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CHAIR D-236 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR EFFECTIVE DATE: 12-25-94 REVISED: 10-01-96,07-01-99,03-09-00,09-01-00 03-01-04, 11-02-16, 10-05-17 AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff T. Gattie REFERENCE: Title 15, Sections 1029, 1058, 1058.5, and 1083; Title 9, Section 784.37; Penal Code Sections 147, 1497 2652.57 3407 and 6030; Fresno County Sheriffs Office Jail Division Policies and Procedures Sections D-215 and D-230; Fresno County Sheriff's Office Policy and Procedure Section 300; and Hall, et al. v. County of Fresno, E.D. Cal. No. 1-11-CV-02047-LJO-BAM (2015). PURPOSE: The purpose of this policy is to establish a standard of use, procedure and operation forthe Pro-Straint restraint chair to safely secure violent or self-destructive inmates who pose an immediate threat to themselves or others in a humane and lawful manner. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division that the Pro-Straint restraintchair may be used by correctional staff to provide safe containment of an inmate exhibiting violent or self-destructive behavior and to prevent immediate injury to themselves or to others and only when it appears that less restrictive alternatives would be ineffective in controlling the violent or self-destructive behavior. It is the policy of the Fresno County Sheriffs Office Jail Division that the Pro-Straint restraint chair may be used in a preemptive maneuver to restrain inmates who have a high violence potential or who are high security risks during movement. PROCEDURES: I. DEFINITIONS A. RESTRAINT DEVICE - Equipment utilized to restrict the movement of an inmate. This includes handcuffs, leg shackles, soft restraints and any device which immobilizes an inmate's extremities and/or prevents the inmate from being ambulatory. Page 1 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR B. PRO-STRAINT RESTRAINT CHAR- Is a specifically manufactured metal and ABS plastic chair. It is equipped with buckles and retracting straps capable of securing a person to the chair in such a fashion as to limit their ability to move. Each Pro-Straint restraint chair has also been equipped with a wheeled transport carriage for movement from one point to another after the inmate has been secured into the chair. II. USE OF PRO-STRAINT RESTRAINT CHAIR A. Inmates shall only be placed into the Pro-Straint restraint chair under the following conditions and with the prior approval of the Watch Commander- 1. To provide safe containment of an inmate exhibiting violent or self- destructive behavior and to prevent immediate injury to themselves or to others. NOTE: When the behavior involves head banging, the use of the restraint chair is preferable to placement in a safety cell. 2. Restraints may be used on inmates who display behavior which results in the destruction of property. However, the restraint chair should be utilized only when it appears that less restrictive alternatives would be ineffective in controlling the disordered behavior. Response should be implemented, as appropriate, in the following order of consideration: a. Remove the property that is being destroyed. b. Place the inmate in a safety cell where there is no property to destroy. c. Place the inmate in a restraint chair. 3. Inmates who are extremely combative and where a cell extraction team has been used to restrain the inmate. The restraint chair may be used to transport the inmate out of the affected area to another location within the facility. 4. When an inmate poses a high risk to jail safety and security, the restraint chair may be used in a preemptive maneuver (e.g., to restrain inmates who have a high violence potential or who are high security risks) during movement. The Watch Commander shall consult with mental health staff unless exigent circumstances exist (which shall consequently be delineated in the incident report). B. The restraint chair shall not be used for "attitude adjustment," Page 2 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR punishment, as a substitute for treatment, for medical purposes,or during any medical procedure. C. Medical staff shall not participate in decisions to initiate use of the restraint chair. D. Inmates known to be pregnant shall not be placed into the restraint chair. E. Prior to placement, the Watch Commander shall confirm that there are no medical ALERT's that may prohibit the inmate from placement into the restraint chair. III. PRO-STRAINT RESTRAINT CHAIR PRE-RESTRAINTS Unless the inmate is cooperative, restrain the inmate with shackles and handcuffs or waist chains prior to placing them in the Pro-Straint restraint chair. If using a waist chain, secure the waist chain lock in front. Ensure that the optional back support is in place on the restraint chair and place the inmate in the restraint chair using approved control techniques and reasonable force, if necessary. IV. PLACEMENT INTO THE PRO-STRAINT RESTRAINT CHAIR A. A Sergeant and a minimum of three officers shall be present and assist with the placement of an inmate into the Pro-Straint restraint chair. An additional designated officer shall be responsible to videorecord the incident. (Refer to Policy D-215/Recording Planned Emergency Responses [FILE: VIDEO RECORDINGS].) B. Stabilize the restraint chair by disengaging the wheels (refer to Section VI I). C. Whenever possible, inmates will be clothed when placed in the restraint chair. If this is not possible, a safety cell garment or jail-issued sheet or blanket shall be utilized to cover the inmate. D. The restraint chair shall be kept away from walls and other obstructions. The inmate does have some freedom to move their head and may be capable of butting into a nearby wall or other obstruction resulting in self- injury. E. The inmate shall be backed up to the restraint chair with one officer on Page 3 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR either side. The inmate shall be directed to step onto the diamond-plated base of the restraint chair. The third officer shall stand in front of the inmate and step on the shackle chain to hold the inmate's feet down and reduce the likelihood of injury to staff from kicks by the inmate. F. The two officers on each side of the inmate shall assist the inmate into the restraint chair. Help support the inmate, usually by the elbows and shoulders, and lower the inmate into the restraint chair by having the inmate sit down. Once seated, strap the inmate in using the securing procedure. G. Maintain officer safety. Be cognizant of attempts by the inmate to head butt, spit upon, bite, or kick staff. 1. When an inmate is seated in the restraint chair, the potential for staff being successfully kicked by the inmate is greater because of the degree of slant in the restraint chair. The slant is purposefully placed in the restraint chair so that it is easier to seat an inmate and it is more difficult for the inmate to rise up and out of the chair. 2. If the inmate engages in spitting or biting behavior (or signals an intention to spit), a spit hood may be utilized. The transparent mesh hood prohibits spitting while allowing the inmate to breathe freely. The hood is slid over the inmate's head and held in place by an elastic band which does not restrict the inmate's airway. a. If not present, the supervising Sergeant shall be notified immediately. b. The use of the spit hood shall be documented in the incident report. c. The spit hood will be discontinued immediately if the inmate displays signs of possible airway compromise, such as respiratory distress, vomiting, or loss of consciousness. d. The spit hood shall be removed as soon as the inmate ceases spitting or biting behaviors. e. The spit hood shall be disposed of in a biohazard waste container. f. If a spit hood is not readily available, a medical mask may be Page 4 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR placed over the inmate's mouth and nose. The chin portion of the mask shall be cut out to prevent the inmate from aspirating vomitus or saliva. Use of a medical mask is subject to the same requirements as the spit hood. V. SECURING PROCEDURE The following procedure is provided as a guideline for securing an inmate into the Pro-Straint restraint chair. Although the procedure depicts securing the chest straps prior to restraining the hands, the procedures may be performed in any order as deemed appropriate for each situation. A. Completely loosen all straps prior to placing the inmate into the restraint chair. B. Pull the cross-chest straps completely out (similar to a retractable seatbelt). Secure the two cross-chest straps across the inmate's chest (upper right to lower left and upper left to lower right; the D-ring and buckle are color-coded to ensure proper application). The straps should go across the upper biceps portion of the arms and not across the top portion of the shoulders. Improper placement across the top portion of the shoulder could restrict blood flow and cause injury. 1. When securing the cross-chest straps, control the inmate's head so that the inmate is unable to head butt or bite an officer. Pass the strap to the officer on the other side, rather than bend over or reach in front of the inmate. 2. Pull the straps tight by pulling on the D-ring retractor handle. Ensure the straps are snug (approximately one finger width from the body). Loose straps could result in an inmate tipping over or freeing themselves. 3. The D-ring retractor handle must be pulled straight back from its retainer to make the cinching mechanism function properly. Do not jerk the handle outward as it may cause damage to the retainer. 4. When completed, return the D-ring handle to its retainer. Page 5 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR C. Secure the hands. The Pro-Straint restraint chair is equipped with Trilock Handcuffs. These handcuffs are made of molded plastic with blue autoclavable liners (able to be removed and sterilized). 1. If the inmate's hands are not secured, attach one of the restraint chair's handcuffs to the inmate's wrist. Duplicate the process for the other wrist. 2. If the inmate is handcuffed or in a waist chain, the restraints must be exchanged. Utilize approved control techniques to safely control the inmate during the exchange. 3. Double lock the handcuffs to prevent further tightening. Do not cut off circulation to the hand. D. Tighten the chest straps so that the straps are snug (approximately one finger width from the body). E. Secure the waist strap. Ensure the strap is snug by pulling on the D-ring retractor handle. The tightness of the strap should be the equivalent to the tightness of a seatbelt in a vehicle. Secure the D-ring back into its retainer. F. Secure the legs. 1. Extend the long straps located at the base of the restraint chair (on the back side). 2. Pull the restraints apart so that the restraints are in the shape of a "Y". 3. Place the padded soft portion of the leg restraint behind the calf so the pad is against the inmate's leg and the velcro end is pointed to the outside. a. Firmly wrap the velcro portion around the leg. b. Wrap the strap portion of the restraint around the velcro surrounding the leg and thread the strap through the two D-rings. Thread the strap back over the first D-ring and under the second D-ring and draw back until snug. c. The long straps (located on the back side of the base of the restraint chair) shall be drawn tight so that the legs are pinned snugly against the restraint chair. Tie off the loose ends so that they don't drag on the floor when the restraint chair is moved. Page 6 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR 4. Secure the padded restraint band across the legs. Place the metal tip into the buckle and cinch until snug. Secure the second smaller restraint band between the inmate's legs, around the outside of the padded leg restraint band and through the D-rings at the top of the leg restraint. Ensure the strap is snug. G. Once secured, transport the inmate to the desired isolated holding cell. Inmates in restraints shall not be placed into a cell with other inmates. VI. MEDICAL ASSESSMENT A. The on-duty charge nurse shall be notified at the time of initial placement and a medical opinion on placement and retention shall be secured as soon as possible, but no later than one hour from the time of placement. 1. A registered nurse (RN) or LVN under the supervision of an RN shall complete a medical assessment and document vital signs, mental status, sensation of limbs and check for injuries incurred during the restraining application within the first hour of placement, and by medical staff at least every sixty (60) minutes thereafter. 2. Medical staff shall check all restraint belts and hard restraints to ensure the inmate has proper circulation. Restraints may need to be loosened to ensure adequate blood flow. B. A mental health consultation shall be secured as soon as possible, but no later than one hour after placement to assess the need for mental health treatment. If the inmate has attempted or expressed imminent suicide, that information shall be conveyed to the charge nurse to ensure that mental health staff is contacted immediately. VI I. USE OF THE TRANSPORT CARRIAGE A. The Pro-Straint restraint chair has a transport carriage which can be separated from the restraint chair. It is attached to the Pro-Straint restraint chair with two screws, located just above the base of the side legs of the restraint chair. B. To engage the wheels, step down on the upper lever bar of the compound lever mechanism. Press the lever down until the hook latches. C. To disengage the wheels, press the edge of the locking mechanism with Page 7 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR the toes and let the lever up slowly. Do not disengage the hook with a finger, as the lever can fly up and pinch the fingers between the lever and the seat of the restraint chair. D. The inmate shall not be left unattended when the carriage wheels are engaged. Set the restraint chair down in the disengaged position. E. The carriage and restraint chair should be stable in themselves. However, if the inmate is extremely violent it may be advisable to remove the screws that attach the chair to the carriage. Vill. STAFF MEMBER RESPONSIBILITY A. Direct visual observation shall be conducted at least twice every thirty (30) minutes after the time of initial placement to ensure that the restraints are properly employed, and to ensure the safety and well-being of the inmate. B. At the time of the first check, the inmate shall be offered a drink of water. A styrofoam cup may be used for this purpose. Staff shall provide proper hydration as safely as possible during the duration of restraint chair placement. C. Staff shall monitor restrained inmates and immediately remove the restraints and notify medical staff if the inmate displays any of the following symptoms- 1. Difficulty breathing/shortness of breath 2. Unconsciousness 3. Vomiting 4. Choking 5. Seizing 6. Discoloration 7. Swelling of extremities 8. Complaining of numbness D. At no time shall any restraint device be utilized in such a way as to Page 8 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR intentionally inflict pain or punishment, or be used as a substitute for treatment. Any playful or careless use may result in disciplinary action. E. At no time shall a restraint device be placed around the head or neck of an inmate for any purpose. F. In the event of an emergency evacuation, a designated staff member shall be responsible to ensure that any occupied restraint chairs are transported from the affected area. G. Cardiopulmonary resuscitation equipment is available in the nurse's booking station and in both the Main Jail and South Annex Jail's 2nd floor medical stations. Resuscitation masks are located in each security station near the protective apparel and are provided for use in emergency mouth-to-mouth resuscitations. IX. RANGE OF MOTION EXERCISE AND TEMPORARY MOBILITY A. Staff shall allow the inmate to exercise their extremities in range of motion exercises for a minimum often (10) minutes (total) every two (2) hours. 1. Extend the long straps on the leg restraints to their full length (one at a time). 2. Uncuff the handcuffs (one at a time). B. Proper nutrition and toileting shall be provided as safely as possible during the duration of the restraint chair placement. The inmate shall be provided with temporary mobility under the following circumstances- 1. Upon request of the inmate, they shall be given the opportunity to eliminate body waste with an appropriate reduction of restraints. If the actions or behavior of the inmate poses a threat to their safety or that of others, then the opportunity may be denied until it is determined by a Watch Commander to be safe to do so. 2. The inmate shall be offered the opportunity to eat meals at the proper times. The food will be provided via paper bag (e.g., sack lunch) or served on a styrofoam tray. a. The inmate shall be given the means to disinfect their hand(s) before the meal (e.g., antimicrobial towelette). Page 9 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR b. Appropriate finger foods may be substituted if eating utensils are withheld for safety reasons. c. If the actions or behavior of the inmate poses a threat to their safety or that of others, then the opportunity may be denied until it is determined by a Watch Commander to be safe to do so. C. Sufficient staff shall be present to safely control the inmate anytime restraints are removed, as determined by the Sergeant. X. DOCUMENTATION UPON PLACEMENT A. An incident report shall be completed by the officer who initiated the placement of an inmate into the Pro-Straint restraint chair. This report shall include, but not be limited to the following- 1. Reason for the placement into the restraint chair (detailing the location, behavior and/or circumstances). 2. Names and titles of staff members involved, including medical and mental health staff. 3. Name of the Watch Commander who approved the placement. B. If the restraint chair is being used at the direction of the Watch Commander for preemptive movement, a report shall be written for each use. C. The Booking I Officer shall ensure the inmate's transfer into the"Restraint Chair" and appropriate cell has been recorded into the OffenderTrak system. D. Staff shall document the initial placement into the restraint chair via the Safety Check System. The inmate's JID number shall be entered into the appropriate field. The JID number shall also be entered during the following transactions: 1. The first entry of each shift 2. Transfer into a different cell 3. Removal Page 10 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR All subsequent and remaining transactions shall not require input of the JID number. E. The following information shall be written on the dry-erase board posted outside of the cell in which the inmate is placed, as well as on the notification boards posted inside the Booking Office and at the 1st Floor Station: 1. Inmate's name 2. Inmate's JID number 3. Reason for placement 4. Any additional security precautions (e.g., "yellow suiter,""spitter,"etc.) 5. The 2-hour projected time for the range of motion exercises 6. The 4-hour projected time for removal F. A designated Population Management Officer will make a notation of the placement onto the inmate's Class Comment log in OffenderTrak. The involved Sergeant shall ensure the Population Management Unit is notified of the inmate's placement into the restraint chair. XI. DOCUMENTED CHECKS A. The inmate shall be visually checked and the check documented via the Safety Check System twice every thirty (30) minutes. If more than one action is performed, an additional entry will need to be entered. The documentation of such shall be maintained and monitored by the 1st Floor Officer, with the assistance of available staff. B. The following list of items shall be checked and documented to ensure that the inmate receives humane treatment and is afforded basic human necessities. In addition to the initial placement and removal events, the following notations will be entered on every occasion when applicable: 1. Anytime restraints are checked, reduced, or removed, or when extremities are exercised in a range of motion exercises. 2. Any provisions for hydration, nutrition, or toileting needs. 3. To document medical and mental health evaluations. Page 11 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR 4. To document supervisor checks. C. Inmates must have a documented review for continued retention in the restraint chair a minimum of once every hour. 1. The Sergeant shall be responsible to assess the inmate's continued retention in the restraint chair, and to relay their recommendation to the Watch Commander. The specific determination to continue an inmate in the restraint chair is the responsibility of the Watch Commander. 2. The Sergeant shall ensure that the review is documented in the Safety Check System. XII. PRO-STRAINT RESTRAINT CHAIR REMOVAL A. Inmates should be kept in restraints for the least amount of time necessary to handle each particular situation. The inmate shall be released from the restraints as soon as they no longer display a current threat to themselves or others. 1. Each time an officer checks the inmate, they shall determine if the inmate's behavior is such that the inmate can be removed from the restraints. 2. If an officer believes an inmate is capable of being released from restraints, they shall contact the Sergeant who shall evaluate the inmate for release. 3. The on-duty charge nurse shall be notified and a mental health consultation shall be secured prior to the inmate's removal from the restraint chair. B. No inmate shall remain in the restraint chair longer than four (4) continuous hours. C. An inmate may be removed from the restraint chair only under the direction of a Sergeant (or higher authority). D. The chest and waist strap buckles may be released using a standard Page 12 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR handcuff key or ink pen. Insert the key or pen into the hole on the buckle assembly. This will release the tip assembly. The leg restraint can be released by pressing on the buckle release on the back of the buckle assembly (like a standard car seatbelt buckle). All buckles and straps on the restraint chair shall be returned to the "ready" position. E. Medical staff shall check the inmate for injuries following their removal from the restraint chair within one (1) hour of removal. F. If necessary, a designated Population Management Officer shall initiate a HOUSING ALLOCATION movement to a new housing location. G. The Booking I Officer shall ensure the following is completed: 1. A wristband shall be placed on the inmate, if necessary. 2. The inmate's location is updated in OffenderTrak as appropriate(e.g., removed from "Restraint Chair," redesignated as "In Transit," or transferred into a safety cell). H. A supplemental incident report shall be completed by the Sergeant documenting the removal of the inmate from the Pro-Straint restraint chair. This report shall include, but not be limited to the following- 1. Reason for the removal from the restraint chair(detailing the location, behavior and/or circumstances). 2. The time the inmate was removed from the chair, along with the time that the range of motion exercises were performed. 3. Staff members involved, including medical and mental health staff. 4. Watch Commander who approved the removal. 5. New housing assignment, if applicable. XIII. TRAINING REQUIREMENTS Staff shall attend a two (2) hour instructional course specific to the Pro-Straint restraint chair and its securing procedures prior to their participation as a member of a Pro-Straint restraint chair team. Only officers trained in the use of the Pro-Straint restraint chair shall place an inmate into the Pro-Straint restraint chair. XIV. CLEANING Page 13 of 14 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: PRO-STRAINT RESTRAINT CHAIR NO: D-236 FILE: CHAIR A. Clean the belt webbing only with a mild soap solution recommended for cleaning upholstery or carpets. Follow the instructions provided with the soap. B. The plastic seat can be shined using a plastic protectant (e.g., Pledge or Armor All). C. When an inmate worker is assigned to clean the Pro-Straint restraint chair, officers shall follow-up to ensure that the chair is clean and ready for its next use. XV. STORAGE LOCATIONS A. There are five (5) Pro-Straint restraint chairs available for use. The restraint chairs are stored in the following locations: 1. Main Jail 1st floor Booking hallway (3) 2. South Annex Jail 2nd floor - in the storage room inside the infirmary hallway (1) 3. North Annex Jail Basement - in the expansion tunnel across from the Basement security station (1) B. The chairs shall be cleaned and returned to their proper location after use. XVI. REPAIR The Pro-Straint restraint chair should be virtually indestructible. However, should damage or malfunctioning develop, the following shall be completed: A. Notify the facility Sergeant. B. Notify the Services Unit (refer to Jail Division Policies and Procedures Section F-210/Maintenance Reporting and Repairs [FILE: MAINTENANCE REPAIRS].) C. Ensure that the damaged or malfunctioning Pro-Straint restraint chair is clearly marked "out of order." D. Write a report documenting the occurrence. Page 14 of 14