Positional asphyxia
Positional asphyxia, also known as postural asphyxia, is a form of
Background
A 1992 article in The American Journal of Forensic Medicine and Pathology[1] and a 2000 article in The American Journal of Forensic Medicine and Pathology said that multiple cases have been associated with the hogtie or hobble prone restraint position.
The
Resuscitation of persons who exhibit cardiac arrest following restraint has proven to be difficult, according to a 1995 article in Annals of Emergency Medicine. Even in cases where the subject was in the immediate care of paramedics, resuscitation has failed and the subject has died.[5] A March 1999 article in the Academic Emergency Medicine journal reported that one group of doctors had presented a method of resuscitation, correcting acidosis in the blood of the victim, which proved effective in their small scale study.[6] A 2010 article in the Journal of the Tennessee Medical Association reported a single case of successful resuscitation using "aggressive sedation", "ventilatory assistance" among other interventions but added that "avoiding hobble and prone restraint positions may eliminate some of the problems".[7]
In 1997 Annals of Emergency Medicine article reported on a single small laboratory study in which "15 healthy men ages 18 through 40 years" were placed in the "hobble" or "hog-tie" restraint position. Researchers found that the effects of restraint on the breathing and oxygen levels these 15 healthy men, was limited.[8]
A 2002 review of the literature published in the British Journal of Forensic Practice said that restraining a person in a face-down position is likely to cause greater restriction of breathing than restraining a person face-up.[9]
A 2008 article in Medicine, Science and the Law said that the way the subject is restrained can also increase the risk of death, for example kneeling or otherwise placing weight on the subject and particularly any type of restraint hold around the subject's neck. Research measuring the effect of restraint positions on lung function suggests that restraint which involves bending the restrained person or placing body weight on them has more effect on their breathing than face-down positioning alone.[10]
In the United States, there were 16 cases reported deaths in police custody between 1998 and 2009 in which restraint was a "direct or contributory factor to the death." The investigation into the deaths resulted in a 2010 report tabled by the Independent Police Complaints Commission (IPCC).[11]
Prolonged (particularly resisted) restraint, obesity, prior cardiac or respiratory problems, and the use of illicit drugs such as cocaine can increase the risk of death by restraint, according to a 2001 article in American Journal of Emergency Medicine.[12]
Positional asphyxia is not limited to restraint in a face down position according to a 2011 article in Medicine, Science, and the Law. Restraining a person in a seated position may also reduce the ability to breathe, if the person is pushed forwards with the chest on or close to the knees. The risk will be higher in cases where the restrained person has a high body mass index (BMI) and/or large waist girth.[13]
A 2012 series by the Bureau of Investigative Journalism (TBIJ) reported that, since the late 1990s, coroners used the term "excited delirium", to explain restraint-related deaths involving police officers.[14] A May 1997 article in Wiener klinische Wochenschrift said that deaths in real life situations occur after excited delirium, which had not been studied in laboratory simulations at that time.[15]
Accident or illness
Positional asphyxia may also occur as a result of accident or illness, according to a 2008 article in the Journal of Forensic and Legal Medicine.[16] This can include bed rail strangulation.[17]
A 2008 EMBO Reports article on
Olympic track athlete
both died due to positional asphyxia, the former following an epileptic seizure and the latter following a fall down a flight of stairs.References
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- ^ a b Positional Asphyxia—Sudden Death (PDF) (Report). 1995.
- ^ ISSN 0362-4331. Retrieved June 8, 2020.
- ^ Reay, D.T. (1996). "Suspect Restraint and Sudden Death". Law Enforcement Bulletin. Quantico, Virginia. via Federal Bureau of Investigation
- PMID 7741355.
- PMID 10192677.
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- PMID 9360565.
- ^ Parkes, J. (2002) ‘A Review of the Literature on Positional Asphyxia as a Possible Cause of Sudden Death During Restraint.’ British Journal of Forensic Practice. 4(1) 24–30.
- S2CID 46557450.
- ^ Bell, Dan (January 1, 2012). "Police guidelines permit techniques that can kill". The Bureau of Investigative Journalism (TBIJ). Archived from the original on January 27, 2013. Retrieved June 7, 2020.
- PMID 11326341.
- S2CID 28631704.
- ^ Mole, Charlie; Stickler, Angus (February 13, 2012). "Excited delirium case list". The Bureau of Investigative Journalism (TBIJ). Archived from the original on January 27, 2013. Retrieved June 7, 2020.
- PMID 9200808.
- PMID 18761306.
- ^ "Cold Spring nursing home cited after resident's bed-rail asphyxiation – Twin Cities". 23 July 2013. Retrieved 2020-06-08.
- PMID 18246101.
- Salon.
- ^ "Medical examiner says a fall killed John Marzano". Philadelphia Inquirer. July 18, 2008.