Positional asphyxia, also known as postural asphyxia, is a form of

asphyxia 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 m ...

which occurs when someone's

position Position often refers to: * Position (geometry), the spatial location (rather than orientation) of an entity * Position, a job or occupation Position may also refer to: Games and recreation * Position (poker), location relative to the dealer * ...

prevents the person from

breath Breathing (spiration or ventilation) is the neuroscience of rhythm, rhythmical process of moving air into (inhalation) and out of (exhalation) the lungs to facilitate gas exchange with the Milieu intérieur, internal environment, mostly to flu ...

ing 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.

Background

A 1992 article in ''The American Journal of Forensic Medicine and Pathology'' 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 The City of New York Police Department, also referred to as New York City Police Department (NYPD), is the primary law enforcement agency within New York City. Established on May 23, 1845, the NYPD is the largest, and one of the oldest, munic ...

's guidelines, explaining protocols for mitigating in-custody deaths, were published in a 1995 Department of Justice bulletin on "positional asphyxia." The NYPD recommended that, " soon as the subject is handcuffed, get him off his stomach. Turn him on his side or place him in a seated position." 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. via Federal Bureau of Investigation 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. A March 1999 article in the ''Academic Emergency Medicine'' journal reported that one group of doctors had presented a method of resuscitation, correcting

acidosis Acidosis is a biological process producing hydrogen ions and increasing their concentration in blood or body fluids. pH is the negative log of hydrogen ion concentration and so it is decreased by a process of acidosis. Acidemia The term ac ...

in the blood of the victim, which proved effective in their small scale study. 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". 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. 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. A 2008 article in ''

Medicine, Science and the Law ''Medicine, Science and the Law'' is a quarterly peer-reviewed medical journal covering forensic medicine and forensic science, science. It was established in 1960 and was originally published by Sweet & Maxwell; it is now published by SAGE Public ...

'' 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. 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). 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''. 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 Body mass index (BMI) is a value derived from the mass (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...

(BMI) and/or large waist girth. 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. A May 1997 article in said that deaths in real life situations occur after excited delirium, which had not been studied in laboratory simulations at that time.

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''. This can include bed rail strangulation. A 2008 ''EMBO Reports'' article on

sudden infant death syndrome Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and ...

, said that the number of diagnoses of 'accidental suffocation', 'wedging' or 'positional asphyxia' had increased." Olympic track athlete Florence Griffith-Joyner and ex-Major League Baseball player

John Marzano John Robert Marzano (February 14, 1963 – April 19, 2008), commonly referred to as "Johnny Marz", was an Americans, American professional baseball catcher, who played in Major League Baseball (MLB) for the Boston Red Sox, Texas Rangers (baseball ...

both died due to positional asphyxia, the former following an epileptic seizure and the latter following a fall down a flight of stairs.

References

{{reflist, 30em Asphyxia Law enforcement Causes of death