Physical Control in Care Training Manual - Independent Advisory ...

PHYSICAL CONTROL IN CARE• Free movement of the ribs• Free movement of the diaphragmCompromise of any one, or more, of these will restrict or preventbreathing.At rest, only minimal movement is required, and this is largelyachieved by the diaphragm and the inter-costal muscles between theribs. Following exertion, or when an individual is upset or anxious, thedemands of the body increase greatly. Due to increased carbondioxide in the blood, the rate and depth of breathing increases. Thiswill require the movement of both the rib cage and the diaphragm toallow increased lung inflation. Failure to supply the body with theadditional demand for breathing (particularly during or following thestress of a physical struggle) is potentially dangerous and may lead todeath within a few minutes.Restraint AsphyxiaAny restraint technique that compromises the airway or expansion ofthe lungs may seriously impair a young person’s ability to breath, andcan lead to asphyxiation. This includes covering the mouth and/ornose, pressure to the neck region, restriction of the chest wall andrestriction of the diaphragm, which may be caused by the abdomenbecoming compressed in seated, kneeling or prone (face down)restraint positions 4 .There is a common misconception that if an individual can talk, theyare able to breath. This is not the case. Only a small amount of air isrequired to generate speech in the voice box, a much larger volume isrequired to maintain adequate oxygen levels around the body,particularly over the course of several minutes of struggle during aresisted restraint. A person dying from restraint asphyxia may well beable to speak before collapse.A degree of asphyxia can result from any restraint position in whichthere is restriction of the airway, chest or diaphragm, particularly inthose where the head is forced downward towards the knees.4 Parkes, J. (2002) ‘A Review Of The Literature On Positional Asphyxia As A Possible Cause OfSudden Death During Restraint.’ British Journal Of Forensic Practice. 4(1) 24-30© National Offender Management Service National Tactical Response GroupJuly 201031