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RESTRAINTS D-230 01-24-23 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS EFFECTIVE DATE: 08-06-90 REVISED: 11-04-91, 10-01-93, 12-25-94, 06-04-95, 02-14- 96, 08-01-97, 11-01-98, 01-01-00, 03-01-04, 07- 01-10, 12-16-13, 10-13-16, 07-25-17 AUTHORITY: Sheriff M. Mims APPROVED BY: Assistant Sheriff T. Gattie REFERENCE: California Code of Regulations, Title 9, Section 784.37 and Title 15, Sections 1029, 1052, 1058, and 1058.5; Penal Code Sections 147, 149, 2652.57 3407 and 6030; Fresno County Sheriff's Office Policies and Procedures Section No. 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 restraints when necessary for sustained, prolonged intervention in controlling disordered behavior. POLICY: It is the policy of the Fresno County Sheriff's Office Jail Division that inmates shall only be placed into restraints for sustained, prolonged intervention with the notification and approval of the Watch Commander. It is the policy of the Fresno County Sheriff's Office Jail Division that Jail Division staff shall only utilize restraint devices to control inmates who display behavior which results in the destruction of property or reveal an intent to cause physical harm to themselves or others. It is the policy of the Fresno County Sheriff's Office Jail Division that only trained and qualified staff members are authorized to utilize restraints. Restraint devices include any devices which immobilize an inmate's extremities and/or prevent the inmate from being ambulatory. Physical restraints should be utilized only when it appears less restrictive alternatives would be ineffective in controlling the disordered behavior. All restraints used in accordance with this policy shall be those approved for use in advance by the Sheriff's Office. The notification and documentation components of this policy do not apply to the routine use of handcuffs and shackles or other restraint devices when used to restrain inmates for security reasons (e.g., to temporarily restrain an inmate to gain control of a situation, or during transportation within or outside of the facility). Page 1 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS PROCEDURES: I. DEFINITION RESTRAINT DEVICE — Equipment utilized to immobilize an inmate's extremities and/or prevent the inmate from being ambulatory. The following are authorized restraining devices that may be utilized alone or in combination with handcuffs- 1. Flex-cuffs and cord-cuffs 2. Waist or belly chains 3. Shackles 4. Pro-Straint Restraint Chairs (refer to policy D-236/Pro-Straint Restraint Chair [FILE: CHAIR]) 5. Other restraints approved and utilized by specialty units (e.g., SERT, Transportation Unit) II. SECURING PROCEDURE A. Restrain the inmate and place handcuffs on them using control techniques approved by the Sheriff's Office. Handcuffs shall be put on before shackles (and shackles shall be removed before removing the handcuffs). The following guidelines describe the standard procedure that should ideally be followed when handcuffing an inmate: 1. The inmate's hands are placed behind their back. 2. The backs of their hands should be together, palms out. 3. Position the keyholes towards the officer (away from the inmate's fingers). The locking mechanisms should be facing up (if facing down, the mechanism can be unlocked when struck against a hard object or the inmate may tamper with the locking mechanism). 4. Secure the handcuffs on the arm tightly enough so that they don't slip over the wrist bone (tight enough to touch the skin is considered correct application). If an inmate is handcuffed too tightly, nerves could be damaged or blood circulation could be reduced. If the restraint device is too loose, the inmate could escape. Make adjustments, if necessary, to minimize the risk of injury. Page 2 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 5. Always double lock. Double locking is important to prevent further tightening of the restraint. B. Steps for applying shackles- 1. Position the inmate so that they can't kick (a kneeling position is preferable). The officer should be positioned so that the shackles can be applied while viewing the inmate's move-ments and actions. Do not apply the shackles from in front of the inmate. 2. Place the shackles on the leg above the anklebone. Position the keyholes towards the ground (away from the inmate's fingers). 3. Secure the shackles so that they're not too tight when the inmate stands (approximately one finger width from the leg). 4. Always double lock. Double locking is important to prevent further tightening. C. Steps for applying waist or belly chains- 1. If the inmate is to be placed into a belly chain, the procedure for handcuffing may vary slightly. If the inmate is being cuffed through a pass-through (e.g., in an FF cell), cuff the inmate with their hands in front. The keyholes should be positioned towards the inmate's fingers (this is only a temporary restraint). 2. Place the belly chain around the inmate's abdomen. Run the large ring through a link in the chain in a snug position (remember to allow for the two-inches of play that will occur after the cuff is placed through the ring). 3. Run one handcuff through the metal ring of the belly chain. 4. Place the handcuffs above the temporary set of cuffs. Position the cuffs so that the locking mechanisms are facing up and the keyholes are facing away from the inmate's fingers. Double lock the cuffs. The inmate will briefly be wearing two sets of cuffs. 5. Remove the original set of cuffs (if both keyholes were positioned in the same direction, it would be difficult to remove the original set of cuffs). Page 3 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 6. The excess length of chain will be left dangling in front of the inmate. Standing behind the inmate, reach through their legs, grab the chain, and clip the end of the chain to a link at the inmate's back. If the chain does not reach through the inmate's legs, the chain shall be securely clipped onto a link on the chain around the waist. D. Escort the inmate to the desired isolated holding cell or destination. E. The inmate shall be left in a position away from walls and other obstructions. F. While in restraint devices, all inmates shall be housed alone. The only exception shall be if more than one inmate is restrained in a room under constant staff supervision. Under no circumstances should restrained inmates be housed with inmates who are not in restraints. III. NOTIFICATION A. Inmates shall be placed in restraints only 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 Facility Sergeant immediately and inform them of the circumstances. The Sergeant will notify the Watch Commander to inform them of the circumstances and obtain their approval. 2. Whenever the situation is one of a predictable nature, prior Watch Commander approval shall be obtained. B. The on-duty charge nurse shall be notified at the time of initial placement. 1. The inmate's health record shall be immediately reviewed for any contraindications or accommodations required, and if present, immediately communicated to appropriate custody staff. 2. A registered nurse (RN) or LVN under the supervision of an RN shall document vital signs, mental status, sensation of limbs and check for injuries incurred during the restraining application within the first hour of placement. If the inmate requires obvious medical attention, that information shall be conveyed to the charge nurse. Page 4 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 3. 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. IV. DOCUMENTATION 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 inmate. The checks shall be documented via the Safety Check System. B. An incident report shall be written whenever restraints are used for a sustained, prolonged intervention. The report shall include, but not be limited to the following- 1. Reason for the restraint placement (detailing the location, behavior and/or circumstances). 2. The time the inmate was removed from their restraint shall be included, along with the time the range of motion exercises were performed, if applicable. 3. Names and titles of staff members involved, including medical and mental health staff. 4. Name of the Watch Commander who approved the placement and removal. C. It shall not be necessary to document the routine use of handcuffs and shackles or other restraint devices when used to restrain inmates for security reasons (e.g., when used to temporarily restrain an inmate to gain immediate control of a situation, or during transportation within or outside of the facility), unless extraordinary circumstances apply or the inmate complains of injury. D. If the inmate complains of injury: 1. Photograph any visible injuries, as well as any area the inmate is claiming to be injured. 2. Notify medical staff. 3. Notify the supervising Sergeant. Page 5 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 4. Document the incident and actions taken in a report. Submit any photographs with the report prior to going off-duty. V. SUBSEQUENT MEASURES A. If the inmate attempts to cause damage to the cell (e.g., continues to kick the cell door), shackles may be applied to their legs. The cuffs and shackles may be interlaced in front of their body. B. If handcuffs and shackles appear to be ineffective in controlling the disorderly behavior, the inmate shall be reevaluated for transfer to either the Pro-Straint Restraint Chair or a safety cell. Inmates who continue to intentionally cause physical harm to themselves (e.g., hit their head on the floor) or whose behavior resulted in the placement of restraints, shall be transported as soon as possible for housing in a safety cell and mental health staff notified. (Refer also to D-210/Safety Cell [SAFETY CELL] and D-236/Pro-Straint Restraint Chair [CHAIR].) C. More prolonged behavior disturbances may be symptomatic of underlying psychological or medical problems that require specific intervention and monitoring. VI. CONTINUED RETENTION OF RESTRAINTS A. The inmate shall be considered for a reduction of restraints at least hourly. Staff members conducting the safety checks shall notify the Facility Sergeant if the inmate warrants a reduction of restraints. B. A medical opinion on placement and retention shall be secured within one (1) hour from the time of placement. Medical staff shall check all restraints to ensure the inmate has proper circulation and document vital signs, mental status, and sensation of limbs at least once every sixty (60) minutes. C. Continued retention in restraints shall be reviewed by a Sergeant a minimum of once every hour. D. If the Watch Commander, in consultation with responsible health care staff determines that an inmate cannot be safely removed from restraints after eight (8) hours, the inmate shall be taken to a medical facility for further evaluation. Page 6 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS VI I. TEMPORARY RESTRAINT REMOVAL Sufficient staff shall be present to safely control the inmate anytime restraints are removed, as determined by the Sergeant. A. If a handcuffed subject 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. A 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 health care staff can conduct an examination and/or treat the inmate. B. If an inmate requires temporary mobility and/or use of their hands; the following shall be performed: 1. If the inmate is handcuffed with their arms behind their back, the handcuffs shall be re-affixed in front of their body. 2. If the inmate's handcuffs and shackles are intertwined in front of their body, the restraints shall be disengaged from each other. C. Provisions for mobility include, but are not limited to- 1. Toileting needs. 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 such privileges may be denied until it is determined by a Watch Commander to be safe to do so. 2. Meal distribution. The inmate shall be offered the opportunity to eat meals at the proper times. The food should be provided via paper bag (i.e., 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). b. Appropriate finger foods may be substituted if eating utensils are withheld for safety reasons. Page 7 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 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. 3. Breathing difficulty or medical emergency. 4. Transportation (i.e., disengage the restraints from each other if the restraints are interlaced). 5. Exercise of extremities. Staff shall remove the restraints (one at a time) and allow the inmate to exercise their extremities in range of motion exercises for a minimum of ten (10) minutes (total) every two (2) hours. If the inmate 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: a. Notify medical staff and request a medical evaluation. b. Document the inmate's behavior in an incident 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 inmate was allowed to exercise their extremities. 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 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. Elevated physical exertion can cause unusually high fluid replacement needs. Staff shall provide proper hydration as safely as possible during the duration of the restraint 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 Page 8 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 2. Unconsciousness 3. Vomiting 4. Choking 5. Seizing 6. Discoloration 7. Swelling of extremities 8. Complaining of numbness D. 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. E. In the event of an emergency evacuation, a designated staff member shall be responsible to ensure that any restrained inmates are transported from the affected area. F. Staff must be familiar with the location of all cardiopulmonary resuscitation equipment within their working area- 1. Resuscitation masks and Artificial Manual Breathing Units (AMBU- bags) are located in each security station near the protective apparel. 2. Automated external defibrillators (AEDs) are located in the medical exam rooms on the housing floors, in the Booking medical exam room, and in both the Main Jail and South Annex Jail 2nd floor medical exam rooms. IX. RESTRICTIONS AND SPECIAL CONSIDERATIONS A. Restraints shall not be used for medical purposes or during any medical procedures. B. Medical staff shall not participate in decisions to initiate use of restraints by correctional staff. Page 9 of 10 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS C. 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. Any playful or careless use may result in disciplinary action. D. At no time shall a restraint device be placed around the head or neck of an inmate for any purpose. E. At no time shall an individual be restrained with both the hands and the feet together behind the back (i.e., "hog-tied"). F. Subjects shall not be handcuffed to a fixed object, unless the fixed object was specifically designed for that purpose, or in cases of emergency. G. Deaf inmates shall be restrained so they remain able to communicate in sign language. If necessary to handcuff a deaf inmate, the application should be restricted to cuffs in front of the inmate. However, if the inmate is actively combative, nothing shall preclude cuffing the inmate with their hands behind their back until a belly chain can be procured and safely substituted. H. A pregnant inmate in labor, during delivery, or in recovery after delivery, shall not be restrained by the wrists, ankles, or both, unless deemed necessary for the safety and security of the inmate, the staff, or the public. 1. If necessary to restrain a pregnant inmate for any reason, the application of restraints shall be restricted to handcuffs to the front of the inmate only. In every instance, special effort shall be made to avoid harm to the unborn child. (Refer also to D-235/Use of Restraints During Inmate Transportation [RESTRAINTS DURING TRANSPORT] and D-238/Guarding Inmates at Off-Site Medical Facilities [GUARDING HOSPITALIZED INMATES].) 2. Restraints shall be removed when a professional who is currently responsible for the medical care of a pregnant inmate during a medical emergency, labor, delivery, or recovery after delivery determines that the removal of restraints is medically necessary. Page 10 of 10