Physical Restraint and Near Death of a Psychiatric Patient

Abstract

Physical restraint is used as a last resort emergency measure to calm and safeguard agitated and/or aggressive psychiatric patients. This can sometimes cause injuries, and rare fatalities have occurred. One mechanism of injury and death while in physical restraint is that of severe asphyxiation. We present the case of a hospitalized man in his mid-30s, suffering from schizophrenia. The patient was obese. He became aggressive and had to be manually restrained with a "takedown." After having been put in the prone position on the floor with a significant weight load on his body, he lost respiration and consciousness. Subsequently, he was given CPR. He regained consciousness and respiration, while the cyanosis receded in 1-2 min. Psychiatrists and pathologists should be aware that physically restraining a patient in the prone position with a significant weight load on the torso can, in rare cases, lead to asphyxiation.

The clinical case report: a review of its merits and limitations

“…Or another example: Physical restraint is sometimes associated with sudden, unexpected death. The cause or causes for this are to some degree enigmatic, and it is hard to conceive of a controlled study that could be ethical [35,36]. Case reports and case series being “natural experiments” might be the only evidence available for guiding clinical practice.…”

Frequency of Physical Restraint and Its Associations With Demographic and Clinical Characteristics in a Chinese Psychiatric Institution

“…Some authors argue that PR is still necessary to prevent violence and protect the safety of patients and staff (Bak & Aggernaes, ; Cannon, Sprivulis, & McCarthy, ; Downey, Zun, & Gonzales, ; Knutzen, Sandvik, Hauff, Opjordsmoen, & Friis, ; Tunde‐Ayinmode & Little, ). Others insist that because PR has harmful physical and psychological effects on both staff (Fisher, ; Foster, Bowers, & Nijman, ) and patients (Armgart et al., ), including positional asphyxia (Nissen, Rorvik, Haugslett, & Wynn, ) and increased risk of patient mortality (Rakhmatullina, Taub, & Jacob, ), use of PR should be strictly controlled and even banned (Downey et al., ; Gaskin, Elsom, & Happell, ; Knox & Holloman, ; Sees, ; Smith et al., ).…”

Exposures to Conducted Electrical Weapons (IncludingTASER®Devices): How Many and for How Long are Acceptable?

“…Short-duration use of a CEW may be preferable to procedures such as going "handson," which may result in increased exertion by a subject and, consequently, more acidosis (214,215). Physical restraint of a psychiatric patient, particularly in a prone position, can result in asphyxiation (216). Kunz et al (217) have discussed the role of this activity as a confounding factor in cases of death otherwise presumed to be due to CEW exposure.…”