☰ Revisor of Missouri


Chapter 190

< > Effective - 28 Aug 2023, 2 histories    bottom

  190.147.  Behavioral health patients — temporary hold, when — memorandum of understanding, contents — physical restraints, use of. — 1.  A paramedic may make a good faith determination that such behavioral health patients who present a likelihood of serious harm to themselves or others, as the term "likelihood of serious harm" is defined under section 632.005, or who are significantly incapacitated by alcohol or drugs shall be placed into a temporary hold for the sole purpose of transport to the nearest appropriate facility; provided that, such determination shall be made in cooperation with at least one other paramedic or other health care professional involved in the transport.  Once in a temporary hold, the patient shall be treated with humane care in a manner that preserves human dignity, consistent with applicable federal regulations and nationally recognized guidelines regarding the appropriate use of temporary holds and restraints in medical transport.  Prior to making such a determination:

  (1)  The paramedic shall have completed a standard crisis intervention training course as endorsed and developed by the state EMS medical director's advisory committee;

  (2)  The paramedic shall have been authorized by his or her ground or air ambulance service's administration and medical director under subsection 3 of section 190.103; and

  (3)  The paramedic ground or air ambulance service has developed and adopted standardized triage, treatment, and transport protocols under subsection 3 of section 190.103, which address the challenge of treating and transporting such patients.  Provided:

  (a)  That such protocols shall be reviewed and approved by the state EMS medical director's advisory committee; and

  (b)  That such protocols shall direct the paramedic regarding the proper use of patient restraint and coordination with area law enforcement; and

  (c)  Patient restraint protocols shall be based upon current applicable national guidelines.

  2.  In any instance in which a good faith determination for a temporary hold of a patient has been made, such hold shall be made in a clinically appropriate and adequately justified manner, and shall be documented and attested to in writing.  The writing shall be retained by the ambulance service and included as part of the patient's medical file.

  3.  Paramedics who have made a good faith decision for a temporary hold of a patient as authorized by this section shall no longer have to rely on the common law doctrine of implied consent and therefore shall not be civilly liable for a good faith determination made in accordance with this section and shall not have waived any sovereign immunity defense, official immunity defense, or Missouri public duty doctrine defense if employed at the time of the good faith determination by a government employer.

  4.  Any ground or air ambulance service that adopts the authority and protocols provided for by this section shall have a memorandum of understanding with applicable local law enforcement agencies in order to achieve a collaborative and coordinated response to patients displaying symptoms of either a likelihood of serious harm to themselves or others or significant incapacitation by alcohol or drugs, which require a crisis intervention response.  The memorandum of understanding shall include, but not be limited to, the following:

  (1)  Administrative oversight, including coordination between ambulance services and law enforcement agencies;

  (2)  Patient restraint techniques and coordination of agency responses to situations in which patient restraint may be required;

  (3)  Field interaction between paramedics and law enforcement, including patient destination and transportation; and

  (4)  Coordination of program quality assurance.

  5.  The physical restraint of a patient by an emergency medical technician under the authority of this section shall be permitted only in order to provide for the safety of bystanders, the patient, or emergency personnel due to an imminent or immediate danger, or upon approval by local medical control through direct communications.  Restraint shall also be permitted through cooperation with on-scene law enforcement officers.  All incidents involving patient restraint used under the authority of this section shall be reviewed by the ambulance service physician medical director.


(L. 2018 H.B. 1355 merged with S.B. 870, A.L. 2023 H.B. 402 merged with S.B. 24 merged with S.B. 186)

---- end of effective  28 Aug 2023 ----

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190.147 8/28/2023
190.147 8/28/2018 8/28/2023

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