When someone is restrained, there is a risk of injury to all involved. There is additional risk to restrained people which is known as positional asphyxia. Again, the below information are British Police guidelines.

What Is Positional Asphyxia

A person can stop breathing because of the position they are in and then become ‘asphyxiated.’ Positional asphyxia occurs when someone is in a position which impedes their inhalation and/or exhalation.

When Is Positional Asphyxia Most Likely?

• When a person is in a prone position causing the stomach to press up to the ribs.
• When a person is in a sitting position, and their head drops between the knees compressing the chest and abdomen.
• When a person’s head falls forward restricting the windpipe.

This can occur extremely rapidly. There are documented cases of this happening within 4 to 7 minutes. In these cases, the postmortems have failed to identify any other anatomical or toxicological findings to explain the death.

Positional Asphyxia Risk Factors

The following are factors that have been shown to add to the potential for positional asphyxia:

• Subject’s body position results in partial or complete airway constriction
• Alcohol or drug intoxication (the major risk factor)
• Inability to escape the position
• The subject is prone
• Obesity (particularly large “beer bellies”)
• Restraints
• Stress
• Respiratory muscle fatigue, following violent muscular activity (such as fighting or running away)

Positional Asphyxia Signs and Symptoms

When you see the following symptoms in someone, take immediate action to alleviate them and apply first aid if required:

• Body position is restricted to prone and face-down
• Cyanosis (face is discolored blue due to lack of oxygen)
• Gurgling/gasping sounds
• An active subject suddenly changes to passive – from loud/violent to quiet/tranquil
• Panic
• Telling you he/she cannot breathe

You must be able to recognize the risks and symptoms associated with positional asphyxia, especially where alcohol and obesity are factors. If you believe a person is suffering from positional asphyxia, call an ambulance immediately. Early recognition of signs and symptoms should help to significantly reduce the chance of these fatalities from occurring.

In any violent confrontation, it may be impossible to avoid placing someone in a prone position to gain control. As soon as you have control and the person is no longer at risk of causing injury to themselves or others, they should be moved onto one side or placed in a kneeling, sitting or standing position to avoid positional asphyxia.

Conclusion

As I said previously in this chapter, the technical notes here are from over 26 years ago. I remember teaching one class to a police force in the Middle East and the students wanted to know why the same mistakes with use of force are made again and again in the U.S., and why obvious issues were not addressed and rectified. Well, I could not answer the question as it’s beyond my comprehension why the same mistakes are made over and over again. But the U.S. is a different culture to the rest of the world so, if they do not think they are making mistakes, there is nothing to rectify, everyone else is wrong, not them.

Sadly, in these days of the all-powerful and rabble-rousing social media and news platforms, it only takes the stupidity of one cop in America to cause protests, social divisions and inflame racial issues internationally. Of course, if there are justified racial or police brutality issues anywhere, they need to be responsibly addressed. But these days the only ones with a voice seem to be the extremists on all sides, who seem intent on fracturing society and communities as much as they can.

I hope this article and the others in this series have put a few things into perspective and not just the issues of positional asphyxia, excited delirium, and neck restraints bit self-defense for close protection in general. In my opinion were the high-profile deaths of black males in the U.S. due to racism and police brutality? No! The deaths happened because the cops involved were not properly trained, if trained at all, in the basics of use of force and restraint techniques.

Orlando “Andy” Wilson

Books on Amazon
Close Protection: Luxury & Hostile Environments
This book is relevant to those in the close protection business as well as private investigators, journalists and those working in hostile environments.
Audio Book @ https://www.amazon.com/dp/B0FHWYT3TF
Kindle @ https://www.amazon.com/dp/B07CNSKXJF
Paper Back @ https://www.amazon.com/dp/1980900388
Hard Cover @ https://www.amazon.com/dp/B0FK26C35M