For 15 years, Wikbeauty has supported clinic owners across 150+ countries in maintaining safety standards. Safe patient selection is foundational—it protects patients, protects clinics, and ensures best outcomes. This detailed guide covers contraindications, screening protocols, and when to require medical clearance.

Why Contraindications Matter

Patient Safety Priority

Three Essential Protections:

1. Identify patients who shouldn't be treated (absolute contraindications)
2. Identify patients requiring medical clearance (relative contraindications)
3. Document everything (liability protection)

Clinic Protection:

• Documented screening = liability protection
• Medical clearance = shared responsibility
• Informed consent = risk management
• Safety protocols = standard of care

Patient Protection:

• Prevents adverse events
• Ensures appropriate medical oversight
• Reduces risk of complications
• Prioritizes wellbeing

Absolute Contraindications (NEVER TREAT)

What Are Absolute Contraindications?

Definition: Conditions where EMSZero treatment is unsafe, regardless of patient desire or risk-benefit analysis. NO exceptions, NO medical clearance overcomes absolute contraindications.

The Four Absolute Contraindications

1. Pacemaker or Implanted Cardioverter Defibrillator (ICD)

Why This Is Absolute:

• EMSZero uses electromagnetic stimulation (HIFEM 14 Tesla)
• Pacemakers/ICDs are electronic devices
• Risk: Device malfunction, false signals, arrhythmia
• Severity: Life-threatening potential
• No workaround: Cannot safely treat

Clinical Reality:

• Patient asks: "Can you treat around my pacemaker?"
• Correct answer: "No, we cannot treat you"
• Alternative: Refer to physician for alternative options
• Document: "Pacemaker—declined treatment per safety protocol"

Screening Question:

• "Do you have a pacemaker or ICD device?"
• If YES: Cannot treat, refer to physician

2. Active Pregnancy

Why This Is Absolute:

• EMSZero contracts uterine muscles (stimulates labor contraction patterns)
• Pregnancy complications risk: Preterm labor, miscarriage
• Fetus safety: Unknown effects of HIFEM on fetal development
• Liability: Potential pregnancy loss liability
• No treatment option: Too high risk

Clinical Reality:

• Pregnant patient asks: "Is it safe during pregnancy?"
• Correct answer: "No, we wait until postpartum"
• Timeline: Can treat 6-8 weeks postpartum (after clearance)
• Documentation: "Pregnant—declined treatment, offered postpartum option"

Screening Questions:

• "Are you currently pregnant?"
• "Could you possibly be pregnant?"
• If YES or MAYBE: Cannot treat, offer postpartum option

3. Active Infection or Fever

Why This Is Absolute:

• Immune system already fighting infection
• EMSZero stimulus adds additional stress
• Risk: Worsening infection, sepsis, systemic inflammation
• Timing: Body needs rest, not muscle stimulus
• Rule: Treat when patient is healthy

Clinical Reality:

• Patient with active cold/flu: "Can I still come?"
• Answer: "No, reschedule when you feel better"
• Rescheduled patient: Healthier, better results

Screening Questions:

• "Do you have a fever or feel sick today?"
• "Any active infection or illness?"
• If YES: Reschedule when healthy

4. Severe Uncontrolled Epilepsy

Why This Is Absolute:

• Electromagnetic stimulation = seizure risk
• Uncontrolled = unpredictable seizure pattern
• HIFEM frequency could trigger seizure
• Controlled epilepsy (medication-stable): Possibly okay with clearance
• Uncontrolled: No safe treatment option

Clinical Reality:

• Patient with epilepsy: "Can you treat me?"
• Correct approach: Requires neurology clearance
• Controlled: Likely okay, requires MD letter
• Uncontrolled: Cannot treat safely

Screening Question:

• "Do you have epilepsy or seizure disorder?"
• If YES: Requires neurology clearance letter before treating

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Relative Contraindications (Require Clearance)

What Are Relative Contraindications?

Definition: Conditions requiring medical clearance OR protocol modification. Treatment possible with MD approval and/or adjusted settings. Requires documentation and informed consent.

Major Relative Contraindications

1. Recent Surgery (Last 6-8 Weeks)

Why It's Relative:

• Fresh surgical sites still healing
• Incisions not fully closed/strengthened
• Risk: Increased bleeding, delayed healing
• Timeline: 6-8 weeks minimum before treatment
• After clearance: Can usually treat conservatively

Medical Assessment Needed:

• Type of surgery (abdominal vs. limb)
• Healing timeline (individual variation)
• Surgeon approval: Best to get letter
• Infection risk: Must be infection-free

Treatment Protocol (After Clearance):

• Start conservative: Intensity 6-7/10 (not maximum)
• Avoid surgical area: Treat different region first
• After 8 weeks: Can gradually increase intensity
• Timeline: Extend protocol if needed

Screening Question:

• "Have you had surgery in the last 6-8 weeks?"
• If YES: Require MD clearance letter, conservative settings

2. Severe Diastasis Recti (Abdominal Separation)

Why It's Relative:

• Abdominal muscles separated (pregnancy, childbirth)
• Severe cases: Weakened, non-functional rectus
• Risk: Worsening separation with EMSZero intensity
• Moderate/mild: Usually fine with conservative approach
• Severe: Requires physician assessment

Clinical Assessment:

• Patient self-report: "Doctor said I have diastasis"
• Severity classification: Mild (1-2 finger gap), moderate (2-3 fingers), severe (3+ fingers)
• Mild/moderate: Can usually treat 8-10/10 after postpartum clearance
• Severe: Start very conservative 5-6/10, or refer to physician

Treatment Protocol (Conservative):

• Intensity: Start 6-7/10 (higher intensity can worsen)
• Different areas first: Glutes, thighs, not abdomen initially
• Abdomen later: Month 3-6 after protocol starts
• Timeline: Gradual approach, monitor response

Screening Question:

• "Do you have diastasis recti or separated abdominal muscles?"
• If SEVERE: Require physician clearance

3. Metal Implants/Hardware (Non-Cardiac)

Why It's Relative:

• Metal disrupts electromagnetic field
• Non-cardiac (orthopedic plates, screws) = low risk
• Cardiac (pacemaker) = absolute contraindication
• Assessment: Type and location of metal

Clinical Approach:

• Orthopedic plates/screws: Usually fine
• Spinal fusion hardware: Usually fine (not cardiac)
• Bypass the area: Don't treat directly over metal
• Treat other areas: Glutes, abdomen, thighs possible

Treatment Protocol:

• Avoid direct treatment: Don't put applicators over metal
• Treat adjacent areas: Glutes instead of lower back
• Modified settings: May need conservative intensity
• MD letter recommended: Clarifies type of hardware

Screening Question:

• "Do you have metal plates, screws, or implants?"
• Follow-up: "What type? Where located?"
• If cardiac-related: Absolute contraindication

4. Nerve Damage or Neuropathy

Why It's Relative:

• Neuropathy = reduced sensation, altered perception
• Risk: Patient can't communicate excessive stimulation
• EMSZero creates intense sensation (which patient may not feel)
• Assessment: Type and severity of neuropathy

Clinical Approach:

• Mild neuropathy: Usually fine with modified intensity
• Severe neuropathy: Risky (patient can't sense pain)
• Diabetes-related: Common, assess individual severity
• Chemotherapy-related: Assess current status

Treatment Protocol:

• Conservative intensity: 6-7/10 maximum
• Frequent check-ins: Ask if intensity okay every 5 minutes
• Modified settings: Longer pulse duration, lower frequency
• Avoid problem area: Don't treat where neuropathy worst
• MD letter: Helpful but assess individual risk

Screening Question:

• "Do you have nerve damage or neuropathy?"
• If YES: Assess severity, require conservative settings, MD letter recommended

5. Blood Clotting Disorders or Anticoagulation Therapy

Why It's Relative:

• EMSZero creates intense muscle contraction (micro-hemorrhage risk)
• Blood thinners (warfarin, DOACs) = increased bleeding
• Clotting disorders (hemophilia, etc.) = risk
• Assessment: Specific condition and severity

Clinical Approach:

• On blood thinners (routine anticoagulation): Usually okay with conservative settings
• Severe clotting disorder: May not be candidate
• Recent clot event: Likely not candidate (acute phase)
• MD letter: Highly recommended

Treatment Protocol (If Cleared):

• Conservative intensity: 7-8/10 (not maximum)
• Monitor for bruising: Excessive bruising = reduce intensity
• Frequent check-ins: Ensure comfort
• MD oversight: Regular communication about treatment

Screening Question:

• "Are you on blood thinners or have a clotting disorder?"
• If YES: Require MD clearance letter, conservative settings

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Complete Pre-Treatment Screening Checklist

The Screening Form (Use for Every Patient)

Must-Ask Questions (Mandatory):

□ Do you have a pacemaker or ICD? (YES = cannot treat)

□ Are you pregnant or could you be pregnant? (YES = cannot treat)

□ Do you have active fever or infection? (YES = reschedule)

□ Do you have uncontrolled epilepsy? (YES = requires MD clearance)

□ Have you had surgery in last 6-8 weeks? (YES = requires MD clearance)

□ Do you have severe diastasis recti? (YES = may need MD clearance)

□ Do you have metal implants or hardware? (YES = specify type/location)

□ Do you have nerve damage or neuropathy? (YES = conservative settings)

□ Are you on blood thinners or have clotting disorder? (YES = requires MD clearance)

□ Any recent injuries to treatment area? (YES = assess individually)

□ Current medications (especially blood thinners, anticoagulants)?

□ Any other medical conditions we should know?

Documentation:

• Print form, patient signs
• Keep on file (liability protection)
• Review before each session
• Update annually or after changes

Red Flag Assessment

High-Risk Indicators (Stop and Assess):

• Answers YES to absolute contraindications (stop treatment)
• Recent surgery/injury (assess timeline)
• Multiple medications (review possible interactions)
• Vague answers to medical questions (require clarification)
• Patient seems uncertain about medical history (require MD letter)

When in Doubt:

• Require medical clearance letter
• Better to miss one patient than injure one
• MD clearance = shared responsibility
• Document everything

Medical Clearance Letters

When to Require MD Letter

Always Require:

• Pacemaker (absolute, but get letter for documentation)
• Recent surgery (within 6-8 weeks)
• Severe diastasis recti
• Uncontrolled epilepsy
• Blood clotting disorders
• Unknown or complex medical history

Recommended (Even if Relative):

• Severe neuropathy
• Major medical conditions
• Patient seems uncertain about medical status

What MD Letter Should Say

Minimum Content:

• Patient name and DOB
• Specific medical condition
• Current treatment/medications
• Doctor's clearance: "Patient is cleared for EMSZero treatment"
• Any limitations or modifications needed
• Doctor signature and credentials

Example Letter (What You Want): "I have evaluated [patient name] and confirm she has [condition]. She is currently stable on [treatment] and is medically cleared for EMSZero treatment. No modifications needed."

Red Flag Letter (Don't Accept): "I don't see any reason not to proceed" (too vague) No specific reference to EMSZero No signature or credentials

Special Populations

Postpartum Patients

Timeline:

• Vaginal delivery: 6-8 weeks before treatment
• Cesarean delivery: 8-12 weeks (surgical site healing)
• Breastfeeding: No contraindication, but timing matters

Screening:

• Delivery type and date
• Healing status (any complications?)
• Bleeding status (stopped, or still active?)
• Diastasis recti severity
• Pelvic floor status (prolapse risk?)

Treatment Protocol:

• Conservative intensity initially (weeks 1-4: 6-7/10)
• Avoid abdomen first 4-6 weeks (focus glutes, thighs)
• Gradually introduce core work after adaptation
• Pelvic floor consideration: Especially if history

Older Adults (65+)

Screening:

• Medication list (critical—many on anticoagulants)
• Cardiac history (pacemaker? recent event?)
• Bone density (fracture history?)
• Surgery history (joint replacements common)

Treatment Protocol:

• No age contraindication per se
• More likely to have relative contraindications
• Conservative intensity often appropriate
• Frequent check-ins recommended

Athletes/High-Performers

Screening:

• Recent injuries or surgeries
• Current training load (assess recovery capacity)
• Supplements/PEDs (some may interact)
• Medical clearance (if injury history)

Treatment Protocol:

• Can handle high intensity
• Schedule around training (recovery priority)
• Can combine with gym (different days)
• May want intensive protocol (deadline/performance)

Documentation and Risk Management

The Paper Trail (Liability Protection)

Essential Documents:

1. ✅ Signed screening form (patient answers)
2. ✅ Consent form (patient acknowledges risks)
3. ✅ MD clearance letter (if applicable)
4. ✅ Session notes (what was treated, settings)
5. ✅ Any adverse events (documented immediately)

Organization:

• File per patient (digital or physical)
• Keep for 5-7 years minimum
• Organized and retrievable
• Legally defensible

Informed Consent

What Should Consent Cover:

• Soreness is expected
• Results not guaranteed
• Risks: Soreness, possible bruising, discomfort
• Benefits: Potential muscle gain, fat loss
• Alternatives: Standard 12-week vs. intensive protocol
• Right to stop treatment anytime

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Frequently Asked Questions

Q: If someone has pacemaker, can I do different treatment?
A: No. Pacemaker is absolute contraindication—cannot treat this patient. Refer to physician for alternatives.

Q: How long after surgery can patient be treated?
A: Generally 6-8 weeks minimum. Longer for abdominal/cesarean (8-12 weeks). Require MD clearance.

Q: What if patient lies about medical history?
A: Not your responsibility if patient is untruthful. Documented screening form protects you. Patient liability.

Q: Can I treat around a pacemaker (different area)?
A: No. Electromagnetic field affects the pacemaker regardless of applicator location. Cannot treat patient.

Q: What about patients on aspirin (mild blood thinner)?
A: Usually fine. Aspirin is mild anticoagulant. Requires MD clearance only if high-dose or combined with other thinners.

Q: Is pregnancy an absolute or relative contraindication?
A: Absolute. No exceptions. Risk of preterm labor too high. Refer to postpartum protocol.

Q: What if patient has mild neuropathy?
A: Relative contraindication. Requires MD clearance and conservative intensity (6-7/10). Monitor closely.

Q: Do I need MD letter for every relative contraindication?
A: Recommended for all. Better to have letter and don't need it than need it and don't have it.

Q: What if patient refuses screening form?
A: Don't treat. Screening form is liability protection for you. Reasonable safety requirement.

Q: Can I charge for screening consultation?
A: Yes, reasonable fee for medical consultation acceptable. Protects patient, protects clinic.

Clinical Bottom Line

Safety First:

• Absolute contraindications = no exceptions
• Relative contraindications = require MD clearance
• Documentation = liability protection
• Informed consent = risk management

Key Points:

• Pacemaker, pregnancy, infection, uncontrolled epilepsy = absolute
• Recent surgery, diastasis, neuropathy, clotting = relative (require clearance)
• Screening form mandatory for every patient
• MD letters essential for relative contraindications
• File and organize documentation (5-7 year retention)

Best Practice:

• Err on side of caution (get MD letter when in doubt)
• Document everything
• Have patient sign all forms
• When uncertain, require medical clearance

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EMSZero Safety Protocols: Patient Screening and Contraindications

Contact Wikbeauty:

📧 Email: cetin@wikbeauty.com
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Tell us your safety protocol questions. Contraindications, screening forms, medical clearance procedures, documentation systems, getting started.

15 years of clinic support across 150+ countries. EMSZero safety protocols refined in 150+ clinics worldwide.