Eliminate Unnecessary Restraints:

Nine Steps to Establishing a Restraint Timeline

Any organization that authorizes restraints, and anyone who might have to restrain, should always have a plan before the restraint ever happens. Circumstances may force you to deviate from the plan, but if you know what you are trying to do, and where you are trying to go, you are far more likely to get there. These 9 steps, applied in order, can really help you reduce restraints, make each restraint safer, and learn from each restraint to make the next one both less likely and safer.

1. Always make it Safer. This is the paramount principle that governs the next eight steps. Is what you are about to do safer than what is already happening now? Is it safer – physically and emotionally – for everyone involved?
2. Make the Decision. This should always be the first step – and should be done with at least 2 people. Making the decision early helps you calmly look at your options – like calling for help – before you are in a crisis; having two people confer makes it more likely we are making a good decision. You probably won’t both be mad, stupid or overcome at the same time.
3. Implement Delaying Strategies. After you have made the decision to restrain, now is the time to try to NOT restrain. Delay, de-escalate, defuse, distract – anything you can think of that is safer than what is going on right now will probably be a good idea. If nothing else, this will slow down the action until help arrives. We recommend trying at least three things to try to calm the situation before the next step. Delaying strategies give you time (which is always on your side), and if you are lucky, you delay and delay until a restraint is never needed.
4. Get your Team in Place. Your delaying strategies should have given you time to assemble your team. You should never restrain alone if at all possible. The team should be ready to assist in either restraint avoidance or restraint; for example, having extra people may help the aggressor apply his own self-control.
5. Restrain. Assuming the worst, and a restraint is still the only way to make the situation safer, apply the approved restraint protocol (see Staying Inside the Box and Restraint Evaluation Criteria for some additional thoughts on this process).
6. Monitor the A.B.C.s. From the instant that you begin restraining someone, you should be monitoring their body, looking for pain, injury, and self-maintenance capacity, especially the airway, breathing and circulation. It is our strong recommendation that all employees who restrain be currently CPR-certified, and we also strongly recommend that an uninvolved observer monitor the physical well-being of the person being restrained. If there is injury or distress, you must have a plan to immediately release and treat the person being restrained without endangering others.
7. Release A.S.A.P. As soon as you have gained control, your goal is to release the person – but you may not be able to just let go, because he may re-explode into the environment. You need to test his ability to self-regulate; if he can, you can release a little bit, and then test again. If your focus is on safely ending the restraint as quickly as possible, it will reduce restraint times drastically.
8. Perform a Quick Check. As soon as you have carefully and considerately released the person, now do a quick check to ensure everyone, including the aggressor, is uninjured. If someone is injured, get the necessary medical assistance immediately. Also check emotional safety, ensuring that the people who were involved in the restraint only work with that person again if emotions on both sides allow it.
9. Hold a Post-Incident Review. You should have a process in place; you just have to make sure it happens – and soon. We recommend that you ensure that the Post-Incident Review focuses only on the solutions: What went well? What can we do better next time? Involve the person who was restrained – he may have the best insight of all. Document these findings and apply the lessons to the next restraint that you do – or avoid!