Restraint Dos and Don’ts
Jails across the country are seeing increased scrutiny on restraint policies and practice. Just this month, a state Office of Ombudsman recommended changes to the Administrative Code to address statewide misuse of restraint devices.
Inappropriate restraint practices have been linked to numerous deaths of detainees.¹ Appropriate restraint policies are not enough. Medical and custody staff should receive training on restraint techniques and monitoring to prevent adverse outcomes.
Do not assume “if they can speak, they can breathe”
“If you can speak, you can breathe,” is a common misconception. While rapid and shallow breathing may be observed in a restrained individual, this is not the same as deep breathing.
Imagine you’ve just run two miles. At the end of the run, you feel out of breath, your breathing is heavy, and your chest noticeably rises and falls. Now, imagine you are only able to take shallow breaths. You’ll likely feel lightheaded from the lack of oxygen.
Generally, restraint follows a prolonged physical struggle that leaves each party feeling breathless and tired.¹ Use of restraint may worsen respiratory distress and cause loss of consciousness or death. Do not assume that speaking implies breathing.
This is especially true for individuals who are restrained laying face-down. In a face-down position, an individual’s chest may not have the space to expand to take in oxygen. They may still have the ability to exhale and thus communicate “I can’t breathe,” but their ability to breathe in is limited by the space between their chest and the floor, or the person restraining them. Do not assume “if they can speak, they can breathe.”
Bizarre behavior means they’re sick
Many agencies have moved away from the use of force continuum and instead employ a least restrictive approach. This approach generally instructs jail staff to consider less restrictive alternatives (such as handcuffs or belly chains) before using more restrictive devices (like the restraint chair) and to document when more restrictive options are
used.¹ These policies may also limit the amount of time a detainee may be restrained. Click here to view a sample policy.
When a detainee begins acting bizarre or agitated, many well-meaning first responders have restrained them as a way to protect them from causing injury to themselves until they “calm down.”² However, in many cases, the time spent “calming down” exceeds the time limit outlined in the policy.²
For example, there have been situations where a detainee has ingested a baggie of methamphetamine unbeknownst to anyone, which exploded in their stomach and lead to extreme behaviors. While the detainee was placed in restraints to “calm down,” they overdosed and died before anyone knew what was wrong.
A change in mental status or consciousness should be an indication to stop restraint, not increase it. The goal of restraint for individuals experiencing a medical or mental health crisis should be to get them to the emergency room. If restraint is appropriate to transport a detainee to the hospital, the least restrictive alternative should be used.
Restraint should not be punitive. Limit the amount of time a detainee is restrained and use the least restrictive approach to maintain safety and security. Bizarre behavior means they’re sick and should be sent to the hospital. When in doubt, send them out!®
Do not use leg restraints on pregnant detainees
If a pregnant detainee must be restrained, the least restrictive method should be used to decrease the chance of falls or injury. For example, handcuff the detainee with their arms in the front instead of behind. As a general rule, some restraints to avoid with pregnant detainees are…
Leg and ankle restraints
Wrist restraints behind the back
Four-point restraints
Placing a pregnant detainee face-down
Do not use leg restraints on pregnant detainees.
For more information, please contact training@sparktraining.us.
1. Bivens, M. et al. (2024). Handcuffs and Unexpected Deaths – “I Can’t Breathe as a Medical Emergency,”. New England Journal of Medicine. https://doi.org/10.1056/NEJMp2407162.
2. Granwehr, B. (2024). Sitting in Place: A Re-Examination of Restraint Device Use and Regulations for Iowa’s County Jails, Iowa Office of Ombudsman. https://ombudsman.iowa.gov/browse/files/7c43c51eeccf49ed89c992b29d875edb/download
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®