the patient by the ordering physician within hour of the patient being placed in restraints Orders for restraint can be renewed, but each order cannot exceed hour for children younger than years, hours for children and adolescents between and 17 years, or hours for adults Restraints should be removed as soon as possible in an organized manner, taking into account the severity of the patient’s agitation The same number of personnel needed to place the restraints should be present when the restraints are removed, in case the restraints need to be reapplied There is no consensus as to the optimal method; some remove all restraints once the patient is judged to be safe Others prefer a stepwise approach, releasing an arm first, then the opposite leg, and finally the remaining limbs Between each step, the patient is informed that if they remain under control, the removal process will continue Patients should not be left with only one limb restrained They have too much mobility and could injure themselves or others if they become combative Disposition Patients who are at imminent risk of serious harm to others and who cannot be safely maintained in lower levels of care require admission to an inpatient psychiatric facility Alternatives to inpatient admission include partial hospitalization programs, acute residential treatment, in-home services, routine outpatient care, and, in rare circumstances, placement in the juvenile justice system Outpatient and in-home services may be of particular use when family issues are playing a significant role in the unsafe behaviors Brief placements in respite care or alternative placements for those in foster care may also be considered as a diversion from inpatient hospitalization Special efforts should be made to avoid inpatient hospitalization in very young children, children with reactive-attachment disorders, or those with personality disorders; for these populations in particular, admission may be countertherapeutic Caregivers of those being discharged home should be counseled regarding means restriction of potential weapons, provided with de-escalation strategies, and instructed on indications for return ED physicians may also use this opportunity to help parents establish, present, and/or reinforce any pertinent behavioral rules, rewards, consequences, etc for the child