also cause stress and have adverse consequences for health. The regular and long-lasting use of strap systems can result in muscular atrophy. As a result, the ability to stand and walk deteriorates after a phase of restraint. Forced immobility promotes complications such as decubitus, deep-vein thrombosis in the legs and pneumonia. Improper and unprofessional use, such as restraint using belts, etc., can result in injuries like skin abrasions, haematoma, soft-tissue bruising, nerve damage and fractures; in a worst-case scenario, it can even result in death through suffocation.  Doctors and professional nursing staff must always try to recognise the causes for restlessness, tendencies to run away and potential risks of falls and to remedy them without restraints if possible.  Restraints using straps may only be used with medical products approved for this use. 2.2. Hospitals and psychiatric institutions and facilities 2.2.1. Introduction In the year under review, the commissions visited 30 hospitals, including 19 psychiatric and 11 somatic clinics/wards. The expansion of visits by the NPM to hospital wards with a different specialisation than psychiatric illnesses is due to the circumstance that elderly persons with dementia and multi-morbidity increasingly require treatment in hospitals. Hospitals have to be prepared with regard to safeguarding their rights to freedom. They are also subject to the regulations of the Nursing and Residential Homes Residence Act for the particular protection of this group of persons. In the course of these visits, commissions found repeatedly that more lenient solutions to avoid measures that restrict freedom such as low profile beds or sensor floor mats are not available or only available to an insufficient extent. This means that the equipment in hospitals has more deficits than in retirement and nursing homes. Furthermore, the commissions identified deficits in information and training for personnel in the areas of de-escalation, aggression management and handling measures that restrict freedom. Deficits in equipment and training As a reaction to these observations by Commission 5, the Land Lower Austria assured the NPM that it will increase its investment in such alternatives. In 2015 and also continuing in 2016, some of the focal points in training offerings for hospital personnel in Lower Austria were/will be victim protection and prevention of violence, application of the Nursing and Residential Homes Residence Act in hospitals, deescalation, self-defence and self-protection. For the first time, courses will be offered to train “trainers for de-escalation and safety 44