Broward County Sheriff's Fire Rescue Physical Restraint Policy PDF

SHERIFF’S POLICY MANUAL 6.2 FIRE RESCUE PHYSICAL RESTRAINT POLICY: The intent of this policy is to establish procedural guidelines to be used when a patient is in need of physical and/or chemical restraint to protect the patient, other individuals, and/or our...

SHERIFF’S POLICY MANUAL 6.2 FIRE RESCUE PHYSICAL RESTRAINT POLICY: The intent of this policy is to establish procedural guidelines to be used when a patient is in need of physical and/or chemical restraint to protect the patient, other individuals, and/or our personnel from harm. A. Restraint will be defined as any mechanism that physically restricts a person's freedom of movement, physical activity, or normal access to the person's body. This “restraint” policy is specifically limited to restraints used solely for the purpose of protection from harm to the patient, other individuals and/or our employees and does not apply to medical devices or interventions that restrict bodily movement for other medical purposes." B. Use of a restraint and/or law enforcement assistance may be necessary in the following circumstances, but only after feasible, less restrictive measures including verbal, family and pharmacological interventions are deemed ineffective or unavailable: 1. Clinically justified situations 2. Patients who attempt an act that poses an immediate threat of harm to themselves or others 3 Patients who exhibit behaviors that are harmful to themselves or others, were Baker Acted, and/or who are acting out in a manner that may be dangerous to themselves or others C. Methods of Restraint: 1. Partial or Full Restraint: a. Patients will be placed supine on a long spine board or stretcher. Patients will not be placed on the stretcher in a prone position, prone with legs flexed up, in the hog-tie position, or in a hobble position. b. Fire rescue employees will continually assess and ensure that re- straints do not restrict a patient's breathing. Fire rescue employees must be aware of the potential for the development of positional asphyxia, requiring continuous airway assessment monitoring, Reviewed: 08/24/2023 Revised: 12/22/2023 Rescinds: 10/22/2012 Effective: 01/19/2024 6.2 Page 1 of 4  SHERIFF’S POLICY MANUAL assessing for airway patency, breathing pattern changes, signs of positional asphyxia, or airway aspiration. Monitoring should include continuous oxygen saturation monitoring and remain consistent to the “Joint EMS Protocols” approved through the Medical Director. c. Fire rescue employees will continually assess and ensure that restraints do not restrict a patient's circulatory status. 2. Partial Restraint: a. Straps will be secured across the waist and thighs. Straps will not be placed across the patient's chest or abdomen. b. Wrists and ankles will be secured on the same side of the stretcher frame (not the side rails) if necessary. 3. Full Restraint: a. Straps will be secured across the waist, thighs, and calves. Straps will not be placed across the patient's chest or abdomen. b. Wrists will be secured with one arm on the same side and the other above the head on the stretcher frame (not side rails). c. Ankles will be secured on the same side of the stretcher frame (not side rails). D. Types of Restraints: 1. The Posey T-A-T restraint system is the only approved device for use by fire rescue employees. 2. Manual Restraint (Physically Holding Patient): a. Physically holding a patient may be necessary when employing other methods of restraint if there is an immediate need to protect the patient or others from harm by the patient. Reviewed: 08/24/2023 Revised: 12/22/2023 Rescinds: 10/22/2012 Effective: 01/19/2024 6.2 Page 2 of 4  SHERIFF’S POLICY MANUAL b. Fire rescue employees will attempt to contact law enforcement for assistance. Law enforcement employees should be present during this procedure. c. When using manual restraint, care will be taken to avoid harm to the patient and attending employees. d. The maximum number of fire rescue and law enforcement deputies necessary will be utilized when employing manual restraint to limit the chance of harm to the patient or employees. e. Fire rescue employees will avoid utilizing any type of choke hold while attempting a restraint. f. Fire rescue employees will not place excessive weight on the patient's back, abdomen, or chest during the process of restraining the patient. g. Fire rescue employees will be aware of the potential for the development of positional asphyxia. E. Restraint by Law Enforcement Deputies: 1. Before physically restraining a person who refuses medical treatment without that person's consent, a law enforcement deputy will attempt to receive direct supervision from a physician through two-way voice communication pursuant to Florida Statutes if the situation allows. 2. Law enforcement deputies may elect to use handcuffs or flex cuffs during a restraint situation. Should this occur, the following procedure will apply: a. If practical, a backboard will be utilized when handcuffs are applied. b. Fire rescue employees will place the patient in a supine position on the backboard. c. A law enforcement deputy will accompany the restrained patient being transported to the hospital in the fire rescue vehicle. Reviewed: 08/24/2023 Revised: 12/22/2023 Rescinds: 10/22/2012 Effective: 01/19/2024 6.2 Page 3 of 4  SHERIFF’S POLICY MANUAL d. Fire rescue employees will not place a patient in a fire rescue vehicle while the patient is restrained in a prone or hog-tie position. The patient will be placed in the vehicle only after being removed from this position and properly restrained in accordance with this section. e. A fire rescue battalion chief will be dispatched to the scene immediately. F. Monitoring a Restrained Patient: 1. All patients in restraints will be monitored continuously by the following methods: a. 12 or 3 lead ECG b. Oxygen saturation with a pulse oximeter c. Blood pressure (full vital signs) d. Mental status monitoring Note: All use of monitoring methods will be properly documented. 2. Fire rescue employees will visually monitor the patient's airway at all times. 3. At least two paramedics will be required to accompany a restrained patient to the hospital. 4. Monitoring devices will remain attached to the patient until the patient is transferred to the emergency department stretcher and hospital staff. 5. If a patient's condition deteriorates, the restraints should be removed, and the patient treated in accordance with fire rescue protocols. Reviewed: 08/24/2023 Revised: 12/22/2023 Rescinds: 10/22/2012 Effective: 01/19/2024 6.2 Page 4 of 4