Positional Asphyxia...Sudden In-Custody Death Syndrome...Custody Death.
However you phrase it, the death of a person in custody is an ugly subject. To the public, a custody death might translate into excessive force, when in reality the death was due to causes unrelated to the officer's actions. The headline usually reads,
"Man dies in police custody." The story often lacks facts such as the subject was under the influence of an illegal substance or had a heart condition that was affected by his drug abuse.
The individuals who die from positional asphyxia usually have levels of a foreign substance in their systems that trigger abnormal behavior, actions, or, reactions. This is often accompanied by a pre-existing medical condition. These are the issues that need to be understood when discussing the prevention of in-custody deaths due to positional asphyxia.
What is it?
A basic definition of positional asphyxia is a condition that occurs when the position of the body interferes with the person's ability to breathe. This interference is exacerbated when a subject is placed in a physically compromised position from which they cannot remove themselves.
An example of this might occur during the arrest of an intoxicated person. Upon arrest, the person is combative. The subject is sprayed with a chemical agent and a take down is executed to bring the subject under control. At this point, the officers apply their weight on top of the subject to control and handcuff him. If the subject is still struggling and difficult to control, he is placed in hog-tie restraints. Next the subject is placed in a vehicle for transport (usually face down). This position, because of his condition (intoxicated and combative), may affect the operation of the diaphragm and interfere with his breathing, especially if the subject is overweight. Because the subject cannot remove himself from this position, he is 'at-risk'. Officers can avoid an in-custody death in this type of situation if they understand what the risk factors are.
Risks Contribute to Positional Asphyxia
There are several risk factors that contribute to positional asphyxia that are beyond the officers' control. These factors include pre-existing medical conditions (heart disease, emphysema, asthma, bronchitis), alcohol use or drug intoxication. These factors, coupled with an intense physical confrontation, can cause a dangerous, sometimes-lethal reaction and outcome.
In addition to pre-existing medical conditions and intoxication, there are other factors to consider in assessing a subject and to determine if an individual is in danger. These factors include: behavior descriptions (bizarre, violent, aggressive, paranoia); obesity; physical activity level;
hypothermia (elevated body temperature); cyanosis (blueness) of nail beds or lips and anti-psychotic drug use.
There are also conditions that represent serious or immediate threats to safety that necessitate immediate medical evaluation and/or treatment. These conditions are loss of consciousness, shock, seizure, severe headache, chest pains, respiratory distress, and, gagging, choking, or, gasping for more than four minutes after ingestion of a chemical agent. Medical personnel must evaluate any subject exhibiting these symptoms immediately.
It is essential that law enforcement and corrections officers recognize these signs of respiratory distress, the identifiable symptoms and risky behavior patterns. Subjects must be monitored until medical attention is obtained. In addition, medical personnel must be given a detailed report regarding the symptoms and behavior exhibited, the type of chemical agent used, and any first aid given. A detailed report can help medical personnel evaluate an individual quicker.
The report should include:
* the nature of the incident
* observations by officers
* physical activity of the individual
* verbalization by the individual
* appearance
* behavior
* level of consciousness
* alcohol/drug intoxication
* obvious injuries
* witness observations
* transporting personnel observations
* medical history (if known)
* force options used by officers
* effectiveness of force options and the restraints used.
Medical evaluation and/or treatment is essential when individuals show signs of being at risk.
In addition, there are several preventative steps that officers can take. They should avoid hog-tying subjects, especially those whom may be at risk, and consider utilizing an alternate method to hobble the subject. One alternative method is related to applying handcuffs and shackles. Another set of shackles can be attached from the handcuffs to the shackles IN FRONT OF THE SUBJECT. This method allows the subject to be placed in an upright position that is controlled and does not place the individual in a physically comprising position.
Officers should be aware of the volatile nature of custody deaths and the criminal investigations, and/or, be wary of criminal and civil actions that always follow.
Thomas R. Bollaro is a Sergeant with the Monmouth County Sheriffs Office, in Freehold, N.J. He is a N.J. Police Commission Certified Instructor, a certified SICDS Instructor, and, a member of the MCSO Gang Intelligence Unit.
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