do not cinch the strap tight. You should be able to insert one finger between the limb and the device.
    • Ensure that the device is properly applied per the manufacturer's instructions, as some products can constrict circulation when improperly installed.
  3. Secure one of the patient's arms on the upper part of the long spine board and the other arm on the lower part of the long spine board.
  4. Secure the patient's ankles to the lower portion of the long spine board.
  5. Secure the strap to the long spine board with a quick-release tie.
  6. Check for and correct any circulatory, respiratory, or neurological compromise caused by the restraint.
  7. Document the time when the restraint is applied.
  8. Utilize the strapping mechanisms of the long spine board to provide additional security and support for the patient with moving.
  9. Continuously monitor the patient for the following issues:
    • Tightening of the strap around the limb.
    • Changes in mental status.
    • Changes in vital signs.
    • Changes in pulse oximetry.
    • ECG changes.
    • Changes in respiratory effort (positional asphyxia).
    • Vomiting.
    • Signs of circulatory and/or neurological compromise at the site of the restraint.
  10. Immediately address any changes in patient status.
  11. Document the duration of the restraint.