Acute excited states and sudden death

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1171 (Published 11 April 1998) Cite this as: BMJ 1998;316:1171

Death after restraint can be avoided

  1. Derrick Pounder, Professor of forensic medicine
  1. Department of Forensic Medicine, University of Dundee, Royal Infirmary, Dundee DD1 9ND
  2. City and County of San Francisco, Hall of Justice, San Francisco, California CA94103, USA

    EDITOR—Farnham and Kennedy's recent editorial on sudden death in patients with acute psychiatric illness1 who are being restrained does not reflect the forensic literature fairly. It omits evidence from key publications 2 3 and twice misattributes statements to a paper that specifically excluded such deaths from the reported study.4

    The current consensus on “restraint asphyxiation” is reflected in a guidance statement of the United States Department of Justice.5 Any person who is restrained prone has trouble breathing when pressure is applied to his or her back or when handcuffed and “hog tied,” 2 3 and obesity exacerbates this. People's natural reaction is to struggle more violently, which may be met with still more restraining force, resulting in greater oxygen deficiency and, in some cases, death. Risk factors include any condition, such as ischaemic heart …

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