DEFINITIONAny body positions of ones own

body that obstructs the restrained

persons airway or interferes with

the muscular or mechanical

components of respiration and

person can not get enough

oxygen(hypoxia) - result in

positional asphyxia.

• Deprived of Oxygen.

• Excess carbon dioxide.

• Hypoxia .

• Loss of consciousness.

Breathing is a mechanical process

involving the chest wall, rib cage,

diaphragm and abdominal muscles,

and if the movement of all, or any

of these are significantly impaired

for any length of time, then death

may result as a consequence of

hypoxia which may disturb heart

rhythm.

• Positional asphyxia has

been associated with a

number of deaths during

physical restraint,

mechanical restraint but

also during ‘hands on’

techniques, which

physically restrict the

person’s freedom of

movement.

What are Risk Factors?

• Position During Restraint (particularly face down prone but also hyper flexion).

• Prolonged struggle/agitated delirium syndrome

• Drug or alcohol intoxication, in particular cocaine and methamphetamine intoxication or cocaine-induced psychosis

• Mania

• Obesity

• Sedation/Accidents/Organic diseases/quadriplegia

• Respiratory Syndromes including Asthma and Bronchitis.

• Cardio Vascular Disorder including an enlarged heart

(hypertrophic cardiomyopathy) and other cardiovascular

disorders

• Prescribed Drugs.

A combination of factors may place individuals at Risk of

Positional Asphyxia.

Prolonged violent physical agitation

Stage 1 – Development of an incident –

The individual exhibits irrational,

violent, aggressive behaviour and

paranoia. The person may be

physically active and aroused.

Stage 2 – Intervention –

One or more interveners' are

tempted to sit or lean on the subject

to maintain control.

• The subject may perceive

this hostile and fight even

harder in an attempt to get

relief.

• The person may also be

fighting harder because they

cannot breathe and what is

perceived to be increasing

violence may actually be

increasing desperation to

stay alive.

Stage 3 – Exhaustion

• While struggling with security

staff the person expends large

amounts of energy trying to

breathe.

• The individual becomes

exhausted with low blood

oxygen and when they are

finally unable to struggle any

more, it may be too late.

Obesity

puts additional stress on

the body. In a prone

position inhibits the

person’s ability to

properly contract the

diaphragm and raise the

ribs to enlarge the chest

and inhale.

Psychosis

stimulant drugs (amphetamines,

speed, ‘ICE’, ecstasy) can create an

“excited delirium” in which the

person is paranoid, over excited

and potentially violent. The

stimulation of the heart can

produce cardiac rhythm

disturbances which can be fatal. In

this situation any difficulty

breathing can result in sudden

deterioration in condition and

death.

Pre-existing physical conditions –

• Any disease condition thatimpairs breathing under normalcircumstances will put a personat a higher risk when they arephysically restrained. Examplesare heart disease, asthma,emphysema, bronchitis andother chronic lung diseases.

• On down in a prone position,the greater the risk that therewill pressure on the person’sabdomen making it difficult tobreathe.

Influence of drugs

profound effect on the

respiratory and cardiovascular

system.

Also known as

Agitated delirium

Cocaine induced psychosis

Acute exhaustive mania • It is characterised by purposeless, often violent activity coupled

with incoherent or often meaningless speech and hallucinations with paranoid delusions

o Bizarre or aggressive behaviour• Impaired thinking• Combativeness• Super-Human Strength• Disorientation • Hallucinations• Acute onset of paranoia• Shouting

• Psychiatric illness

(combined with Drink and/or

Drugs)

• Drug intoxication

(Cocaine is the best known

cause of excited Delirium)

• Alcohol

• Hypothermia

• High tolerance to pain

• Quick to fatigue –

especially after a violent

struggle

• Skin may be hot to touch

• Abnormal Strength

Prader-Willi risk factors

Obesity

• more prone to obstructive

apnea, pulmonary

compromise, and diabetes.

High pain threshold

• Someone with PWS has

high threshold and in

addition may have difficulty

localizing pain.

Increased risk of respiratory difficulties• Hypotonic and weak chest muscles

Thick saliva• complicates airway management

Chronic stomach reflux and aspiration

Temperature instability

• Idiopathic hyper and hypothermia have been reported. Fever

may be present despite serious infection.

Bruise easilyAnatomic and physiologic differences

• such as : narrow airway, underdevelopment of the larynx,

edema, hip dysplasia, and scoliosis

Hogtie bondage

• Hogtie bondage requires the

tying of all four limbs

together behind a person's

back. It typically involves

connecting a person's wrists

and ankles behind their back

whilst lying face down using

some form of physical

restraints.

Ball tie

• The ball tie is a bondage position in

which a person is bound tightly into

a ball position. A ball position (also

called a fetal position) is one where

the legs are bent double so the heels

press against the bottom; the legs

should also be brought up so that

the thighs are pressed against the

chest. Pressing the thighs against

the abdomen may restrict

breathing .

Newborns at risk

• In newborns the airway is

kinked due to baby’s

heavy head resting with

his chin on his little chest.

However, it can also

happen in all directions

your little one’s head can

be turn.

• Who is at risk?

Newborns from 0-4 month old are the greatest risk group.

Babies under 4 months old

Newborns with low birth weight

Premature babies

Babies with hypotonia (low muscle tone)

Babies placed in reclined baby holding devices

Where can positional asphyxia happen?

Car seats

Swings

Strollers

Activity saucers

Ill designed or incorrectly used baby carriers

Crib

Playpen

Bike trailer

Incident

of

Restraint

Vicious cycle

Violent muscle activity

Respiratory muscle

energy deficit

Muscle

weakness

Hypercatabolic state

Increased oxygen

demand

Stress on heart

• Extreme physical energy expenditure generates

excessive production of adrenalin and

noradrenalin.

• A progressively increasing amount of these body

chemicals in the individuals system can occur

creating a

• “hyper- catabolic state”.

• A hyper-catabolic state can weaken all the body's

muscles especially the

• Respiratory muscles.

• The hyper-catabolic state also puts “stress” on

the heart by increasing its workload

(requiring faster and stronger contractions).

• Thus the heart needs more than normal

amounts of oxygen in order to keep it

functioning.

• If an individual with severe respiratory muscle

fatigue is restrained in a position that impairs

or prevents breathing it is easy to understand

why asphyxia can occur so quickly!

General signs and symptoms

• Noisy, laboured

breathing

• Grey-blue skin

(cyanosis/excess

deoxygenated

haemoglobin in blood )

• congestion of the face

• facial oedema

• Flaring of the nostrils

• Reversed movement of

the chest while

breathing; the chest wall

will suck in as the

casualty breathes in.

• Drawing in of the chest

wall between the ribs

and of the soft spaces

above the collarbones

and breastbone.

How to asphyxiate

• Compression to neck

• Compression to chest/back/torso

• Obstructed airways/vomiting

• Chemical/environmental

• Postural position

Distress signs

• Gurgling gasping sounds.

• Extremities cold to touch

• Face becomes flush or ashy

• Bleeding or bruising

• Seizures

• Unconsciousness

• Complaints of “I can’t breathe” or “I have chest pain”

• Limpness of the arms and legs

• A violent and loud individual suddenly changes to a passive, quiet, tranquil.

Safety points

Avoid putting direct weight or pressure on chest, stomach or back

Never put pressure on the neck or put the head in a position that compresses

the neck

Never restrain on a soft surface (mattress) or place a pillow, towel under the

head or over the mouth.

Achieve a kneeling, sitting or standing position as soon as practical.

Monitor the individual’s vital signs.

Get medical assistance immediately if you have any concerns about the

condition of the individual under restraint.

Staff made aware of basic warning signs and of respiratory distress.

Must be able to recognise factors that contribute to Positional Asphyxia

(medical history, use of drugs, etc).

Vigilant monitoring of the person’s condition must be stressed.

Recent history i.e. past 24 hours – drug taking, alcohol use etc.

Medical history – establish any heart complaint, breathing problems etc.

thanks