Successfully reported this slideshow.
You’ve unlocked unlimited downloads on SlideShare!
Any body positions of ones own
body that obstructs the restrained
persons airway or interferes with
the muscular or mechanical
components of respiration and
person can not get enough
oxygen(hypoxia) - result in
• Deprived of Oxygen.
• Excess carbon dioxide.
• Hypoxia .
• Loss of consciousness.
Breathing is a mechanical process
involving the chest wall, rib cage,
diaphragm and abdominal muscles,
and if the movement of all, or any
of these are significantly impaired
for any length of time, then death
may result as a consequence of
hypoxia which may disturb heart
• Positional asphyxia has
been associated with a
number of deaths during
mechanical restraint but
also during ‘hands on’
physically restrict the
person’s freedom of
What are Risk Factors?
• Position During Restraint (particularly face down
prone but also hyper flexion).
• Prolonged struggle/agitated delirium syndrome
• Drug or alcohol intoxication, in particular cocaine
and methamphetamine intoxication or cocaine-
• Sedation/Accidents/Organic diseases/quadriplegia
• Respiratory Syndromes including Asthma and Bronchitis.
• Cardio Vascular Disorder including an enlarged heart
(hypertrophic cardiomyopathy) and other cardiovascular
• Prescribed Drugs.
A combination of factors may place individuals at Risk of
Prolonged violent physical agitation
Stage 1 – Development of an incident –
The individual exhibits irrational,
violent, aggressive behaviour and
paranoia. The person may be
physically active and aroused.
Stage 2 – Intervention –
One or more interveners' are
tempted to sit or lean on the subject
to maintain control.
• The subject may perceive
this hostile and fight even
harder in an attempt to get
• The person may also be
fighting harder because they
cannot breathe and what is
perceived to be increasing
violence may actually be
increasing desperation to
Stage 3 – Exhaustion
• While struggling with security
staff the person expends large
amounts of energy trying to
• The individual becomes
exhausted with low blood
oxygen and when they are
finally unable to struggle any
more, it may be too late.
puts additional stress on
the body. In a prone
position inhibits the
person’s ability to
properly contract the
diaphragm and raise the
ribs to enlarge the chest
stimulant drugs (amphetamines,
speed, ‘ICE’, ecstasy) can create an
“excited delirium” in which the
person is paranoid, over excited
and potentially violent. The
stimulation of the heart can
produce cardiac rhythm
disturbances which can be fatal. In
this situation any difficulty
breathing can result in sudden
deterioration in condition and
Pre-existing physical conditions –
• Any disease condition that
impairs breathing under normal
circumstances will put a person
at a higher risk when they are
physically restrained. Examples
are heart disease, asthma,
emphysema, bronchitis and
other chronic lung diseases.
• On down in a prone position,
the greater the risk that there
will pressure on the person’s
abdomen making it difficult to
Influence of drugs
profound effect on the
respiratory and cardiovascular
Also known as
Cocaine induced psychosis
Acute exhaustive mania
• It is characterised by purposeless, often violent activity coupled
with incoherent or often meaningless speech and hallucinations
with paranoid delusions
o Bizarre or aggressive behaviour
• Impaired thinking
• Super-Human Strength
• Acute onset of paranoia
• Psychiatric illness
(combined with Drink and/or
• Drug intoxication
(Cocaine is the best known
cause of excited Delirium)
• High tolerance to pain
• Quick to fatigue –
especially after a violent
• Skin may be hot to touch
• Abnormal Strength
Prader-Willi risk factors
• more prone to obstructive
compromise, and diabetes.
High pain threshold
• Someone with PWS has
high threshold and in
addition may have difficulty
Increased risk of respiratory difficulties
• Hypotonic and weak chest muscles
• complicates airway management
Chronic stomach reflux and aspiration
• Idiopathic hyper and hypothermia have been reported. Fever
may be present despite serious infection.
Anatomic and physiologic differences
• such as : narrow airway, underdevelopment of the larynx,
edema, hip dysplasia, and scoliosis
• Hogtie bondage requires the
tying of all four limbs
together behind a person's
back. It typically involves
connecting a person's wrists
and ankles behind their back
whilst lying face down using
some form of physical
• The ball tie is a bondage position in
which a person is bound tightly into
a ball position. A ball position (also
called a fetal position) is one where
the legs are bent double so the heels
press against the bottom; the legs
should also be brought up so that
the thighs are pressed against the
chest. Pressing the thighs against
the abdomen may restrict
Newborns at risk
• In newborns the airway is
kinked due to baby’s
heavy head resting with
his chin on his little chest.
However, it can also
happen in all directions
your little one’s head can
• Who is at risk?
Newborns from 0-4 month
old are the greatest risk
Babies under 4 months
Newborns with low birth
Babies with hypotonia
(low muscle tone)
Babies placed in reclined
baby holding devices
Where can positional
Ill designed or incorrectly
used baby carriers
Violent muscle activity
Stress on heart
• Extreme physical energy expenditure generates
excessive production of adrenalin and
• A progressively increasing amount of these body
chemicals in the individuals system can occur
• “hyper- catabolic state”.
• A hyper-catabolic state can weaken all the body's
muscles especially the
• Respiratory muscles.
• The hyper-catabolic state also puts “stress” on
the heart by increasing its workload
(requiring faster and stronger contractions).
• Thus the heart needs more than normal
amounts of oxygen in order to keep it
• If an individual with severe respiratory muscle
fatigue is restrained in a position that impairs
or prevents breathing it is easy to understand
why asphyxia can occur so quickly!
General signs and symptoms
• Noisy, laboured
• Grey-blue skin
haemoglobin in blood )
• congestion of the face
• facial oedema
• Flaring of the nostrils
• Reversed movement of
the chest while
breathing; the chest wall
will suck in as the
casualty breathes in.
• Drawing in of the chest
wall between the ribs
and of the soft spaces
above the collarbones
How to asphyxiate
• Compression to neck
• Compression to chest/back/torso
• Obstructed airways/vomiting
• Postural position
• Gurgling gasping sounds.
• Extremities cold to touch
• Face becomes flush or ashy
• Bleeding or bruising
• Complaints of “I can’t breathe” or “I have chest pain”
• Limpness of the arms and legs
• A violent and loud individual suddenly changes to a passive, quiet, tranquil.
Avoid putting direct weight or pressure on chest, stomach or back
Never put pressure on the neck or put the head in a position that compresses
Never restrain on a soft surface (mattress) or place a pillow, towel under the
head or over the mouth.
Achieve a kneeling, sitting or standing position as soon as practical.
Monitor the individual’s vital signs.
Get medical assistance immediately if you have any concerns about the
condition of the individual under restraint.
Staff made aware of basic warning signs and of respiratory distress.
Must be able to recognise factors that contribute to Positional Asphyxia
(medical history, use of drugs, etc).
Vigilant monitoring of the person’s condition must be stressed.
Recent history i.e. past 24 hours – drug taking, alcohol use etc.
Medical history – establish any heart complaint, breathing problems etc.