The issue of POSITIONAL ASPHYXIA has sadly hit the news headlines in recent days following the death of George Floyd in the USA. I feel it is a fitting time to now remind SIA operatives of their duty of care and to heighten awareness of this potentially deadly complication should (as a last resort) the use of restraint become necessary.

What is positional asphyxia? (Also known as postural asphyxia)

Positional asphyxia is a medically recognised form of mechanical asphyxia. It is brought about when a person is immobilised in a posture which DOES NOT facilitate adequate pulmonary ventilation, resulting in respiratory failure. In some cases, the body position has a detrimental effect on regular circulation and venous return to the heart. These factors can contribute to the obstruction of the body’s normal gas exchange. If a person is unable to free themselves from the position, death can occur extremely rapidly.

Restraint and Positional Asphyxia

All restraints come with the risk that breathing could become restricted. Restraint can have a negative impact on the ability of a person to breathe normally as the expansion of the chest plays a vital role in inhaling and drawing air into the lungs. Problems arise when the body is unable to expand the lungs fully and the required oxygen levels are not being met as a result.

In a restraint situation where physical activity is likely to be high a restraint has the capability to deny a person the extra oxygen required. Identifying that a person is becoming Oxygen depleted can be very difficult. They can one minute be engaging (fighting) and the next fall out of consciousness.

Risk factors during a restraint;

  • Intoxication (Drugs or alcohol)
  • Mental illness
  • There is some form of airway obstruction
  • A person is substantially overweight
  • Increased demand for oxygen (high levels of physical activity)
  • Size (a person who is of smaller stature)
  • Existing physical ailments
  • Exhaustion
  • Exhaustion, when combined with prolonged restraint and drug use as well as underlying cardiac conditions, can result in sudden death with little or no warning.

Reducing the risk of positional asphyxia;

  • Ensure the close and constant monitoring of any person held in a restraint.
  • Only restrain a person for as long as is absolutely necessary.
  • Do not put weight on a person’s neck or back.
  • Do not bend a person forward.
  • Avoid anything that may restrict chest expansion.

During any kind of restraint regular checks of the person’s vital signs should be made. REMEMBER…. AIRWAYS, BREATHING, CIRCULATION

Monitor for shifts in behaviour. Is the person becoming suddenly more aggressive or less aggressive? Both can be signs that oxygen levels are being restricted and they are fighting for air.

A noisy person may suddenly become quiet and passive.

Signs of positional asphyxia;

  • Vomiting
  • Becoming unresponsive (or less responsive)
  • Visible difficulty breathing
  • Expansion of veins (particularly in the neck)
  • Swelling of the face or the neck
  • LISTEN! Is the person telling you they are experiencing breathing difficulties?
  • Cyanosis a blue/grey discolouration of the face.

Call 999 for immediate medical help if you are concerned about someone’s condition.

Restraint is always a high-risk option and least favourable escalation and outcome of any intervention. Always use de-escalation skills and only use restraint when all other options have been exhausted or there is an immediate risk to a person’s safety.


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