Standing Restraint vs. Prone Restraint

The argument for standing vs. prone restraint when discussing crisis intervention training has been one that has been around for quite some time. There have been many arguments for both, though I want to examine some of them here:

Prone Restraint

A large percentage of physical interventions end up going to the ground. Skilled fighters will often try to take their opponent to the ground in efforts to contain them and/or restrict their ability to return strikes or blows. Larger opponents can enjoy the benefits of weight dominance and lessen the likelihood that their opponent will try to run away or escape by pinning them to the ground.  Once on the ground, the risk of falling to the ground is removed, therefore reducing chance of injury once responders utilize a ground-based restraint hold. These are the most common reasons (ability to restrict movement, gross tonnage, reduced risk of falling, etc) that are often cited in arguments regarding why using a prone restraint is desired. Yet, there are many drawbacks involved.

At CCG we do not endorse the use of prone restraint techniques for the following reasons: First and foremost, statistically the majority of injuries occur during restraints when forcing someone from a standing position to the ground. Therefore, knowing that injuries during restraints are more likely to occur from the actual “restraining” then getting hit, or kicked, one would think that avoiding such risk would be wise.

Secondly, once an individual is forced to the ground, responders are now limited in their ability to effectively move the individual, and often only able once the aggressor has de-escalated completely. Have you ever seen or participated in an intervention when someone tries to move the aggressor from the prone restraint position when the aggressor is unwilling or uncooperative? Not fun, to say the least.

Thirdly, once on the ground, there is an incredibly strong desire by responders to “hold down” the individual, or “pin” them in place, using the floor as a stopping point against an aggressor’s movement.  Once this thought kicks in, the end result is usually downward pressure on a limb/s or on the upper torso of the aggressor.  All too often, the responder’s hands end up on the thoracic cavity (chest, lungs, or lower back area) thereby risking positional asphyxia and death. In other cases, the neck, head, shoulders, buttocks, and ankles, are often used as well to help “pin down” the individual.  All of these areas should be considered “off limits” during interventions, though it is not uncommon during a real crisis for staff to forget these “rules” and decide that the situation requires such responses. Combined with this is the added temptation to simply place their own body weight on top of the individual to further subdue them.  Although these tactics may work in the heat of the moment, it both violates the dignity of the individual and is extremely dangerous.

How do I know this? From over 8 years of experience working in a highly volatile locked psychiatric hospital with over 400 documented crisis incidents (each of which I was personally involved). Unfortunately, my coworkers and I at the time had no effective alternative, leading us to do exactly as stated above.  We did not have any other effective technique, even after going through years of alternative crisis intervention training programs.  During those years, staff were often injured. Patients were often injured. I was personally injured. Looking back, I have to ask myself “Were we wrong?”  If one does not have any other effective technique to use during emergencies and acts with the best intentions for the greater good, I believe that it was the right thing.  However, the reality is that there is now a better method; a safer and more effective intervention technique.  There is no longer the need to forcefully place someone on the ground in order to restrain them. Though there is no reason to do a “take down.”  The prone or supine restraint position is outdated, unsafe, and unnecessary.  We have practically eliminated the dangers found during crisis intervention/restraints through utilization of our highly effective and progressive curriculum.

Standing Restraint

We know that during a crisis, the “hands on” portion is not “pretty” and often is not textbook or as simply performed during prior training.  Any company that insists things will be “simple, quick, and easy” with their magical technique is not based in reality. Employing a standing restraint technique can be difficult. You must practice, working with your coworker to improve timing and coordinated responses.  Even so, when taught an effective, safe, and realistic standing restraint position that can be easily employed in a moment’s notice, risks found during restraint is mitigated for the following reasons.

– With an effective standing hold there is no pressure placed on the thoracic cavity

– With an effective standing hold the responders are not having to force the individual into a specific position

– It is likely that individual will initially begin the aggressive episode in a standing position, so avoiding having to do a “take-down” eliminates the risk of injury from the impact of forcing them to the ground

Dignity may be maintained by the individual while in an upright position, even though they are being held by responders in an effective standing hold

-While in an effective standing hold the ability to escort the individual from the area is possible and more easily achieved than if required to first pick up the individual from a prone or supine position

-With an effective standing hold it is not possible that the “pig pile” or “gross tonnage” (process of responders simply piling on top of a prone or supine individual) will occur

For these reasons and many others, we teach an effective, safe, and realistic standing restraint position.  Give us a call to find out more, as we are always willing to discuss how we are revolutionizing the crisis intervention training industry, through online courses and certifications. Have a comment? Send us your thoughts!