title: Asphyxial death during prone restraint revisited: a report of 21 cases.
abstract: Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.
authors.affiliation: Office of the Medical Examiner, Ventura County, Ventura, California, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: O'Halloran
authors.forename: J G
authors.initials: JG
authors.lastname: Frank
mesh_terms: D000293:Adolescent; D000328:Adult; D001237:Asphyxia / Q000209:etiology* / Q000401:mortality*; D001344:Autopsy; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006801:Humans; D008875:Middle Aged; D016684:Prone Position; D012149:Restraint, Physical / Q000009:adverse effects*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*