positional asphyxia

Positional asphyxia, also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents the person from breathing adequately. People may die from positional asphyxia accidentally, when the mouth and nose are blocked, or where the chest may be unable to fully expand. Background A 1992 article in The American Journal of Forensic Medicine and Pathology and a 2000 article in The American Journal of Forensic Medicine and Pathology said that multiple cases have been associated with the hogtie or hobble prone restraint position. The New York Police Department’s guidelines, explaining protocols for mitigating in-custody deaths, were published in a 1995 Department of Justice bulletin on "positional asphyxia." The NYPD recommended that, “[a]s soon as the subject is handcuffed, get him off his stomach. Turn him on his side or place him in a seated position." A 1996 FBI bulletin said that many law enforcement and health personnel were being taught to avoid restraining people face-down or to do so only for a very short period of time. Resuscitation of persons who exhibit cardiac arrest following restraint has proven to be difficult, according to a 1995 article in Annals of Emergency Medicine. Even in cases where the subject was in the immediate care of paramedics, resuscitation has failed and the subject has died. A March 1999 article in the Academic Emergency Medicine journal reported that one group of doctors had presented a method of resuscitation, correcting acidosis in the blood of the victim, which proved effective in their small scale study. A 2010 article in the Journal of the Tennessee Medical Association reported a single case of successful resuscitation using "aggressive sedation", "ventilatory assistance" among other interventions but added that "avoiding hobble and prone restraint positions may eliminate some of the problems".