BOP Program Statement 5566.07 § 8

When the Warden determines that four-point restraints are the only means available to obtain and

maintain control over an inmate, the following procedures must be followed:

(a) Soft restraints (e.g., vinyl) must be used to restrain an inmate unless:

(1) Such restraints previously have proven ineffective with respect to that inmate, or

(2) Such restraints are proven ineffective during the initial application procedure.

This may not be delegated below the Warden’s level.

(b) Inmates will be dressed in clothing appropriate to the temperature.

(c) Beds will be covered with a mattress, and a blanket/sheet will be provided to the inmate.

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Under no circumstances shall an inmate be allowed to remain nude or uncovered without a

blanket/sheet unless determined necessary by qualified health personnel. If the inmate damages

or manipulates the clothing, blanket/sheet, or other materials in a way that poses risk to the

inmate, the Captain in consultation with Health Services and Psychology Services may authorize

their limitation or removal.

(d) Staff shall check the inmate at least every 15 minutes, both to ensure that the restraints are

not hampering circulation and for the general welfare of the inmate. When an inmate is

restrained to a bed, staff shall periodically rotate the inmate’s position to avoid soreness or

stiffness.

To assist in ensuring the general welfare, inmates asleep at the time of the 15-minute check are to

be awakened to visually assess their condition and this information must be documented. Visual

checks are not to be conducted via closed circuit television (CCTV).

(e) A review of the inmate’s placement in four-point restraints shall be made by a Lieutenant

every two hours to determine if the use of restraints has had the required calming effect and so

that the inmate may be released from these restraints (completely or to lesser restraints) as soon

as possible. At every two-hour review, the inmate will be afforded the opportunity to use the

toilet, unless the inmate is continuing to actively resist or becomes violent while being released

from the restraints for this purpose.

Based on the nature of the situation, the Lieutenant who has offered the inmate a bathroom break

will determine how many employees are needed to release the inmate from the restraints and

provide the inmate a bathroom break. The Lieutenant will assemble the employees and visually

observe and direct employees as they complete this task. The Lieutenant will determine what

protective equipment is needed, if any, for the employees assisting with the inmate’s bathroom

break.

The goal of the two-hour reviews is to determine, as soon as possible, the inmate has regained

self-control and may be placed in lesser restraints. The Lieutenant should look for a pattern of

non-disruptive behavior over a period of time indicating the inmate has regained self-control and

is no longer a disruptive threat. Additionally, the 15-minute and two-hour check logs must be

reviewed to support any decision for lesser measures or the removal of restraints. Inmates asleep

at the time of the two-hour reviews should be awakened to assess their condition.

If an inmate is released temporarily from four-point restraints for any reason (e.g., to use the

toilet, consumption of food or beverage, etc.) without continuing disruptive or aggressive

behavior, the Lieutenant must consider authorizing lesser restraints or removing the restraints. If

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an inmate is returned to four-point restraints after a non-disruptive break, the Lieutenant must

document the reasons for the action in detail.

(f) When the inmate is placed in four-point restraints, qualified health personnel shall initially

assess the inmate to ensure appropriate breathing and response (physical or verbal). Staff shall

also ensure that the restraints have not restricted or impaired the inmate’s circulation. When

inmates are so restrained, qualified health personnel ordinarily are to visit the inmate at least

twice during each eight hour shift. Use of four-point restraints beyond eight hours requires the

supervision of qualified health personnel. Mental health and qualified health personnel may be

asked for advice regarding the appropriate time for removal of the restraints.

Qualified Health Services personnel shall evaluate the inmate restrained to a bed to determine the

position the inmate should be placed in. When qualified Health Services personnel are not

immediately available, the inmate will be placed in a “face-up” position until evaluated.

Health Services employees performing initial and subsequent required checks, must examine and

document the following:

■ date and time of examination

■ examining employee

■ body position

■ restraints (adequate circulation)

■ vital signs (blood pressure, pulse, respiration, and temperature)

■ medication

■ injuries

■ the inmate’s intake, output, hydration, etc.

■ possible medical reasons for behavior

■ deterioration of inmate’s health

■ any other significant findings and comments

In institutions without 24-hour medical coverage, Health Services employees must report to the

institution twice during each eight-hour shift an inmate remains in progressive or four-point

restraints. Such employees will be compensated (overtime, compensatory time, etc.) in

accordance with the regulations. Under no circumstances will non-medical employees perform a

medical assessment of an inmate.

(g) When it is necessary to restrain an inmate for longer than eight hours, the Warden (or

designee) or institution administrative duty officer shall notify the Regional Director or Regional

Duty Officer by telephone.

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The above notification will be made for each consecutive eight-hour period the inmate remains

in restraints. Documentation detailing the reasons for the placement of each inmate in four-point

restraints, regardless of the duration, must be provided to the Regional Director or Regional Duty

Officer the following workday.