Emergency use of manual restraints under 245D.061.

Subdivision 9 puts a fork in the road every license holder must choose at, in writing. The policy must either describe the types of manual restraint staff are allowed to use on an emergency basis, or prohibit them and identify the alternative measures staff must use when conduct poses an imminent risk of physical harm and less restrictive strategies would not achieve safety (Minn. Stat. 245D.061, subd. 9). There is no silent option. Either way, the policy must also specify:

• The positive support strategies staff must use to attempt de-escalation before behavior poses an imminent risk of physical harm
• Instructions for safe and correct implementation of any allowed restraint procedures
• The training staff must complete, and by when, before they may implement an emergency use of manual restraint
• The monitoring procedures and forms: what is monitored, how often, and who is responsible
• The instructions, forms, and timelines for the implementing staff person's incident report
• The procedures and timelines for the internal review and expanded support team review, and who ensures corrective action or support plan addendum revisions happen

The training requirement has teeth. Beyond orientation and annual training under section 245D.09, subdivision 4, restraint training must cover eight named subjects — among them alternatives to restraint, de-escalation and avoiding power struggles, simulated experience of both administering and receiving any allowed procedure, thresholds for starting and stopping, and recognizing physical signs of distress, including positional asphyxia (Minn. Stat. 245D.061, subd. 9).

This document stays a live obligation regardless of the licensing climate — the current 245D application moratorium pauses new licenses, not the duties of existing license holders. See our guide to the full 245D policy and procedure set for where it fits among the others.

Each emergency use starts a fixed sequence:

• During the incident — complete the commissioner-approved monitoring form (subd. 4).
• Within 3 calendar days — the implementing staff person reports in writing to the designated coordinator: who was involved, the environment, what less restrictive alternatives were tried and for how long, everyone's condition before, during, and after, any injuries, and whether a debriefing was held or is planned. A copy goes in the service recipient record (subd. 5).
• Within 5 working days of the use — the license holder completes and documents an internal review (subd. 6).
• Within 30 days of the internal review — any corrective action plan it produces must be implemented (subd. 6).
• Within 5 working days of the internal review — the expanded support team is consulted to define the antecedent, identify the function the behavior served, and decide whether the support plan addendum needs revision under sections 245D.07 and 245D.071 (subd. 7).
• Within 5 working days of the team review — all three documents go to DHS and the Office of the Ombudsman for Mental Health and Developmental Disabilities (subd. 8).

The internal review is not a formality. It must evaluate whether the person's service and support strategies need revision, whether policies were followed and were adequate, whether staff need more training, whether the event resembles past events, and whether corrective action is needed to protect health and welfare (Minn. Stat. 245D.061, subd. 6).

One nuance agencies get wrong: the single-incident rule. A release attempt followed by immediate re-escalation and immediate reimplementation counts as one incident — provided staff attempted release the moment they believed the imminent risk had passed. Anything else is a separate incident with its own reporting chain (Minn. Stat. 245D.061, subd. 5).