II. Indications

  1. Dangerous and uncontrolled Violent Behavior

III. General

  1. Never use for convenience
  2. Never restrain in prone position (case reports of asphyxia)
  3. Never place weight on patient's back while prone
  4. Run like a Resuscitation code
  5. Command cooperation
    1. Explain to the patient the need for restraints
  6. Document justification and frequent Vital Signs

IV. Technique

  1. Remove jewelry, ties, weapons
  2. Patient should be positioned supine (not prone)
  3. May place oxygen mask over the patient's face to prevent spitting
  4. Apply by at least 5 assistants
    1. One assistant to secure patient's head
    2. One assistant per limb
      1. Tie each leg to the opposite side of the gurney (if not disallowed by facility policy)
  5. Restraint materials: Five point restraints
    1. Leather restraints are usually necessary
    2. Soft restraints may be adequate for elderly
    3. Figure-of-four arm lock may allow IV placement or IM Chemical Restraint injection
  6. Patient stays in seclusion room while restrained

V. Management: Monitoring

  1. Physical Restraints require 1:1 observation (staff is with them 100% of the time)
  2. Medical provider must order the Physical Restraints and must see the patient within 1 hour of order
    1. Physical Restraints may not be ordered as needed
  3. Reevaluation by provider
    1. Children <9 years: Every 1 hour
    2. Children 9-18 years: Every 2 hours
    3. Adults: Every 4 hours

VI. Precautions

  1. Physical Restraints are a bridge to other management (typically transient use for 30-60 minutes)
  2. Typically used to obtain IM access to deliver sedative (e.g. Ketamine, Benzodiazepines, Haloperidol, Olanzapine)
  3. Prolonged use of Physical Restraints risks life threatening complications for the patient (e.g. Rhabdomyolysis)
  4. Remove the Physical Restraints once sedation or other effective measures are implemented
  5. Deaths have occurred in physically restrained children
  6. Do not partially restrain
    1. Risk of patient still getting out of bed, falling or Choking

VII. Complications: Patient

VIII. Complications: Staff

  1. Eye Injury
  2. Musculoskeletal Injury (strains and sprains)
  3. Scratches
  4. Needlestick Injury
  5. Blody Fluid Exposure

IX. References

  1. Mason, Mallon and Colwell in Herbert (2018) EM:Rap 18(10): 11-2

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Physical Restraint (procedure) (C0035260)

Definition (MSH) Use of a device for the purpose of controlling movement of all or part of the body. Splinting and casting are FRACTURE FIXATION.
Definition (PSY) Use of any physical means to restrict the movement of a client or subject, human or animal.
Definition (NIC) Application, monitoring, and removal of mechanical restraining devices or manual restraints which are used to limit physical mobility of patient
Concepts Therapeutic or Preventive Procedure (T061)
MSH D012149
SnomedCT 386423001
English Physical Restraint, Physical Restraints, Restraint, Physical, Restraints, Physical, Physical Restraint (procedure), physical restraint, restraints physical, physical restraints (treatment), physical restraints, Physical restraint (procedure), Physical restraint, Immobilization, Physical, Physical Immobilization, Restraint (Physical)
Swedish Tvång, fysiskt
Czech omezení fyzické
Finnish Liikkuvuuden rajoittaminen
Russian FIZICHESKIKH DVIZHENII OGRANICHENIE, ФИЗИЧЕСКИХ ДВИЖЕНИЙ ОГРАНИЧЕНИЕ
French Immobilisation physique, Contention physique, Contrainte physique
Italian Contenzione fisica, Immobilizzazione fisica
Polish Przytrzymanie, Unieruchomienie fizyczne, Przymus fizyczny, Przymus bezpośredni
Japanese 身体抑制, 拘束-肉体的, 束縛-肉体的, 肉体的束縛, 抑制-身体, 抑制法-肉体的, 肉体的抑制法, 肉体的拘束, 身体拘束
Croatian FIZIČKO SPUTAVANJE
Norwegian Fysisk restraint, Fysisk tvang, Tvangstrøye, Fysiske tvangsmidler
Spanish restricción física (procedimiento), restricción física, Restricción Física
German Fixierung (Psychiatrie), Körperliche Zwangsmaßnahme, Zwangsmaßnahme, körperliche
Dutch Beperking, fysische, Fysische beperking
Portuguese Restrição Física

Ontology: Patient restraint (C1095960)

Concepts Therapeutic or Preventive Procedure (T061)
Italian Contenimento del paziente
Japanese 患者拘束, カンジャコウソク
Czech Nucený pobyt pacienta
English patients restraints, patient restraints, restraint patient, patient restraint, Patient restraint, Restraint of patients
Hungarian Beteg korlátozása
French Patient soumis à une contention
Portuguese Restrição dos movimentos do doente
Spanish Restricciones al paciente
Dutch dwangmiddel voor de patiënt
German Einen Patienten unter Gewahrsam stellen