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EMR
EMT
AEMT
Paramedic
Extended
Restraint Policy
Transportation of a violent or uncooperative patient may require physical or pharmacologic restraints. The top priority
during these transports is maintenance of personal safety and injury prevention of the prehospital care providers and of the
patient. Prehospital care providers should not attempt to enter or control a scene where physical violence or weapons are
potentially present. The local law enforcement agency should be contacted immediately and advised of the scenario.
Prehospital care providers may enter the scene for the provision of patient care after safety of the scene is confirmed by
law enforcement personnel.
All restrained patients should be placed on a stretcher with adequate foam padding. Extremity restraints should be secured
to the stationary portion of the stretcher frame in a fashion where they can be removed quickly in the event of an
emergency. Restraints that require a key or use multiple knots are unacceptable. Stretcher straps should be placed on all
patients as these serve as seatbelts during transport. Restraint of the extremities in a spread eagle fasion significantly
reduces the strength the patient can generate from the large muscle groups. Restraints that may restrict chest wall motion
are prohibited.
Prehospital care providers reserve the right to refuse elective transport of patients who are deemed too violent or
uncooperative to be controlled by the restraint methods and devices permitted by the Trumbull Memorial Hospital EMS
Protocols. The safety of prehospital care providers will be maintained at all times during transport. The prehospital care
provider reserves the right to request completion of transport by law enforcement personnel. The prehospital care provider
may administer an appropriate dose of Haldol and Versed as a pharmacological restraint prior to transport of the patient.
Patient must be monitored by ALS after administration of medications. A decision to refuse elective transport of a violent
or uncooperative patient may be made by any member of the prehospital care team or their supervisor. Medical direction
may be contacted at any time for advice.
There are two acceptable positions for transport of the violent or uncooperative patient. The patient may be transported in
the supine position in four or five restraints. All four extremities should be restrained to the stationary portion of the
stretcher frame. A fifth restraint may be placed around the thighs just above the knees to secure that patient to the frame of
the stretcher. A sheet or stretcher strap may be used for this purpose. Placement of the stretcher in the sitting position is
preferable as aspiration is less likely and the strength generated by flexion of the abdominal muscle groups is reduced.
More physically uncooperative patients should be restrained in the supine or lateral decubitus position. All four
extremities should be restrained to the stationary portion of the stretcher frame. The upper extremities should be
positioned with one hand below the waist and one hand above the head. Additional sheets or stretcher straps may be
placed around the lower lumbar region, below the buttocks, or around the thighs, knees, and legs to prevent flexion and
extension of the torso, hips, and legs.
Physical assessment of all restrained patients must be performed during the entire transport. The airway, respiratory and
mental status should be noted. In addition, the skin condition of the patient and the capillary refill and pulses of the
extremities distal to the restraints should be noted. Pulse oximetry should be performed continuously. The physical
assessment should be continuously performed and documented in writing on the prehospital care report. Cot straps and
extremity restraints should be adjusted as needed to permit unrestricted respirations and adequate circulation to distal
extremities.
For restraints that require a key, law enforcement must be present to adjust or remove them as needed.
Restraint Policy