# 295 Handcuff Injuries
One way of distinguishing the 'socioeconomic' class of your facility or activity is how often it must deal with patients who are handcuffed or manacled. Generally, 'public' ie government operated facilities will, more likely, interface with authorities and those in their custody, than 'private' or upscale facilities. You might also be in an area where 'sweeps' or large-scale arrest and detention operations are occurring,
Patients in custody may be brought to you for care due to: exacerbation of their own health problems; for mandatory medical clearance because of health, intoxication, arrest injuries or exposure to chemical agents; or injuries received as a victim or combatant. While in your care, they will usually be supervised by an officer, and if deemed a flight risk will be handcuffed to the bed.
Regardless of reason for exam, the patient should be checked for injuries or latent injuries, as the consequence of being in custody. The history given may be limited or unreliable, as the prisoner may not feel able to speak freely and incur 'punishment' from the authorities , other prisoners, or even his own confederates. At times, officers have been known to minimize the 'event', or say they "weren't there" or "he fell."
You should be able to ask for periodic repositioning of limbs and rotation of cuff site, just as any patient who is immobile needs repositioning. Inspect for abrasions, lacerations, neuropathy or apraxia. X-ray when necessary to clarify potential injury.
Handcuffs are of several types: chain-linked traditional style; rigid bar; hinged cuff; or disposable 'flex-cuffs' similar to large and sturdy cable ties. All are capable of injury, either in application, or after. Additionally, as the population increases in size, so too, special large-size restraints have been made, or if not used, one prisoner may have two handcuffs: one on each wrist, and then to the other, so as to allow for the greater span between shoulders, which may be strained if confined too closely, and compression plexopathy or impaired circulation might be encountered.
Most metal cuffs have a swing-through ratchet that moves through the stationary bow so that it may be quickly fastened. If not 'double-locked' by a special pin or key so that the ratchet cannot move in either direction to minimize injury, continued pressure on the bow increases the tightness and compression. Likewise, if the cuffs were inadvertently double-locked when snapped against the wrist, it would act as a hammer; this can also happen if in the struggle the cuff was inverted when snapped against the wrist. The moments of greatest struggle or attempt to escape are when one wrist is cuffed and the other is free; freedom is to be lost and great resistance may occur (even if just repositioning on the bed).
Bulky dressings should not be used on the area where the handcuff will be affixed. They may be picked apart to try to slip the wrist free, or if long enough used as a means of suicide. Medical staff at the custodial facility should be informed prior to transfer and may have useful suggestions. If restraints, transport, and medical needs are incompatible, the patient may need further consultation or admission.
Excellent documentation is essential to protect all parties should there be contention as to what 'really' happened.
Payne-James, J. J. (2016). Restraint Techniques, Injuries, and Death: Handcuffs. ©Elsevier. Retrieved from www.researchgate.net.
All Tips: 2013 2014 2015 2016 2017 2018 - Updated! (11/04/2018)
