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U.S. Department Justice June 1995 Police, sheriffs, and correctional officers have a limited and largely inadequate set of tools to use to safely subdue violent and aggressive subjects. Through NIJ's National Law Enforcement Technology Center (NLETC), the Federal Government is working to identify and support the development of a range of less-than-lethal technologies-from those suitable for one-on-one encounters to those that might be used for stopping fleeing vehicles. In a recent analysis of in-custody deaths, we discovered evidence that unexplained in-custody deaths are caused more often than is generally known by a little-known phenomenon called positional asphyxia. This NLETC bulletin presents information relevant to positional asphyxia-i.e., death as a result of body position that interferes with one's ability to breathe- as it occurs within a confrontational situation involving law enforcement officers.. We offer this information to help officers recognize factors contributing to this phenomenon and, therefore, enable them to respond in a way that will ensure the subject's safety and minimize risk of death. The bulletin identifies factors found to precipitate positional asphyxia, and provides recommendations for ensuring a subject's safety and advisory guidelines for care of subjects. Information regarding the collection of potential evidence in cases involving positional asphyxia is also included. Through officer awareness and resultant action, it is anticipated that deaths attributable to this cause will be reduced. Sudden in-custody death is not a new phenomenon-it can occur at any time, for a variety of reasons. Any law enforcement agency may experience a sudden in-custody death, and while rare, such deaths appear to be associated most often with the following variables: Cocaine-induced bizarre or frenzied behavior. When occurring while confined by restraints, cocaine induced excited delirium (an acute mental disorder characterized by impaired thinking, disorientation, visual hallucinations, and illusions) may increase a subject's susceptibility to sudden death by effecting an increase of the heart rate to a critical level. Drugs and/or alcohol intoxication. Drug and acute alcohol intoxication is a major risk factor because respiratory drive is reduced, and subjects may not realize they are suffocating. Violent struggle extreme enough to require the officers to employ some Ape of restraint technique. Subjects who have engaged in extreme violent activities may be more vulnerable to subsequent respiratory muscle failure. Unresponsiveness of subject during or immediately after a struggle. Such unresponsive behavior may indicate cardiopulmonary arrest and the need for immediate medical attention. It is important to understand how preexisting risk factors, combined with the subject's body position when subdued or in transit, can compound the risk of sudden death. Information contained in this bulletin may help to alert officers to those factors found frequently in deaths involving positional asphyxia. Basic Physiology of a Struggle A person lying on his stomach has trouble breathing when pressure is applied to his back. The remedy seems relatively simple: get the pressure off his back. However, during a violent struggle between an officer or officer and a suspect, the solution is not as simple as it may sound. Often, the situation is compounded by a vicious cycle of suspect resistance and officer restraint: A suspect is restrained in a face-down position, and breathing may become labored. Weight is applied to the person's back-the more weight, the more severe the degree of compression. The individual experiences increased difficulty breathing. The natural reaction to oxygen deficiency occurs-the person struggles more violently. The officer applies more compression to subdue the individual. Predisposing Factors to Positional Asphyxia Certain factors may render some individuals more susceptible to positional asphyxia following a violent struggle, particularly when prone in a face-down position: Obesity. The risk of positional asphyxia is compounded when an individual with predisposing factors becomes involved in a violent struggle with an officer or officers, particularly when physical restraint includes use of behind-the-back handcuffing combined with placing the subject in a stomach-down position. Advisory Guidelines for Care of Subdued Subjects To help ensure subject safety and minimize the risk of sudden in-custody death, of ricers should learn to recognize factors contributing to positional asphyxia Where possible, avoid the use of maximally prone restraint techniques (e.g., hogtying). To help minimize the potential for in-custody injury or death, officers should: Follow existing training and policy guidelines for situations involving physical restraint of subjects. As soon as the suspect is handcuffed, get him off his stomach. Ask the subject if he has used drugs recently or suffers from any cardiac or respiratory diseases or conditions such as asthma, bronchitis, or emphysema. Monitor subject carefully and obtain medical treatment if needed. Be trained to recognize breathing difficulties or loss of consciousness and immediately transport the individual to the emergency room, or call for an emergency medical team (EMT) unit if such signs are observed. Obtain medical care upon subject's request. If the subject is turned over to a detention facility, inform the facility's custodians of any preexisting medical conditions (cardiac, respiratory) or that the subject requested or needed medical treatment because of respiratory difficulty or because he became unconscious. Collection of Potential Evidence Officers involved in confrontational situations should collect information that may later be of value in a civil or perhaps criminal action. A use-of-force report should include details of how the individual was restrained. The following information should be included: What was the nature of the post-arrest restraint procedure? Identify whatever type of restraint (including chemical incapacitants) was used. How long was the subject face down and/or restrained? How was the subject transported, and in what position was the subject during transport? How long did the transport phase last, and what observations were made of the subject's condition? To reasonably establish the cause of death or serious injury, a broad range of factors must be examined: Nature of the confrontation. Weapon(s), if any, employed by officer. Duration of the physical combat. System or type of post-arrest restraint employed. Transportation of the subject: destination, duration, mode of transport, and position of subject during transport. Emergency room observations and actions, names of attending medical personnel. Postmortem examination (autopsy) of subject: nature of injuries, diseases present, drugs present, and other physical factors. Conclusion To help minimize the risk of positional asphyxia, diligent observation and monitoring of subjects displaying any one or a combination of the described indicators are procedurally warranted. Furthermore, the use of maximal, prone restraint techniques should be avoided. If prone positioning is required, subjects should be closely and continuously monitored. By implementing such procedural protocols, the potential for in-custody deaths may be lessened. |
