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Positional asphyxia, is also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents them from breathing adequately. A small but significant number of people die suddenly and without apparent reason during restraint by police, prison (corrections) officers and health care staff.[1] Positional asphyxia may be a factor in some of these deaths.

  • Positional asphyxia is a potential danger of some physical restraint techniques,
  • People may die from positional asphyxia by simply getting themselves into a breathing-restricted position they cannot get out of, either through carelessness or as a consequence of another accident.

Research has suggested that restraining a person in a face down position is likely to cause greater restriction of breathing than restraining a person face up.[2] Many law enforcement and health personnel are now taught to avoid restraining people face down or to do so only for a very short period of time.[1] Risk factors which may increase the chance of death include obesity, prior cardiac or respiratory problems, and the use of illicit drugs such as cocaine.[3] Almost all subjects who have died during restraint have engaged in extreme levels of physical resistance against the restraint for a prolonged period of time.[3] Other issues in the way the subject is restrained can also increase the risk of death, for example kneeling or otherwise placing weight on the subject and particularly any type of restraint hold around the subject's neck. Research measuring the effect of restraint positions on lung function suggests that restraint which involves bending the restrained person or placing body weight on them, has more effect on their breathing than face down positioning alone [4]

There is a degree of controversy amongst researchers regarding the extent to which restraint positions restrict breathing. Some researchers report that when they conducted laboratory studies of the effects of restraint on breathing and oxygen levels, the effect was limited.[5] Other researchers point out that deaths in real life situations occur after prolonged, violent resistance which has not been studied in laboratory simulations.[6]

Positional asphyxia may also occur as a result of accident or illness. Olympic track athlete Florence Griffith-Joyner[7] and ex-Major League Baseball player John Marzano[8] both died due to positional asphyxia, the former following an epileptic seizure and the latter following a fall down a flight of stairs.


  1. ^ a b Reay, D.T. (1996) 'Suspect Restraint and Sudden Death.' Law Enforcement Bulletin. Quantico, Virginia: Federal Bureau of Investigation. (
  2. ^ Parkes, J. (2002) ‘A Review Of The Literature On Positional Asphyxia As A Possible Cause Of Sudden Death During Restraint.’ British Journal Of Forensic Practice. 4(1) 24-30
  3. ^ a b Stratton SJ, Rogers C, Brickett K, Gruzinski G (2001). "Factors associated with sudden death of individuals requiring restraint for excited delirium". Am J Emerg Med 19 (3): 187–91. doi:10.1053/ajem.2001.22665. PMID 11326341.  
  4. ^ Parkes, J. & Carson, R. (2008) ‘Sudden Death During Restraint: Do Some Positions Affect Lung Function.’ Medicine, Science and the Law 48(2) 137-41
  5. ^ Chan TC, Vilke GM, Neuman T, Clausen JL (1997). "Restraint position and positional asphyxia". Ann Emerg Med 30 (5): 578–86. doi:10.1016/S0196-0644(97)70072-6. PMID 9360565.  
  6. ^ Roeggla G, Roeggla H, Moser B, Roeggla M (1999). "Cardiorespiratory consequences of the hobble restraint". Acad Emerg Med 6 (10): 1076–7. doi:10.1111/j.1553-2712.1999.tb01201.x. PMID 10530674.  
  7. ^ Kristina Rebelo Anderson. "The Uneasy Death Of Florence Griffith Joyner".  
  8. ^ Medical examiner says a fall killed John Marzano | Philadelphia Inquirer | 07/18/2008

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