This bulletin presents information about positional asphyxia in order to educate the law enforcement community, thereby minimizing sudden in-custody deaths.
The cause of most explained in-custody deaths is a little-known phenomenon called positional asphyxia, in which body position interferes with the ability to breathe. Several pre-existing factors are identified that increase an individual’s susceptibility to positional asphyxia, including cocaine-induced frenzied behavior, other drugs and/or alcohol intoxication, violent struggle resulting in restraint of subject, and unresponsiveness during or immediately after struggle. A subject’s pre-existing risk, coupled with their body position when subdued or in transit, can combine to substantially increase their risk of sudden death from positional asphyxia. Other pre-disposing factors that raise the risk for positional asphyxia following a violent struggle, particularly when the subject is in a face-down position, include obesity and an enlarged heart. Advisory guidelines for the care of subdued subjects are offered to minimize the potential for in-custody injury or death. The officer should remove the subject from their stomach as soon as they are handcuffed; it should be ascertain if the subject has recently used drugs or suffers from any medical condition; the subject should be monitored carefully; officers should be trained to recognize problematic breathing; medical care should be obtained upon the subject’s request; and detention staff should be alerted of any irregularities. A use-of-force report should include the nature of the post-arrest restraint procedure, the length of restraint time, and position of subject during transport. If an in-custody death occurs, the investigation should focus on the nature of the confrontation, the duration of the physical contact, and the system or type of restraint used. By being aware of the potential for positional asphyxia, law enforcement officers can minimize the risk posed to subjects involved in struggles with officers. Figure
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