Physical Restraint

Summary

The overriding principle is your responsibility to work safely and to keep other people safe when they are in your duty of care.
Fill in an incident report after every time you physically restrain a child.
When should you physically restrain a child? Here's a guideline:

You should not if:	You can still talk to the child (conflict resolution), or You have not been trained, or It is too dangerous.
You may if:	The child is clearly dangerous to him/herself or others, and You have been trained, and You think you can do so safely.
You should if:	The child is clearly dangerous to him/herself or others, and You have been trained, and You can clearly do so safely.

Instructions

You may restrain children who are physically dangerous to you, themselves, or other people, for example:

attempted self-harm

self-harm through erratic behaviour

erratic behaviour endangering others

attacks on staff or others

fights

threats using weapons, including improvised weapons.

Use physical restraint as a last resort.

You should only use it when you can’t use normal conflict resolution.

You don’t have to try conflict resolution first in an emergency where you need to physically restrain someone immediately.

If you believe you are in danger, you have the right to use reasonable force to defend yourself.

The way you restrain children should minimize risk of harm to both yourself and the child.

You don’t have to restrain a child if you’d be in danger. You are responsible to keep yourself safe.

The person in charge may decide to call police if a criminal offence is committed or if it is too dangerous for you to control.

Try to leave the incident if you start to lose your temper.

Be especially careful when restraining people who have never been restrained before. They are likely to be especially violent and to prolong the struggle.

They are likely to believe that they can successfully defend themselves or escape. They might also feel threatened and in danger because you have superior force. People who have been restrained a number of times realize that it is all over as soon as they are firmly held.

Use only a "reasonable" level of force. That is, use the minimum level of force to restrain the child satisfactorily and safely. As a general principle, you need two staff members to restrain one person if everyone involved is about similar physical size and fitness and the child has no weapons. Use force for only as long as you need to.

The level of force is unreasonable if:

it is clearly more than you need to satisfactorily and safely restrain the child, and/or

it inflicts unnecessary physical pain and suffering on the child, especially if it includes deliberately harmful actions (e.g. punching, kicking, biting, using weapons).

is maintained for longer than necessary.

if you deliberately humiliate or degrade the person.

A reasonable level of force can still result in extreme discomfort for the child. It could also result in minor injury that is necessary to the restraint, unintended, and/or results from minimum risk. For example, a person who strenuously resists might thrash around and bruise themselves on the floor or knock their head. But that doesn't mean it's your fault.

Follow your training.

Your training should include physical practice and you should do regular refresher courses to keep your skills up.

You should be trained in:

safe holds for immobilizing children. (Arms pinned behind their backs, or pinned face down on the floor for a short period.)
safe zones (You can be so close to the child that they can’t hit you, and you can be too far away to be hit. In between, they can hit you very effectively.)

It is your duty to physically restrain a child if:

there is a clear need,

you are appropriately trained, and

you are able to do so safely according to the guidelines.

If you refuse to do so when you clearly should and can, and somebody is hurt, you could be charged with neglecting your duty of care.

Fill in an incident report after every time you physically restrain a child. It helps protect you if the parents decide to make a formal complaint or tries to take legal action later on, or if your agency gets adverse publicity.

Look after yourself. Major incidents can bring on Post Traumatic Stress Disorder. Properly debriefing the incident afterwards may help. Get counselling if you need it.

Legal aspects

You have a duty of care for yourself, your children and anybody else on the premises. (OSH Act WA)

You can’t be successfully sued for following standard best practice as health care professionals. (Civil Liability Act WA)

You can't use a mechanical devise or apparatus to restrain someone. (Mental Health Act WA)

Police should not arrest you if you can show that the use of restraint was justified. If they do, you will probably be released because you have no case to answer.

You can still be arrested for assault if you attack a child. That is, physical restraint is not an excuse for violence.

Risks

Restraining people the wrong way can cause injury or death.

A person being restrained by held face-down on the floor for long periods cannot breathe freely and is at risk of suffocating. The risk is increased if

they are obese,

they have a history of respiratory problems,

they resist vigorously for a prolonged time, or

the staff member kneels on them or puts weight on them some other way.

The person being restrained is also at risk if:

they have a history of cardiac problems,

they are drunk,

they use illicit drugs,

they have psychosis, including drug-induced psychosis,

the restrainer holds something around their neck,

they could hit solid objects (furniture, walls) by vigorously resisting.

Staff members face a risk of muscle damage caused by transition from rest to sudden strenuous physical activity. (Warm-up exercise would normally prevent this kind of injury.)

Category	What to do^*
Verbally threatens assault	Crisis communication. Intervene non-physically to de-escalate.
Assault, but little or no medical treatment required	Where practical, remove the victim from line of attack. Seek help. Use physical intervention
Threats to cause serious injury (includes threats using an object as a weapon)	Protect self or others. Seek help. Use physical intervention.
Assault causing serious injury (includes using an object as a weapon) Medical attention required	Protect self or others. Seek help. Use physical intervention.

* Adapted from MDB Managing Difficult Behaviour, by Ross Priestman N.d.