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RESTRAINTS D-230 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, 01-24-23 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, 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 incarcerated people experiencing a behavioral crisis. POLICY: It is the policy of the Fresno County Sheriff's Office Jail Division that incarcerated people 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 incarcerated people 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 incarcerated person's extremities and/or prevent the incarcerated person from being ambulatory. Physical restraints should be utilized only when it appears less restrictive alternatives (i.e., verbal de-escalation) would be ineffective in controlling the incarcerated people experiencing a behavioral crisis. All restraints used in accordance with this policy shall be those approved for use in advance by the Sheriff's Office. When applicable, maximum time limits for restraint placement shall coincide with the specific restraint device manufacturer's recommendation. Page 1 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 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 incarcerated people for security reasons (e.g., to temporarily restrain an incarcerated person to gain control of a situation, or during transportation within or outside of the facility). PROCEDURES: I. DEFINITION RESTRAINT DEVICE — Equipment utilized to immobilize an incarcerated person's extremities and/or prevent the incarcerated person 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]) 55. Wrap Restraint (refer to policy D-232/Use of the Wrap Restraint[FILE:WRAP RESTRAINT]) 6. Other restraints approved and utilized by specialty units (e.g., SERT, Transportation Unit) II. SECURING PROCEDURE A. Restrain the incarcerated person 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 incarcerated person- 1. The incarcerated person'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 incarcerated person'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 incarcerated person may tamper with the locking mechanism). Page 2 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 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 incarcerated person is handcuffed too tightly, nerves could be damaged or blood circulation could be reduced. If the restraint device is too loose, the incarcerated person could escape. Make adjustments, if necessary, to minimize the risk of injury. 5. Always double lock. Double locking is important to prevent further tightening of the restraint. B. Steps for applying shackles- 1. Position the incarcerated person 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 incarcerated person's movements and actions. Do not apply the shackles from in front of the incarcerated person. 2. Place the shackles on the leg above the anklebone. Position the keyholes towards the ground (away from the incarcerated person's fingers). 3. Secure the shackles so that they're not too tight when the incarcerated person 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 incarcerated person is to be placed into a belly chain, the procedure for handcuffing may vary slightly. If the incarcerated person is being cuffed through a pass-through (e.g., in an FF cell), cuff them with their hands in front. The keyholes should be positioned towards the incarcerated person's fingers (this is only a temporary restraint). 2. Place the belly chain around the incarcerated person'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). Page 3 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 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 incarcerated person's fingers. Double lock the cuffs. The incarcerated person 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). 6. The excess length of chain will be left dangling in front of the incarcerated person. Standing behind the incarcerated person, reach through their legs, grab the chain, and clip the end of the chain to a link at the incarcerated person's back. If the chain does not reach through the incarcerated person's legs, the chain shall be securely clipped onto a link on the chain around the waist. D. Escort the incarcerated person to the desired isolated holding cell or destination. E. The incarcerated person shall be left in a position away from walls and other obstructions. F. While in restraint devices, all incarcerated people shall be housed alone. The only exception shall be if more than one incarcerated person is restrained in a room under constant staff supervision. Under no circumstances should restrained incarcerated people be housed with incarcerated people who are not in restraints. III. NOTIFICATION A. Incarcerated people 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. Page 4 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS B. The on-duty charge nurse shall be notified at the time of initial placement. 1. The incarcerated person'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 incarcerated person requires obvious medical attention, that information shall be conveyed to the charge nurse. 3. If the incarcerated person 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 maintained for any incarcerated person that has been placed into a restraint device until a medical opinion can be obtained. B. 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 checks shall be documented via the Safety Check System. C. 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 incarcerated person 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. Page 5 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS D. It shall not be necessary to document the routine use of handcuffs and shackles or other restraint devices when used to restrain incarcerated people for security reasons (e.g., when used to temporarily restrain an incarcerated person to gain immediate control of a situation, or during transportation within or outside of the facility), unless extraordinary circumstances apply or the incarcerated person complains of injury. E. If the incarcerated person 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 incident and actions taken in a report. Submit any photographs with the report prior to going off-duty. V. SUBSEQUENT MEASURES A. If the incarcerated person 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 behavior, the incarcerated person shall be reevaluated for transfer to the Pro-Straint Restraint Chair, Wrap Restraint, or a safety cell. Incarcerated people 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. When the behavior involves head banging, the use of the restraint chair or Wrap Restraint is preferable to placement in a safety cell. (Refer also to D-210/Safety Cell [SAFETY CELL], D-232/Use of the Wrap Restraint[FILE: WRAP RESTRAINT], 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. Page 6 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS VI. CONTINUED RETENTION OF RESTRAINTS A. The incarcerated person shall be considered for a reduction of restraints at least hourly. Staff members conducting the safety checks shall notify the Facility Sergeant if the incarcerated person 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 incarcerated person 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. Where applicable, the facility manager shall use the restraint device manufacturer's recommended maximum time limits for placement. E. 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. VI I. TEMPORARY RESTRAINT REMOVAL Sufficient staff shall be present to safely control the incarcerated person 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 incarcerated person. B. If an incarcerated person requires temporary mobility and/or use of their hands; the following shall be performed: Page 7 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 1. If the incarcerated person is handcuffed with their arms behind their back, the handcuffs shall be re-affixed in front of their body. 2. If the incarcerated person'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 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. The food should be provided via paper bag (i.e., sack lunch) or served on a styrofoam tray. 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 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 incarcerated person to exercise their extremities in range of motion exercises for a minimum of ten (10) minutes (total) every two (2) hours. If 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: Page 8 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS a. Notify medical staff and request a medical evaluation. b. Document the incarcerated person'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 incarcerated person 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 incarcerated person. B. At the time of the first check, the incarcerated person 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 incarcerated people 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. Complaining of numbness D. 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. Page 9 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS E. In the event of an emergency evacuation, a designated staff member shall be responsible to ensure that any restrained incarcerated people 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 following areas by location: • Main Jail 1st Floor- By the computer station • Main Jail 2nd Floor- Just outside the Infirmary • Main Jail 3rd-6t" Floors- Adjacent to staff elevator, mounted to the wall outside of the Security Station. • North Jail 2nd-3rd - Adjacent to staff elevator, mounted to the wall outside of the Security Station South Annex 2nd_4tn Floor- Adjacent to the Security Station • West Annex 1st Floor- Lobby • West Annex Basement- Basement Security Station • West Annex Floors-Adjacent to staff elevator, mounted to the wall outside of the Security Station. 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. 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 incarcerated person 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"). Page 10 of 11 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: USE OF RESTRAINT DEVICES NO: D-230 FILE: RESTRAINTS 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 incarcerated people shall be restrained so they remain able to communicate in sign language. If necessary to handcuff an incarcerated person who is deaf, the application should be restricted to cuffs in front of the incarcerated person. However, if the incarcerated person is actively combative, nothing shall preclude cuffing the incarcerated person with their hands behind their back until a belly chain can be procured and safely substituted. H. An incarcerated person who is pregnant and 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 incarcerated person, the staff, or the public. 1. If necessary to restrain a pregnant incarcerated person for any reason, the application of restraints shall be restricted to handcuffs to the front of the incarcerated person 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 (FILE: RESTRAINTS DURING TRANSPORT) and D-238/Guarding Incarcerated People at Off-Site Medical Facilities (FILE: GUARDING HOSPITALIZED INMATES).] 2. Restraints shall be removed when a professional who is currently responsible for the medical care of a pregnant incarcerated person during a medical emergency, labor, delivery, or recovery after delivery determines that the removal of restraints is medically necessary. Page 11 of 11