Restraint and seclusion in the emergency department

Restraints and seclusion once seemed to be the only option in our arsenal of defense against the agitated and combative patient. We now know that these aggressive measures must be used as a last resort due to the many concerning consequences associated with their use, including physical injury, psychological stress, and the medicolegal concerns associated with their application. These techniques should be utilized only when other safer measures have failed, and only in a final attempt to prevent injury to patients and others. In the event that physical restraints or seclusion are implemented, several general principles should be considered to optimize the outcome of patients and to mitigate any adverse consequences. This chapter will review the use of restraints and seclusion for patients with behavioral emergencies and will provide recommendations according to the best available evidence and practice guidelines.