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

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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
PHYSICAL CONTROL IN CARERestraints where the subject is seated require particular caution,since the angle between the chest and the lower limbs is alreadydecreased. Compression of the torso against or towards the thighsrestricts the diaphragm and further compromises lung inflation. Thisalso applies to prone restraints, where the body weight of theindividual, and restraining staff, can act to restrict the chest wall andthe abdomen. 5Subjects who are obese are particularly vulnerable when placed ineither the prone position or are seated with their stomach pushedforward toward their legs. These positions restrict the diaphragm andcan lead to difficulties in breathing.The use of restraint holds around the neck may be very effective andtherefore tempting to staff in serious situations. However, they have along history of causing sudden death during restraint. 6 Thereforerestraint holds around the neck must not be used.Risk factors for restraint asphyxiaAny factors that increase the body’s oxygen requirements ordecrease the ability to breathe will increase the risk of restraintasphyxia. A list of identified risk factors 7 is given below:• Prolonged restraint, where the person violently resists foran extended period of time. (This has been identified as thesingle greatest risk factor)• Obesity• Restriction of or pressure to the neck, chest and abdomen• Restraint of an individual of small stature• Any underlying respiratory disease (e.g. asthma)• Alcohol, or drug intoxication (alcohol and several other drugscan affect the brain’s control of breathing). Alcohol is associatedwith death at high levels, through alcoholic poisoning.5 Parkes, J. & Carson, R. (2008) ‘Sudden Death During Restraint: Do Some Positions Affect LungFunction.’ Medicine, Science and the Law 48(2) 137-416 Reay, D.T., Eisele, J.W. (1982) 'Death from Law Enforcement Neck Holds.' The AmericanJournal of Forensic Medicine and Pathology. 3(3) 253-8.7 Stratton, S.J., Rogers, C., Brickett, K., Gruzinski, G. (2001) 'Factors associated with suddendeath of individuals requiring restraint for excited delirium.' American Journal Of EmergencyMedicine 19(3): 187-91© National Offender Management Service National Tactical Response GroupJuly 201032
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