Standing Restraint vs. Prone or Supine

Standing Restraint vs. Prone Restraint

The argument for standing vs. prone restraint when discussing crisis prevention training has been one that has been around for quite some time.  There have been many arguments for both, though I want to examine some of them here;

Prone Restraint

Most physical altercations end up on the ground.  Skilled fighters will often try to take their opponent to the ground in efforts to contain them and/or restrict their ability to return strikes or blows.  Larger opponents can enjoy the benefits of weight dominance and lessen the likelihood that their opponent will try to run away, or gain distance by taking them to the ground.  Once on the ground, the risk of falling to the ground is removed, therefore usually reducing chance of injury once responders employ a restraint hold.  Commonly these are the reasons (ability to restrict movement, gross tonnage, risk of falling, etc) that are commonly used in arguments regarding why using a prone restraint is desired.

At CCG we do not endorse the use of prone restraint techniques for the following reasons.  First and foremost, statistically the majority of injuries occur when forcing someone from a standing position to the ground.  Therefore knowing that injuries during restraints are more likely to occur from the actual “restraining” then getting hit, or kicked, one would think that avoiding such risk would be wise.  Secondly, once an individual is forced to the ground, responders are now limited to being able to move the individual only once the aggressor has de-escalated completely.  Have you ever seen or participated in an intervention when someone tries to move the aggressor from the prone restraint position and the aggressor is unwilling?  Not fun to say the least.  Thirdly, once on the ground, there is an incredibly strong desire by responders to “hold down” the individual to the ground, or “pin” them in place using the floor as a stopping point against an aggressor’s movement.  Once this desire kicks in, the end result is usually downward pressure on the limb, or torso of the aggressor.  All too often responder’s hands end up on the thoracic cavity (chest, lung, or lower back area; risking positional asphyxia and death) and in other cases the neck, head, shoulders, buttocks, ankles, etc.  All of these areas should be considered “off limits” during interventions, but not surprisingly, during a real crisis staff forget these rules and quickly break them, believing that the situation requires such reaction.  Combine with this the added temptation which befalls the responders to simply just place their own bodyweight on top of the individual to contain them.  Although these tactics may work in the heat of the moment, it is not the right thing to do, nor is it safe.

How do I know this happens?  How do I know this is fact?  Because for nearly 8 years in the nearly 400 documented crisis incidents I was personally involved in, myself and my coworkers had no effective alternative, and that is what we did.  We did not have any other effective technique.  Therefore, staff was injured.  Patients were injured.  I was personally injured.  Looking back, were we wrong?  If one does not have any other effective technique to use during emergencies, and acts with the best intentions and for the greater good, I would like to believe that it would be considered doing the right thing.  The reality is though, that now, there is a better way.  There is no need to forcefully place someone one the ground in order to restrain them.  Though there is no reason to do a “take down” anymore.  The prone or supine restraint position is outdated, unsafe, and unnecessary.  Our training curriculum was developed with these facts in mind.

Standing Restraint

We know that during a crisis, the “hands on” portion is not “pretty” and often does not go as “textbook” or as simply as it went in training.  Any company that insists that it will be with their “magical” techniques, isn’t worth their salt.  Using a standing restraint technique can be difficult at first to employ.  You must practice.  You must work with your coworker to improve timing and coordinated response.  The reality is though that when taught an effective, safe, and realistic standing restraint position that can be easily employed in a moments notice, risk is lowered for the following reasons.

-With an effective standing hold there is no pressure placed on the thoracic cavity

-With an effective standing hold the responders are not “forcing” the client into a specific position

-It is likely that clients will initially begin an aggressive episode in a standing position, so avoiding having to do a “take-down” eliminates the risk of injury from impact of forcing them to the ground

-It is highly likely that a sense of dignity may be maintained by the client while in an upright position, even though they are being held by responders in an effective standing hold

-While in an effective standing hold the ability to escort the client from the area is possible, and is more easily achieved, then if required to first pick up the individual from a prone or supine position which could easily cause injury to client or responders

-With an effective standing hold it is not likely that the “pig pile” or “gross tonnage” process of responders simply piling on top of a prone or supine client in attempts to physically dominate or control them, would occur

For these reasons, and a few others we fully endorse, and teach an effective, safe, and realistic standing restraint position.  We would welcome your feedback on this topic, so please send us your thoughts!

CCG

Single Person Restraint Technique Vs. Two Person (Pro’s and Con’s)

We often hear facilities ask us “Do you teach a single person restraint technique?”  Our answer is “No”.  The next question is “Why not?”  As this is a question that plagues many employees’ minds, we wanted to take a moment to discuss the reasons for, and against a single person restraint technique when considering crisis prevention training.

Pro’s

1.  Can use when you are working by yourself

2.  Do not have to depend on other staff member’s ability to assist you

3.  If there are more then one individual that needs restraining, less staff are required to intervene per aggressor.

Con’s

1.  Facilities often make the mistake of trying to do more with less.  Most employees would love an administration that would be willing to hire more staff to help out and go over the mandated ratio/staffing numbers when possible.  In reality, a higher the ratio of staff to clients most often results in higher levels of staff morale, a higher level of therapeutic intervention, and a decrease in the amount of crisis situations.  For staff members to seek out a restraint system that can be done by a single staff member they may be giving up a tool to use in improving their case for better staffing ratio’s.

Additionally, when you are by yourself and making physical contact with another individual, the end result (without video or other persons present) is your word against theirs.  Depending on what environment you work in, and with whom, there is a huge danger of false accusations, investigations, possible suspensions, and blemishes to your work history- whether founded or false.

2.  If you are working with staff that are not physically able to assist you in an emergency, (thus you would prefer not having them assist you in a restraint situation) it is an HR issue that needs to be addressed immediately.  Ignoring the problem of unprepared or physically unqualified staff will not go away.  Additionally, if you are the only one capable, or one of the few that can actually perform the technique, (and do so on a regular basis)-congratulations, you just increased your chances of being sued, increased your risk and liability, and increased your chances of a workman’s comp claim due to injuries.  In taking action during these incidents you are doing so for the benefit of the staff member that likely gets paid the same amount, if not more then you, but are unable, or unwilling to meet the requirements of the job.

3.  If you are in a situation where you have to restrain more then one individual and it is just you alone, or with one other staff member; and you are now tied up with the one person, who is watching your back?  (It is usually assumed that the other staff member would be dealing with the other individuals in the area to ensure your safety).

Imagine these realistic circumstances; you move in alone to restrain the individual as you were taught.  For some reason (as we all know, it happens) it doesn’t work just right, or you don’t have it all the way, or you forgot to practice it enough and realize too late you are in trouble.  Your efforts fail.  The aggressor now is in a fight with you to break free or worse, they now try to hurt you.  You now have a fight on your hands where you try and gain the upper hand, and/or defend yourself.  To top it off you are by yourself, remember? Your partner is across the room dealing with the other persons in the area.  Additionally, you have the difficulty of trying to save yourself without causing undue injury or using unnecessary force.

What are you left to do?  –You guessed it! Unfortunately you often resort to other options which are likely to be techniques with cause pain, hyper-extension, or worse. So in the end you don’t use the proper technique you were taught in the end, and have gone “outside” of the scope of what you were procedurally allowed to do.  Congratulations again, the risk and liability factor just skyrocketed.  If and when the individual becomes injured, you are now in a legal battle as the organization distances itself from you and what you did, and the training agency teaching the technique clearly states that you didn’t do the technique correctly, thus you went outside the scope of what they taught- thereby eliminating their liability.

Had you been at least attempting a two person restraint to begin with and it failed- your coworker is there with you to help you recover.  Their assistance simply in person may eliminate your need to go “outside” the scope of what you were trained.  They are there to also verbally relay the events as they happened for the documentation, or investigation that comes after.  They are there to protect you should the situation spiral out of control. Odds are everything in an aggressive encounter.  Odds are built on training, experience, ability to remain calm and controlled in an emergency, in addition to actual numerical odds.

Why do police call for back up?  -Because numbers are your friend.  Why do police have “bat belts” with special tools like a Tazer, baton, Pepper Spray, etc?  Because the reality is, one on one situations where a person is relying on hands and fancy techniques alone are not statistically successful, and often end up with injuries.  The number one time when officers end up in a fight, or become injured is when they go to make actual physical contact with the bad guy (usually when trying to put them into handcuffs).

Ask any cop out there who deals with extremely aggressive, or violent persons on a regular basis and they will tell you that hand-to-hand is the most dangerous.  They love to use their Tazer, Pepper Spray, or other less lethal weapons instead.  Now matter how good they are with their hands, they want the odds on their side.  Those less lethal options are “odds“.   Or, if you are willing, you can spend a minimum of 15 hours a week practicing some sort of martial art.  Often though these arts seek to overpower, throw, or strike your attacker by using combinations of pain, leverage, or hyper-extension techniques.  Additionally, most if not all of those techniques are based in safety for the victim, not the attacker.  Concern of injury to; or liability to the aggressor is very low on the totem pole.  For professionals who are not allowed to use such less-lethal tools, actual additional staff numbers are your greatest ally.

For those of you that work in a therapeutic environment, the safety of the client is most important, as the clients are there for your help, not punishment.  You are expected to be able to handle crisis situations professionally without the assistance of a “bat belt”.  Part of your job entails occasionally being confronted with verbal and/or physical abuse from those that don’t always understand the real consequences of it, and not responding in kind.  You are held to a higher standard then most.

4.  Most single person restraints require both of the responders arms and upper body to become engaged with the aggressor.  When that occurs you are now limited to stance, position, and balance, unless you move to the ground.  When moving to the ground, it is then that statistically the majority of injuries occur during restraints.

5.  Once moving to the ground you are now limited by ability to transport, and move from the area you are situated in.  Usually, you want to move to a different location to assist in de-escalation of the situation.  If you are pinned, or pinning the aggressor to the ground, such movement is limited, and the dangers of positional asphyxia can rise with any pressure placed on the thoracic cavity.

In conclusion;

Finding a single person restraint that can maintain its hold; not be based on pain, hyper-extension, pressure points, or joint-locks, while being conscious of positional asphyxia, and gender-safe related issues, is practically impossible, and we have yet to come across it in our 30+ years working in and around the industry.

Finding a two person restraint that achieves these goals and is proven effective; your search is over.  If you are a current client, we thank you for your continued use of our services.  If you are considering hiring us, please be sure to make an informed decision on which technique, curriculum, and company you choose to train your staff, many lives will be effected by the decision made.

Visit us at www.crisisconsultantgroup.com to find out more about how our curriculum and techniques are safer, more effective, and drastically improving the safety and security of more and more organizations around the globe.