The technique being demonstrated in the picture accompanying this post is promoted as a way for controlling violent patients in a hospital setting.  Unfortunately, it is potentially a deadly restraint and its use might go far beyond control and extend to culpable homicide or corporate manslaughter!

Restraint training has moved on a lot in many areas since its early days, however unfortunately we have had to learn many lessons along the way – a path paved with the tragic remains of those who succumbed to the fragile techniques and deadly restraint procedures we felt our way through as we made our way towards the light.   Even now, controversy exists about what constitutes safe restraint techniques – and even whether such things exist.

Mortui Vivos Docent – “the dead teach the living” – so let’s learn from tragic circumstances and deadly restraint and try to improve what we can.

The team here are assembled and have each taken a specific role in the restraint intervention – which is to be commended.  However, there are issues!

1:  Prone restraint has been the subject of many controversies and continues to divide opinion.   However, even those who promote its use and who use it perhaps hundreds of time per year in their services will admit that it is best to keep the full weight of your body off the subject’s torso.   Sitting on, lying on, pressing down with your hands, putting your knee on or in any other way applying your mass through the subject’s body into a solid surface (like the floor or a wall) is acknowledged as dangerous.   In the photo we can se that two staff are effectively lying backwards on top of the subject.   If he tries to get up, they can – and probably will – lean onto him to keep him secured on the floor under them, leading to a deadly restraint.

2:  In this deadly restraint position, they are unable to monitor his vital signs.    Watching out for warning signs is so important – especially in a hospital setting where it can be assumed that the subject is a medical emergency for one reason or another already!   Epilepsy, Sickle Cell Disease, Chronic Heart or Lung conditions, obesity and a number of other clinical conditions can drastically increase the risk that your subject might suddenly die on you during a restraint incident.   These, combined with the position and the weight issues could conceivably put your subject in a very physiologically compromised situation.   You need to be aware of the vital signs during the incident…but how can you do that if you are leaning on his back staring at the ceiling and/or unable to see their face!     Granted….there may be another person in the room or off-camera in our example who is advocating for the health of the subject, but nevertheless it is a critical component of a safe holding procedure and therefore one worthy of note!

More in this series of brief training tips on restraint techniques (and deadly restraint techniques) to avoid as we continue in our next post!

Until then, go safely,

Gerard O’Dea, Director of Training,

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