Procedure 25 - Restraints: Physical & Chemical

What clinical indication warrants physical or chemical restraint?

Any patient who may harm themselves or others.

How should physical or chemical restraint be considered?

As a "last resort" option.

Is verbal altercation alone an indication for restraint?

No, verbal altercation in itself is not an indication for any restraint procedures.

What may be an acceptable indication for restraint?

An immediate physical threat or attempt of harm to self or others.

What assistance should be requested before restraining a patient?

Law enforcement assistance.

What must be ensured before physically restraining a patient?

That sufficient personnel are available to physically restrain the patient safely.

In what positions should a patient be restrained?

Lateral or supine position.

What equipment should not be placed on top of a restrained patient?

Devices such as backboards, splints, or other equipment.

In what position should a patient never be restrained?

The prone position.

Who must provide constant observation and care for a restrained patient?

A paramedic, at all times.

What monitoring is included in constant observation of a restrained patient?

Direct visualization of the patient as well as cardiac and pulse oximetry monitoring.

How often must circulation be assessed on restrained extremities?

At least every 15 minutes and upon emergency department arrival.

When should the first circulation assessment occur after placing restraints?

Soon after placement of the restraints, as possible.

What should circulation assessment documentation include for restrained extremities?

Skin color, temperature, distal pulse quality, and capillary refill (if applicable for patient's age).

What should PCR documentation include regarding restraint use?

The reason for the use of restraints, the type of restraint(s) used, and the time the restraint(s) were placed.

When should chemical restraints generally be used?

Whenever physical restraints have been applied.

Why should chemical restraints be considered for a patient fighting physical restraints?

To prevent the patient from any harm while physically fighting against the restraints.

When should chemical restraints be administered?

Early, to prevent patient injury.

What is required if a patient is restrained by law enforcement with devices EMS cannot remove?

A law enforcement officer must accompany the patient to the hospital in the transporting EMS vehicle.

What provider levels can perform physical/chemical restraint per CFD protocol?

EMT-A, EMT-B, and EMT-P.