In Custody Death and Restraint Asphyxiation   Many law enforcement agencies across the country are dealing with an increase in Subjects who die while in custody. Multiple reasons have been given for these Occurrences but training has been slow to catch up on preventing subject’s death. We will explore a few signs, symptoms, and appropriate responses in order to give Law enforcement administrations a resource when they address these issues in their policies and training guidance. Positional Asphyxia and sudden death was reported by the National Law Enforcement Technology Center in a 1995 article by Dr. Charles Petty a forensic Pathologist. Today we see a rise in custody deaths and cases involving drugs that are mainly related to stimulants such as cocaine. A cause of death called excited delirium is a misnomer because excitement and delirium are symptoms yet cannot kill you but positional asphyxiation in relation to restraints can. Today’s officers must understand that when dealing with persons who are obliviously under the influence of something, that it can actually be a prescription medication that they take or have a medical condition that can make them exhibit signs and symptoms of someone who just did cocaine. Chemical and medical conditions that cause symptoms (Partial List):   Cocaine   Meth   SSRIs (Antidepressants)   Parkinson Medications   Neuromuscular blockers   Antipsychotics   The approach to this kind of subject should also cause pause before reaction from the responding officer such as calling for immediate back up and having EMS respond. Today’s subjects are not the typical subjects that were arrested in the past. Subjects back then only had one substance involved such as alcohol and few actual known medical conditions. Today when you approach someone they may have more than one substance on board and multiple medical problems to include obesity (which in itself can cause hypoventilation syndrome), heart disease, etc. Those kinds of problems only exacerbate the bodies stress response when physical confrontation happens. The addition of hormones such as epinephrine and cortisol is synergistic when coupled with illicit or prescribed medications, medical conditions, etc. When dealing with subjects who exhibit (SIP) Substance Induced Psychosis, First assess if the subject really needs direct physical contact immediately to keep them from hurting themselves or others. If not, contain the subject without putting yourself in harms way. When back up arrives and the necessity for takedown and restraint of the subject is warranted; make sure EMS is readily available for any emergent care that arises. The officer on the scene will be making many split second decisions in taking the subject in to custody, more so than the usual arrest. Should they follow most use of force departmental policies, (those include chemical spray and Taser) teaching least amount of use of force is best. The main problem with using those two restraint control techniques (chemical and Taser) is that chemical sprays increase the upper respiratory secretions with nasal drainage and tearing along with causing the subject to cough impairing breathing and can cause the stomach to regurgitate putting even more caustic material into the mouth and upper airway. In other cases the Taser has proved ineffective in making the subject lose control of motor movement and has only made them further enraged. After reading many cases where the final out come was death and then looking at cases where the subject was restrained, treated and went on to answer there charges, the following are some considerations that officers on the scene can do that can make a difference in the final arrest outcome.   Have EMS present   Have multiple back up   “SWARM” the subject using appropriate force and restraint   Stop and hold appropriate force once the subject is restrained, adjust that force once the subject is controlled   If the subject is prone, Do not place all your weight on their upper torso and lay them on their side or sit them up as soon as safe to do so   During all aspects of the arrest until appropriate disposition, watch the subject’s airway and respirations. If at anytime you see distress of any type have EMS check the subject immediately.   Work with your local EMS agency if possible to have a protocol that allows EMS to give medications that will act as a chemical restraint.   If the subject becomes unresponsive and has no pulse, start CPR immediately   If any question about the subjects medical condition, have the detention medical personnel or the emergency room evaluate the subject   Document, Document, Document on everything that happened!   Administrations as well as individual officers are now under the microscope from the public more than ever. Administrations should have positional restraint policies in place and training on restraining subjects like the ones with SIP thru venues such as classroom interaction with the officer interacting with a subject who displays SIP and other use of force scenarios in place. Course training documented in officers training files are mandatory. Failure to train will devastate a department and municipality quickly when it could have been prevented or legally defended by taking a small amount of time to incorporate this type of training into officer’s annual inservice.   About the Author Dr. Daniel has been in law enforcement since 1990. He has also served on the SWAT team and was over only one of two nationally accredited jail medical units in the state of Tennessee. He is currently an Internal Medicine/Hospitalist physician. Among his certifications in law enforcement, Dr. Daniel is a Master RIPP restraint instructor. Reference: ILEETA Journal Winter edition vol.5 edition 4 2015

Copyright © 2015 Daniel Consulting (423) 765 - 3142 P.O. Box 8992 Gray, TN 37615