Sudden Death in Individuals in Hobble Restraints During Paramedic Transport

Stratton, Samuel J.; Rogers, Catherine A.; Green, Karen

doi:10.1016/s0196-0644(95)70187-7

Cited by 95 publications

(65 citation statements)

References 9 publications

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“…Theoretically, prone positioning as opposed to lateral positioning is considered an important component for potential positional asphyxia while hobble restrained. [1][2][3][4][5][6][7][8]10 Of the 216 hobble restrained individuals encountered by EMS personnel during the study period, 81% were initially found in prone position on arrival of EMS and 9% in a lateral position, with positioning not determined in 10%. None of those who suffered sudden death while hobble restrained were found in a lateral position and therefore, calculation of a relative risk ratio for unexpected death while in prone position was not possible.…”

Section: Resultsmentioning

confidence: 99%

“…5,6 Most controversy concerning these unexpected deaths has centered on the theory of positional or restraint asphyxia as a primary contributing factor. [1][2][3][4][7][8][9][10][11] Presented in this article is a consecutive case series of 18 excited delirium sudden deaths after struggle and physical restraint. In comparison with previous published data is that all reported cases were cardiopulmonary arrests witnessed by emergency medical service (EMS) paramedics and for 13 (72%) of the cases, the initial cardiac rhythm at the time of paramedic assessment is described.…”

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confidence: 99%

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Factors associated with sudden death of individuals requiring restraint for excited delirium

Stratton

Rogers²,

Brickett

et al. 2001

The American Journal of Emergency Medicine

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273

170

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The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eighteen cases of such deaths witnessed by emergency medical service (EMS) personnel are reported. The 18 cases reported were restrained with the wrists and ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% of the sudden death cases. Associated with all sudden death cases was struggle by the victim with forced restraint and cessation of struggling with labored or agonal breathing immediately before cardiopulmonary arrest. Also associated was stimulant drug use (78%), chronic disease (56%), and obesity (56%). The primary cardiac arrest rhythm of ventricular tachycardia was found in 1 of 13 victims with confirmed initial cardiac rhythms, with none found in ventricular fibrillation. Our findings indicate that unexpected sudden death when excited delirium victims are restrained in the out-of-hospital setting is not infrequent and can be associated with multiple predictable but usually uncontrollable factors. (Am J

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Factors associated with sudden death of individuals requiring restraint for excited delirium

Stratton

Rogers²,

Brickett

et al. 2001

The American Journal of Emergency Medicine

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273

170

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“…7 Because of this, prone positioning used during or after a police use of force event has been commonly implicated as the causal factor in the subject's death, irrespective of the duration of that positioning. [3][4][5][8][9][10] M A N U S C R I P T…”

Section: Introductionmentioning

confidence: 99%

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Hall

Votova

Heyd

et al. 2015

Journal of Forensic and Legal Medicine

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Despite continued cases of sudden in-custody death in subjects who are restrained, little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. This paper reports data from 4828 consecutive use of force events (August 2006-March 2013 in 7 Canadian police agencies in 4 cities including Eastern and Western Canada. Methods: Human subjects committee approval was obtained in each city with approval for enrolment of subjects without consent. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of the cause or outcome. Officers prospectively documented the final resting position of the subject, whether there was knowledge or suspicion that the subject was intoxicated with alcohol and/or drugs, suffering from emotional distress or any combination of those, the number and nature of a standardized list of features of excited delirium present, and the use of all force modalities alone or in combination. Our outcome of interest was sudden, unexpected in-custody death. Confidence intervals for differences were considered significant if the 95% confidence interval for the difference did not include zero. Assuming an alpha error of 5%, a beta error of 20%, a sample size of 1945 subjects per group gives our study 80% power to detect a difference of 0.5% in sudden death between the prone and not prone position. Results: During the study there were over 3.25 million consecutive police-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). 90% of subjects had complete information on positioning; none of the subjects without documentation of positioning died. Subjects were usually male (87.5%); median age 32 years. Subjects were abnormal with 81.5% of subjects documented to have one or more of alcohol and/or drug intoxication, and/or psychiatric/emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; yet over 2000 subjects remained prone. Although 5.3% more subjects with any assessed comorbidity were in the "not-prone" position, over 1500 with any assessed comorbidity were prone. Significantly more individuals with >3 features of excited delirium were not-prone while significantly more subjects with drug intoxication alone were in prone. There was no difference in CEW deployment in any mode between the positions. One individual died suddenly and unexpectedly; the individual was in the not prone position and exhibited all 10 features of excited delirium. No subject died in the prone position. In a worst case scenario our confidence intervals indicate, with a high degree of precision, that 99.8% of subjects would be expected to survive being in either the prone or notprone position following police use of force. Conclusions: Prone positioning is common following police-public interactions. In this study no subject died among thousands who remained in the prone position after po...

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“…The term ''positional asphyxia" may, in fact, only be appropriate for ''intoxicated, massively obese individuals trapped in confined spaces," who are therefore unable to expand their chests. 15 In a series of 18 cases of death associated with excited delirium and restraint, 89 each subject exhibited ''labored or agonal breathing immediately before cardiopulmonary arrest." It is not uncommon for subjects with excited delirium to be observed by police officers as lacking respiratory activity (e.g., Lawrence).…”

Section: Confounding Factors That May Be Present During Ecd Applicatimentioning

confidence: 99%

Deaths in custody: Are some due to electronic control devices (including TASER® devices) or excited delirium?

Jauchem

2010

Journal of Forensic and Legal Medicine

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a b s t r a c tDeaths have occurred after law-enforcement incidents involving applications of electronic control devices (ECDs) (including TASER Ò devices). An ''excited delirium" syndrome (reported in the literature prior to the development of ECDs currently in use), however, includes several factors that may be related to such deaths in custody. In this review, potential detrimental effects of ECDs are compared with possible changes due to excited delirium. Although extreme (i.e., long-duration or repeated) exposures to ECDs can result in significant hyperkalaemia, acidaemia, and myoglobinemia in animal models, limited applications (such as those normally used in law-enforcement situations) would appear to have only transient effects. In addition, the hyperthermia observed in patients with excited delirium does not seem to be directly exacerbated by ECD applications. ECD use is unlikely to be a common cause of ventricular fibrillation, but other events that are generally associated with excited delirium (e.g., drug use) may be related to subsequent ventricular fibrillation or asystole. Metabolic or respiratory acidosis may only be serious consequences of long-duration or repeated ECD applications. On the basis of current available information, factors other than ECDs themselves may be more important when death occurs after the use of ECDs.

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Sudden Death in Individuals in Hobble Restraints During Paramedic Transport

Cited by 95 publications

References 9 publications

Factors associated with sudden death of individuals requiring restraint for excited delirium

Factors associated with sudden death of individuals requiring restraint for excited delirium

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Deaths in custody: Are some due to electronic control devices (including TASER® devices) or excited delirium?

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