Positional asphyxia, also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents the person from breathing adequately. People may die from positional asphyxia accidentally, when the mouth and nose are blocked, or where the chest may be unable to fully expand.
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 New York Police Department's guidelines, explaining protocols for mitigating in-custody deaths, were published in a 1995 Department of Justice bulletin on "positional asphyxia." [2] [3] The NYPD recommended that, "[a]s soon as the subject is handcuffed, get him off his stomach. Turn him on his side or place him in a seated position." [2] [3] A 1996 FBI bulletin said that many law enforcement and health personnel were being taught to avoid restraining people face-down or to do so only for a very short period of time. [4]
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 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]
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 sudden infant death syndrome, said that the number of diagnoses of 'accidental suffocation', 'wedging' or 'positional asphyxia' had increased." [18]
Olympic track athlete Florence Griffith-Joyner [19] and ex-Major League Baseball player John Marzano [20] both died due to positional asphyxia, the former following an epileptic seizure and the latter following a fall down a flight of stairs.
Cardiac arrest, also known as sudden cardiac arrest, is when the heart suddenly and unexpectedly stops beating. As a result, blood cannot properly circulate around the body and there is diminished blood flow to the brain and other organs. When the brain does not receive enough blood, this can cause a person to lose consciousness. Coma and persistent vegetative state may result from cardiac arrest. Cardiac arrest is also identified by a lack of central pulses and abnormal or absent breathing.
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.
Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects all the tissues and organs, some more rapidly than others. There are many circumstances that can induce asphyxia, all of which are characterized by the inability of a person to acquire sufficient oxygen through breathing for an extended period of time. Asphyxia can cause coma or death.
Physical restraint refers to means of purposely limiting or obstructing the freedom of a person's or an animal's bodily movement.
Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, vomiting, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration of vomit, or acute respiratory distress syndrome.
A TASER is a conducted energy device (CED) primarily used to incapacitate people, allowing them to be approached and handled in an unresisting and thus less-lethal manner. Sold by Axon, formerly TASER International, the TASER fires two small barbed darts intended to puncture the skin and remain attached to the target until removed by the user of the TASER device, at a speed of 55 m/s. Their range extends from 4.5 m (15 ft) for non-Law Enforcement Tasers to 10.5 m (34 ft) for Law Enforcement Tasers. The darts are connected to the main unit by thin laquer insulated copper wire and deliver a modulated electric current designed to disrupt voluntary control of muscles, causing "neuromuscular incapacitation." The effects of a taser may only be localized pain or strong involuntary long muscle contractions, based on the mode of use and connectivity of the darts.
The hogtie is a method of tying the limbs together, rendering the subject immobile and helpless. Originally, it was applied to pigs and other young four-legged animals.
Precordial thump is a medical procedure used in the treatment of ventricular fibrillation or pulseless ventricular tachycardia under certain conditions. The procedure has a very low success rate, but may be used in those with witnessed, monitored onset of one of the "shockable" cardiac rhythms if a defibrillator is not immediately available. It should not delay cardiopulmonary resuscitation (CPR) and defibrillation, nor should it be used in those with unwitnessed out-of-hospital cardiac arrest.
Erotic asphyxiation is the intentional restriction of oxygen to the brain for the purposes of sexual arousal. The term autoerotic asphyxiation is used when the act is done by a person to themself. Colloquially, a person engaging in the activity is sometimes called a gasper. Erotic asphyxiation can lead to accidental death due to asphyxia.
Perinatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It remains a serious condition which causes significant mortality and morbidity. It is also the inability to establish and sustain adequate or spontaneous respiration upon delivery of the newborn, an emergency condition that requires adequate and quick resuscitation measures. Perinatal asphyxia is also an oxygen deficit from the 28th week of gestation to the first seven days following delivery. It is also an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs and may be associated with a lack of ventilation. In accordance with WHO, perinatal asphyxia is characterised by: profound metabolic acidosis, with a pH less than 7.20 on umbilical cord arterial blood sample, persistence of an Apgar score of 3 at the 5th minute, clinical neurologic sequelae in the immediate neonatal period, or evidence of multiorgan system dysfunction in the immediate neonatal period. Hypoxic damage can occur to most of the infant's organs, but brain damage is of most concern and perhaps the least likely to quickly or completely heal. In more pronounced cases, an infant will survive, but with damage to the brain manifested as either mental, such as developmental delay or intellectual disability, or physical, such as spasticity.
A chokehold, choke, stranglehold or, in Judo, shime-waza is a general term for a grappling hold that critically reduces or prevents either air (choking) or blood (strangling) from passing through the neck of an opponent. The restriction may be of one or both and depends on the hold used and the reaction of the victim. While the time it takes for the choke to render an opponent unconscious varies depending on the type of choke, the average across all has been recorded as 9 seconds.
Agonal respiration, gasping respiration or agonal breathing is a distinct abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Possible causes include cerebral ischemia, extreme hypoxia, or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death. The duration of agonal respiration can be as brief as two breaths or last up to several hours.
The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.
Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a widely rejected diagnosis characterized as a potentially fatal state of extreme agitation and delirium. It has typically been diagnosed postmortem in young adult black males who were physically restrained by law enforcement personnel at the time of death.
Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. Early symptoms include intoxication, vomiting and abdominal pain. Later symptoms may include a decreased level of consciousness, headache, and seizures. Long term outcomes may include kidney failure and brain damage. Toxicity and death may occur after drinking even in a small amount as ethylene glycol is more toxic than other diols.
The following outline is provided as an overview of and topical guide to emergency medicine:
Roberto Laudisio Curti, known as Beto Laudisio, was a 21-year-old man from São Paulo, Brazil. He died on 18 March 2012 after being pursued, tackled, tasered, sprayed with OC spray, and physically compressed under the weight of multiple police officers of the New South Wales Police Force in Sydney, Australia.
Acute behavioral disturbance (ABD) is an umbrella term referring to various conditions of medical emergency where a person behaves in a manner that may put themselves or others at risk. It is not a formal diagnosis. Another controversial term, the widely rejected idea of excited delirium, is sometimes used interchangeably with ABD.
On March 23, 2020, Daniel Prude, a 41-year-old African-American man, died after being physically restrained by Rochester, New York police officers. Prude had been suffering from a mental health episode after ingesting PCP and left his brother's house in a disturbed and naked state. His brother called the police, which then led to the encounter with law enforcement in the street outside of his brother's house. The officers put a spit hood over his head after he began spitting. They restrained him face-down on the street for two minutes and fifteen seconds, and he stopped breathing. Prude received CPR on the scene and later died of complications from asphyxia after being taken off life support.
Bell's mania, also known as delirious mania, refers to an acute neurobehavioral syndrome. This is usually characterized by an expeditious onset of delirium, mania, psychosis, followed by grandiosity, emotional lability, altered consciousness, hyperthermia, and in extreme cases, death. It is sometimes misdiagnosed as excited delirium (EXD) or catatonia due to the presence of overlapping symptoms. Pathophysiology studies reveal elevated dopamine levels in the neural circuit as the underlying mechanism. Psychostimulant users as well as individuals experiencing severe manic episodes are more prone to the manifestation of this condition. Management solutions such as sedation and ketamine injections have been discussed for medical professionals and individuals with the condition. Bell's mania cases are commonly reported in countries like the United States and Canada and are commonly associated with psychostimulant use and abuse.