What is Positional Asphyxia

The death and murder of George Floyd sent shockwaves around the world in 2020. It ignited protests and social justice initiatives, it sparked controversy and fierce debate throughout global society, and it shone a much-needed light on the horrors of systemic racism – and not just in America, either.

Brother of George Floyd: 'I just want justice' | Black Lives Matter News | Al JazeeraThe murder also provoked discussion concerning the dangers inherent to various restraining techniques sometimes used by police officers, prison officers, security guards and others; principally those techniques that involve compression of the chest or neck so that someone can’t breathe.

Positional asphyxia, which was given as Floyd’s official cause of death, is extremely dangerous. As we’ve unfortunately seen, it can result in sudden death, as well as a multitude of serious injuries.

Table of Contents

In this feature, we’ll be examining the hazards of positional asphyxia, as well as the nature of violence either meted out by or directed toward security officers in general.

Every effort will be made to handle the subject with sensitivity, seriousness and respect.

Positional Asphyxia

Positional asphyxia, also known as postural asphyxia, occurs when a person or animal’s body position prevents them from from being able to breathe.

In some cases, the diaphragm is essentially crushed under the weight of the body abdominal organs, often as a result of compression of the torso. This hampers abdominal breathing and, as time passes, also restricts chest breathing, ultimately suffocating the subject.

In other cases, the mouth and nose are obstructed by the body’s position, which causes asphyxia to occur and stop the person from breathing, resulting in death.

Sometimes, positional asphyxia is caused by disruption of the circulation by the body position, which in turn restricts the body’s normal gas exchange from occurring.

Regardless of how it happens, positional asphyxia is extremely dangerous – and can sometimes result in death.

Positional asphyxia can sometimes be caused by application of various techniques known as ‘prone restraint’. These techniques involve a person being pinned to the ground, sometimes with a knee placed against their chest or neck.

Positional asphyxia can cause death to occur suddenly and is often difficult to determine as a cause of sudden death, usually requiring some other form of corroborating evidence to back-up any evidence of asphyxia discovered during an autopsy.

Risk Factors

Applying any physical restraint carries with it certain unavoidable risks, both to the person applying the technique, as well as to the subject him/herself.

There is often no way of knowing what a person’s level of physical health is before such a technique is applied. As a result, instances such as heart attacks or complications due to pre-existing medical conditions may (and occasionally do) occur during restraint.

It is of great and lasting use to always be aware of any factors that can increase the likelihood of positional asphyxia.

Risk factors may include excessive alcohol consumption or drug misused, obesity, unseen medical conditions (such as those concerning the respiratory system or heart) and exhaustion (which can cause respiratory muscle fatigue, usually after a prolonged and violent struggle with the person restraining them). Other factors may include mental illness and the size of the subject relative to the person restraining them.  

The body’s prone position during restraint is a particularly important factor. If the position of the subject is laying face-down, this increases the risk of position asphyxia, as does any restraining technique that involves airway obstruction or applying pressure to the chest or back.

Instances where a person has been forced to the ground and had their hands bound behind their back have sometimes resulted in a medical emergency or positional asphyxia occurring.

Some of these factors (e.g., too much alcohol) may be easily observed, while others (such as unseen health problems) are not at all easy to detect. It is wise to approach all situations with extreme caution and care.

Levels of breathing

There are three levels of breathing: shallow, deep, and hyperventilation.

Shallow breathing is the most common and refers to taking small, quick breaths. This type of breathing is often seen in people who are anxious or stressed.

Deep breathing is when you take slow, deep breaths from your diaphragm. This type of breathing is often used in meditation or yoga.

Hyperventilation is when you breathe too fast and your body doesn’t have enough time to remove the carbon dioxide. This can lead to dizziness, lightheadedness, and even fainting.

Should you use Neck Restraint Techniques?

We do not advocate the use of any restraint technique that actively involves any person’s neck, this is echoed by the SIA as they say “You should avoid physical restraints on a person that carry a heightened risk of positional asphyxia“, Quite simply, it is a practice that is inherently dangerous and carries with it far too many risks (along with death) as to ever be a worthwhile solution to a problem.

However, if a violent struggle ensues between a security officer and a member of the public, the security officer may find it difficult to avoid the attacker’s neck. Only in extreme cases, when this is an absolute last resort, should a neck restraint ever be employed. Even then, it must be applied as briefly as possible and with the utmost caution and care. 

Positional Asphyxia: Signs and Symptoms

Although positional asphyxia can be hard to detect and may also occur suddenly and without warning, people experiencing it will sometimes display certain symptoms and warning signs.

It is important to be familiar with these signs and symptoms. They may include a noisy person suddenly becoming quiet, vomiting, facial discoloration (such as the face turning blue), gasping for air or showing other signs of breathing difficulties, protruding veins in the neck and elsewhere, swelling (particularly in the face and neck), or verbally explaining that they can’t breathe.

All of these may be signs that positional asphyxia is taking place and should see any restraining holds relinquished at once.

Mitigating the Risk

Knowledge (and occasional use) of restraining techniques is an unfortunate but vital component of many occupations, including emergency services personnel, security officers, healthcare providers, armed forces personnel, prison officers and more.

The effects of positional restraint on heart rate and oxygen saturation - Journal of Emergency MedicineThere are many situations whereby a person may unexpectedly become aggressive or violent and it would be completely unfair to expect the people being placed in harm’s way by their occupation not to at least defend themselves.

This is part of the reason why the terms ‘reasonable force’ and ‘excessive force’ are codified by law. It is also among the reasons that the law allows for varying degrees and descriptions of assault.

However, when restraining another human being, it is always important to be aware of the dangers being posed to both parties. Positional asphyxia death is one of the very worst outcomes of the application of restraint techniques and should be avoided at all costs.

We shall conclude this overview by listing a few steps that can be taken to mitigate the high risk of positional asphyxia occurring in cases of restraint.

Steps to be Taken

Avoid Using ‘Prone Restraint’ Techniques. It is possible that a situation will arise whereby prone restraint is the only option available. Even in such cases, it must be applied with the knowledge that such techniques are extremely dangerous. Positional asphyxia death may occur very quickly and without much, if any, warning. So even as a last resort, prone restraint on the body must only be used briefly and never for extended periods.

Practice Verbally Diffusing a Situation. Anger is a temporary emotion and often arises from people not feeling respected or listened to. It isn’t always possible, but many instances of aggression or violence may be de-escalated via effective mediation techniques, active listening and better communication. Techniques such as these, when practiced properly, can remove the risk altogether.

Ensure that any/all Training is up to date. Security officers should be trained well and have their skills refreshed regularly. Outmoded training can potentially be dangerous, so it is incumbent upon employers to re-train their staff from time-to-time, as well as for security staff to request extra training (e.g., first aid and conflict resolution).

Try not to Work Alone. Where possible, security officers (especially door supervisors) should be accompanied by a colleague (or colleagues) at all times and wear a body worn camera. Sometimes the presence of multiple security officers can be off-putting to those who may be inclined towards violence. In addition, security officers can provide one another with important oversight and advice, as well as gaining evidence from multiple angles (which is useful in cases where a patron unjustly claims to have been assaulted, or to demonstrate that applying restraint on a body was necessary at the time).

Look and Listen. The symptoms of positional asphyxia have been described above. Security officers should be aware of and always pay attention to these signs. Listening is important also, if a restrained person appears to be gasping for air, unable to speak, or is actively stating that they can’t breathe (as happened in the case of George Floyd), the hold must be relinquished immediately.

Call an Ambulance. It is important to always err on the side of caution. If there are any doubts as to a person’s health, no hesitation should exist between the acknowledgement of this and the application of first aid or calling for an ambulance. If someone isn’t breathing every second counts in cases like this.

Monitor the Subject Closely. The restrained person should be closely monitored after the incident has taken place, in order to ensure that they are not suffering any ill effects from being restrained.

By following these steps, the risk of positional asphyxia will be greatly reduced. However, the risk can never be completely eradicated, and all instances of restraint are potentially dangerous.

We hope this feature has been of use to you. Positional asphyxia is a loaded subject, especially in light of the events around George Floyd. However, understanding this subject has arguably never been more relevant and important as it is right now.

The use of illegitimate physical interventions, especially vascular restraints such as choke-holds, for those with an SIA licence are strictly prohibited and poses significant danger. These techniques are not included in the mandatory training for licensed operatives by SIA and should be avoided at all costs.

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