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Restraint Asphyxiation in Excited Delirium

NCJ Number
American Journal of Forensic Medicine and Pathology Volume: 14 Issue: 4 Dated: 1993 Pages: 289-295
Ronald L. O'Halloran M.D.; Larry V. Lewman M.D.
Date Published
7 pages
This study analyzes 11 cases of sudden death of men restrained in a prone position by police officers, with 9 being "hogtied," 1 tied to a hospital gurney, and 1 manually held prone.
All subjects were in an excited delirious state when restrained. The "hogtied" prone position is commonly used by police to restrain violent persons for the protection of others, property, and the subjects themselves during transport to another location. "Hogtying" involves binding a person's wrists and ankles together behind his/her back while the person lies prone. This may be accomplished by combinations of handcuffs, cords, or specially designed hobbles. All subjects were in an excited delirious state when restrained. Three were psychotic, and the others were acutely delirious from drugs (six from cocaine, one from methamphetamine, and one from LSD). The restraint was deemed necessary for transport because of the subject's excited, uncontrolled delirium. These cases are reported in this study in order to alert law enforcement agencies, death investigators, and medical personnel to the risk of using the "hogtied" prone position with delirious people. The delirium and the "hogtied" prone position create the need for oxygen in the excited subject while simultaneously restricting his/her breathing mechanism due to the forced prone position. In three of the reported cases, "positional asphyxiation" was cited as the mechanism of death. To date, 7 of the 11 cases have ended in wrongful death lawsuits against the various public agencies involved. The authors recommend the close monitoring of the breathing of delirious persons controlled by "hogtying" or the use of alternative restraint methods that will not restrain breathing. 1 table and 10 references