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WRAP RESTRAINT D-232 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT EFFECTIVE DATE: 01-24-23 REVISED: AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff S. McComas REFERENCE: California Code of Regulations, Title 9, Section 784.37 and Title 15, Sections 1029, 1058, 1058.5, and 1083; Penal Code Sections 147, 149, 3407 and 6030; 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 and maintain a procedure for the use and application of the Wrap restraint system. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division that incarcerated people shall only be placed into the Wrap restraint as described in this policy with the notification and approval of the Watch Commander. The Wrap shall only be used to control incarcerated people who display behavior which results in the destruction of property or who reveal an intent to cause physical harm to self or others. It is the policy of the Fresno County Sheriffs Office Jail Division that only trained and qualified staff members are authorized to utilize the Wrap. The Wrap shall not be used as punishment or as a substitute for treatment. When applicable, maximum time limits for placement shall coincide with the manufacturer's recommendation. It is the policy of the Fresno County Sheriffs Office Jail Division that intermittent direct visual/verbal supervision shall be provided and documented at least twice every thirty (30) minutes. PROCEDURES: I. THE WRAP RESTRAINT DEVICE The Wrap is a temporary restraining device that immobilizes the body and restricts an incarcerated person's ability to kick or do harm to themselves and others. The Wrap restrains the individual in an upright/seated position of Page 1 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT respiratory recovery, while immobilizing the incarcerated person's extremities and preventing them from being ambulatory. II. USE OF THE WRAP RESTRAINT The Wrap restraint device should be used only when less restrictive alternatives, including verbal de-escalation techniques, have been attempted and are deemed ineffective. A. The Wrap should only be considered for use in the following situations: 1. To immobilize incarcerated people who display behavior that results in the destruction of property or reveal an intent to cause physical harm to self or others. 2. In transportation of violent or combative incarcerated people. 3. To assist with the cell extraction of violent or combative incarcerated people. B. Incarcerated people shall only be placed in the Wrap with the approval of the Watch Commander. 1. In situations of an unpredictable nature, prior approval for the use of restraints may not be possible. Notify the Watch Commander immediately to inform them of the circumstances and obtain their approval. 2. If the situation is one of a predictable nature, prior Watch Commander approval shall be obtained prior to application. C. The Wrap restraint shall not be used for discipline, punishment, as a substitute for treatment, for medical purposes, or during any medical procedure. D. Medical staff shall not participate in decisions to initiate use of the Wrap restraint. E. Incarcerated people known to be pregnant shall not be placed into the Wrap restraint. Page 2 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT III. PLACEMENT INTO THE WRAP RESTRAINT A. A Sergeant and a minimum of three (3) officers shall be present and assist with the application of the Wrap. Only qualified personnel who have received training in the use of the Wrap restraint shall apply the device. (Refer to Addendum A for the Wrap application procedures.) B. Any incident resulting in an incarcerated person being placed in the Wrap will be video recorded, unless exigent circumstances prevent staff from doing so. Any preplanned use shall be video recorded. [Refer to Policy D-215/Recording Planned Emergency Responses(FILE: VIDEO RECORDINGS).] C. Whenever possible, the incarcerated person shall be clothed when placed in a Wrap restraint. If the incarcerated person has removed their clothing, every effort will be made to provide the incarcerated person with a safety garment, sheet or blanket while the incarcerated person is restrained to ensure the incarcerated person's personal dignity is maintained to the extent possible. D. A "spit hood" should be used when appropriate to prevent spitting or biting. A spit hood is located in a pouch on the Wrap harness below the "BACK" label. E. After the incarcerated person has been secured, they are to be placed in an upright sitting position or on their side as soon as possible to allow the incarcerated person to recover. Staff shall ensure the following: 1. The incarcerated person is able to lean back. 2. There is a gap between the incarcerated person's chest and the harness so the incarcerated person can breathe freely. 3. The incarcerated person is breathing sufficiently. 4. Direct visual observation is maintained until a medical opinion can be obtained. F. Place the soft safety helmet on the incarcerated person to prevent self- harm. G. While in the Wrap, incarcerated people shall be housed alone or in an area that will protect them from abuse. (Refer to Section IV for transportation options.) Page 3 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT IV. TRANSPORTATION OF AN IMMOBILIZED INCARCERATED PERSON Transportation of incarcerated people can be accomplished in one of several ways, depending on the cooperation of the incarcerated person. The incarcerated person can be carried, placed in the Wrap Cart, or allowed to walk by shuffling their feet. A. If the incarcerated person must be carried, a minimum of four (4) officers should be used. 1. Two (2) officers should be positioned on either side of the incarcerated person's upper body. The officers should lift the incarcerated person by the upper arms and support the incarcerated person's shoulders. 2. Two (2) officers should be positioned on either side of the incarcerated person's legs and lift using the handles (located on the leg restraint). 3. The officers should lift in unison using their legs (not backs) to avoid injury. B. The Wrap Cart should be used to reduce the risk of injury by eliminating the need to carry the individual. 1. The incarcerated person may be placed in the Wrap Cart by having a minimum of two (2) officers lift the incarcerated person and remain stationary while a third officer positions the cart beneath the incarcerated person. 2. The officers will then lower the incarcerated person into the cart and buckle the seat belt. The handle of the Wrap restraint ankle strap shall be secured with the carabiner located at the foot of the cart. 3. For added stability, the rear wheels have brake levers to prevent the cart from moving. The wheels should be locked anytime the cart is not in motion. C. As an alternative to lifting, the incarcerated person may be moved by means of a shuffle or hobble, but only if the incarcerated person has displayed cooperative behavior. 1. If the incarcerated person is compliant, the lower Wrap leg straps can be loosened to allow some leg movement below the knees without compromising security or safety concerns. By loosening the Page 4 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT strap from the chest to ankles, the incarcerated person can be brought to a standing position with the help of officers, then allowed to shuffle to or from a holding cell. 2. If this method is used, appropriate support must be given to the incarcerated person to prevent injury by falling. D. To transport the incarcerated person by ambulance, the Wrap shall be removed prior to departing the facility. V. MEDICAL ASSESSMENT A. The on-duty charge nurse shall be notified at the time of initial placement into restraints and a medical opinion on placement and retention of the restraints shall be secured as soon as possible, but no later than one (1) hour from the time of placement. B. 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. C. Medical staff shall check all restraint belts and hard restraints to ensure the incarcerated person has proper circulation. Restraints may need to be loosened to ensure adequate blood flow. D. A Mental Health consultation shall be secured as soon as possible but no later than one (1) hour from the time of placement to assess the need for mental health treatment. If the incarcerated person has attempted or expressed thoughts of suicide, jail Mental Health staff shall be contacted immediately. VI. DOCUMENTATION A. An incident report shall be written by the officer who initiated placement of the incarcerated person into the Wrap restraint. The report shall include, but not be limited to the following: 1. Reason for placement into the Wrap restraint (detailing the location, incarcerated person's behavior and/or circumstances). 2. The less restrictive alternatives, including verbal de-escalation Page 5 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT techniques that were attempted and deemed ineffective. 3. Documentation of any injuries (sustained or alleged). 4. Name of the Watch Commander who approved the placement. 5. Names and titles of staff members involved, including Medical and Mental Health staff. 6. The use of a spit hood (if applicable). B. If the incarcerated person sustains or complains of injury- 1. Photograph any visible injuries, as well as any area the incarcerated person is claiming to be injured. 2. Notify Medical staff. 3. Notify the supervising Sergeant. 4. Document the actions taken in the incident report. Submit any photographs with the report prior to going off-duty. C. The incarcerated person shall be visually checked and the check documented via the Safety Check System at least twice every thirty (30) minutes to ensure that the restraints are properly employed, and to ensure the safety and well-being of the incarcerated person. D. The Sergeant is responsible to complete the Wrap removal report. The report shall include- 1. The name of the Watch Commander who approved the removal. 2. The name of the Mental Health staff member who recommended the removal. 3. The time(s) range of motion exercises were conducted (if applicable). If it was not possible to safely exercise the incarcerated person's extremities, the reason the exercises were unable to be conducted shall be documented. 4. The duration of restraint placement. Page 6 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT VI I. CONTINUED RETENTION OF RESTRAINTS A. If the Wrap restraint appears to be ineffective in controlling the disorderly behavior, the incarcerated person should be reevaluated for transfer to either the Pro-Straint restraint chair or a safety cell. NOTE: When the behavior involves head banging, the use of the restraint chair is preferable to placement in a safety cell. [Refer to policies D-210/Safety Cell (FILE: SAFETY-CELL) and D-230/Pro-Straint Restraint Chaig(,(FILE: CHAIR).] B. Each time an officer conducts a safety check, they shall determine if the incarcerated person's behavior is such that the incarcerated person can be removed from the restraints. The staff member conducting the check shall notify the Sergeant if the incarcerated person warrants a reduction or removal of restraints. C. Medical staff shall check all restraints to ensure the incarcerated person has proper circulation and document vital signs, mental status, and sensation of limbs at least once every sixty (60) minutes. D. Continued retention in restraints shall be reviewed by a Sergeant a minimum of once every hour. If it is necessary to restrain the incarcerated person handcuffed behind the back for more than one hour, consideration should be given to reaffixing the handcuffs to the front. E. Incarcerated people should not remain in the Wrap restraint for longer than four (4) continuous hours. F. If an incarcerated person's retention in the Wrap restraint is to exceed four (4) hours, the Sergeant shall obtain approval from the Watch Commander and document the justification for the continuance of the restraint in an incident report. H. If the Watch Commander, in consultation with responsible health care staff determines that an incarcerated person cannot be safely removed from restraints after eight (8) hours, the incarcerated person shall be taken to a medical facility for further evaluation. Page 7 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT Vill. STAFF MEMBER RESPONSIBILITY A. Direct visual observation shall be conducted at least twice every thirty (30) minutes to ensure that the restraints are properly employed, and to ensure the safety and well-being of the incarcerated person. The leg bands and shoulder harness must be checked frequently for tightness, and retightened or loosened as necessary until the Wrap has been removed. B. The incarcerated person is to be offered a drink of water when safe to do so. Elevated physical exertion can cause unusually high fluid replacement needs. 1. Staff shall provide proper hydration as safely as possible during the duration of restraint placement. Fluids should be offered no less than once per hour. 2. Each time fluids are given or offered, correctional staff shall note it via the Safety Check System. C. Monitor the restrained incarcerated person and immediately remove the restraints and notify Medical staff if the incarcerated person 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. Complaints of numbness D. Cardiopulmonary resuscitation (CPR) equipment is available on each housing floor and inside the Booking Office. Staff must be familiar with the location of CPR equipment within their assigned area. 1. Manual resuscitators (also referred to as artificial manual breathing units, or AMBU-bags) are located in each security station inside the red Medical Emergency "Ready Bag." Page 8 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT 2. Automated external defibrillators (AED's) are mounted to the wall of each floor, usually near the security station. E. At no time shall any restraint device be utilized in such a way as to intentionally inflict pain or punishment, or be used as a substitute for treatment. IX. TEMPORARY RESTRAINT REMOVAL A. If the incarcerated person complains of discomfort from the handcuffs, the handcuffs shall be checked for proper application. 1. If the handcuffs appear to be cutting off circulation, the handcuffs shall be loosened at the earliest safe opportunity to do so. 2. An incarcerated person who displays evidence of, or complains of an injury, shall receive appropriate medical attention as soon as possible. Restraints should be removed as needed and as safely as possible such that Medical staff can conduct an examination and/or treat the incarcerated person. B. If an incarcerated person requires temporary mobility and/or use of their hands, the handcuffs shall be re-affixed in front of their body. C. Provisions for temporary mobility include, but are not limited to- 1. Toileting needs. Upon request of the incarcerated person, they shall be given the opportunity to eliminate body waste with an appropriate reduction of restraints. If the actions or behavior of the incarcerated person poses a threat to their safety or that of others, then such privileges may be denied until it is determined by a Watch Commander to be safe to do so. 2. Meal distribution. The incarcerated person shall be offered the opportunity to eat meals at the proper times. a. The incarcerated person shall be given the means to disinfect their hand(s) before the meal (e.g., antimicrobial towelette). b. Appropriate finger foods may be substituted if eating utensils are withheld for safety reasons. c. If the actions or behavior of the incarcerated person poses a threat to their safety or that of others, then the opportunity may Page 9 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT be denied until it is determined by a Watch Commander to be safe to do so. 3. Medical emergency. 4. Exercise of extremities. [Refer to Section X and Addendum B.] D. Sufficient staff shall be present to safely control the incarcerated person anytime restraints are removed, as determined by the Sergeant. X. RANGE OF MOTION EXERCISE A. To ensure that circulatory problems do not develop in the extremities of any incarcerated person placed in the Wrap, staff will exercise the incarcerated person's extremities in range of motion exercises for a minimum of ten (10) minutes (total) every two (2) hours. [Refer to Addendum B.] B. An officer will be assigned by the Sergeant to video record the exercise process. C. If it is not possible to safely exercise the incarcerated person's extremities (e.g., the incarcerated person continues to struggle and removal of the restraint poses a threat to staff), exercise may be denied until it is determined by a Watch Commander to be safe to be allowed. When range of motion is not appropriate: 1. Notify Medical staff and request a medical evaluation. 2. The incarcerated person's behavior shall be documented in the Sergeant's report, to include the date and time of the denial, as well as the names of the Watch Commander and Medical staff member who were notified. Include the time when the incarcerated person was allowed to exercise their extremities. XI. WRAP RESTRAINT REMOVAL A. Incarcerated people should be kept in restraints for the least amount of time necessary to handle each particular situation. The incarcerated person 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 incarcerated person, they shall determine if the incarcerated person's behavior is such that the Page 10 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT incarcerated person can be removed from the restraints. 2. If an officer believes an incarcerated person is capable of being released from restraints, they shall contact the Sergeant who shall evaluate the incarcerated person for release. 3. The on-duty charge nurse shall be notified and a mental health consultation shall be secured prior to the incarcerated person's removal from the Wrap. B. An incarcerated person may be removed from the Wrap only under the direction of a Sergeant(or higher authority). To remove the Wrap, reverse the application procedure. It may be necessary to ease the tension of the tether strap (the strap that connects the harness to the legs). Unlock the security buckles by inserting a cuff key or small object like the top of a ballpoint pen into the inch hole on the metal cover and press down. C. Medical staff shall check the incarcerated person for injuries following their removal from the Wrap within one (1) hour of removal. D. An incident report shall be completed by the Sergeant documenting the removal of the incarcerated person from the Wrap. (Refer to Section VI for documentation requirements.) XII. PREPARATION FOR RE-USE To maximize the application efficiency, it is important that the Wrap is immediately ready for use and prepared for storage in a way that prevents the Velcro on the straps from becoming dirty or entangled. When properly folded, the Wrap can be quickly laid out next to the incarcerated person and applied without the need to untangle the straps. To properly prepare the Wrap for storage, refer to Addendum C. XIII. TRAINING REQUIREMENTS Only qualified personnel who have received training in the use of the Wrap restraint shall be authorized to utilize the device during actual operations. Correctional staff shall attend a two (2) hour instructional course specific to the application of the Wrap restraint prior to being authorized to use the Wrap device or carry an incarcerated person restrained by the Wrap. Page 11 of 12 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF THE WRAP RESTRAINT NO: D-232 FILE: WRAP RESTRAINT XIV. CLEANING AND REPAIR A. The Wrap shall be inspected after each use for signs of wear and damage, and assessed for cleaning needs. 1. All straps should be free of frays, tears, worn or damaged fasteners, or damaged stitching. 2. The interior of the helmet shall be wiped with a general disinfectant. B. If the Wrap is soiled and requires cleaning- 1. Notify the supervising Sergeant and place the Wrap inside the designated carry bag. If the Wrap is soiled with human feces, urine, saliva, vomitus, or blood, the Wrap shall be placed inside a red biohazard bag and securely sealed. Ensure the bag is clearly marked "soiled." 2. The Sergeant (or designee) will notify Jail Services and indicate the location of the soiled Wrap restraint. Services will retrieve and exchange the soiled Wrap restraint. C. If the Wrap is damaged- 1. Notify the supervising Sergeant and place the Wrap inside the designated carry bag. Ensure the bag is clearly marked "damaged." 2. Complete an incident report documenting the discovery. If the damage occurred during the course of an application, document the occurrence in the restraint placement report. 3. The Sergeant (or designee) will notify Jail Services and indicate the location of the damaged Wrap restraint. Services will retrieve and exchange the damaged Wrap restraint. XV. STORAGE LOCATIONS Refer to Addendum D for Wrap storage locations. Page 12 of 12