Comparison of Respiratory Function in the Prone Maximal Restraint Position
With and Without Additional Weight Force on the Back

Eisele JW, Chan TC, Vilke GM, Clausen J.
Comparison of respiratory function in the prone maximal restraint position
with and without additional weight force on the back.
The abstract of an UNPUBLISHED paper presented at the annual meeting of the
American Academy of Forensic Science, in Reno, Nevada: February 21-26, 2000.

Although the "old" version of this paper remains on this page,
in January, 2006, I created a PDF FILE for this paper.

TO PRINT THIS PAPER, it is easiest to do so from THE PDF FILE!
If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.

Comparison of Respiratory Function in the Prone Maximal Restraint Position
With and Without Additional Weight Force on the Back

CHAS' REVIEW of this article is linked at its end.
CLICK HERE to SKIP to the REVIEW link!

Here is the "old" version:

The text of this UNPUBLISHED research abstract was derived from the "book" of papers accompanying the annual meeting of the American Academy of Forensic Science, in Reno, Nevada: February 21-26, 2000. A copy of this paper was faxed to me by them, but was very poorly printed by my FAX machine.
As this paper is so brief, however, I have RETYPED it to post it here!

This UNPUBLISHED research abstract and the November, 1997 Ann Emerg Med article by Chan et al, are the ONLY restraint studies referenced by DiMaio & DiMaio in their text, Forensic Pathology, Second Edition (copyright 2001), in Chapter 22: Sudden Death During or Immediately after a Violent Struggle. Trust me: As soon as possible (don't hold your breath!), I'll be writing a review of this text, and exposing the incredibly obvious bias, and practically criminal shortcomings, of this supposedly "reputable" text!

Comparison of Respiratory Function in the Prone Maximal Restraint Position
With and Without Additional Weight Force on the Back

"PAPER PRESENTERS": John W. Eisele MD, Department of pathology; Theodore Chan MD, Gary Vilke MD, Department of Emergency Medicine; and Jack Clausen MD, Department of Medicine; University of California at San Diego Medical School, 9500 Gilman Drive, La Jolla, CA.

After attending this presentation, the participant will understand the effects on respiratory function of being placed in the prone, maximal restraint position ("hogtying" or "hobble restraint") without weight on the back and with varying weights placed on the upper back.

Although the technique of prone maximal restraint ("hogtying" or "hobble restraint") is widely used in controlling violent or irrational individuals and is generally considered safe, there are several case reports of deaths occurring during this procedure. Some of the fatalities have in addition had weight applied to their back during the restraint. A previous study from this laboratory has presented data regarding the effects on respiratory function during maximum restraint. This study is an extension of the previous investigation in which the additional factor of weight applied to the back is included.

Ten healthy volunteers were recruited and informed of the procedure, and gave verbal and written consent. They were screened for pulmonary function in the sitting position and rejected if baseline forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) were outside of acceptable limits. They were then randomly placed in one of four positions and subsequently crossed-over into the three other positions. These were (1) sitting position, (2) prone maximal restraint position with no weight on the back, (3) prone maximal restraint position with 25 pounds placed between the shoulder blades, and (4) prone maximal restraint position with 50 pounds placed between the shoulder blades. After being placed into position, a baseline blood pressure was determined and this was repeated after 4 minutes in the position. At 1 and 5 minutes after being placed in each position, spirometric measurements including FVC and FEV1 were determined. During the procedures the subjects were monitored continuously with sensors for transcutaneous oximetry (O2sat) and end-tidal CO2 (etCO2), and readings were recorded every 30 seconds.

Results for the first subjects indicate that FVC showed the anticipated decrease to approximately 82% of expected between sitting and prone restraint. After 25 pounds was added there was a decrease to approximately 79% of expected and after 50 pounds a decrease to approximately 75%. FEV1 showed a similar progressive decrease, averaging 81% of expected after prone restraint, 76% of expected with 25 pounds and 72% of expected with 50 pounds. O2 saturation showed a slight decrease, and etCO2 showed minimal and inconsistent changes. Blood pressure showed no significant change. None of the parameters showed major changes during the 5 minute period of observation.

These results indicate that weight placed on the back during maximal restraint does cause a decrease in spirometry parameters. Data collected to date, however, does not indicate a significant effect on oxygen saturation or end tidal CO2. The statistical and clinical significance of these findings will be presented and discussed. Although body size and habitus* are matters of concern in evaluating the effects of restraint, the subjects in this study were intentionally kept within an average range; because of the small number of subjects it was felt that including extremes of body size would decrease the statistical significance of the results. Likewise, the amount of weight in this study was limited, but the authors lack of specific knowledge of the effects of this procedure made this a matter of safety for the volunteers. These are clearly matters of concern for future studies.

This study was supported by a grant from the Pathology/Biology Section Research Committee of the American Academy of Forensic Sciences.

* Since I had to look it up to be sure I understood its use;
here is the 17th ed. of Taber's Medical Dictionary's definition of habitus =
1. A physical appearance, body build, or attitude.
2. A physical appearance that indicates a tendency for a person to develop a specific disease.
However, as used in this context, it seems clear that the abstract authors' use of the term, "habitus," primarily refers the WEIGHT of someone's body.

Read CHAS' NEW (2005) Opinion Paper related to this article!:
"A Comprehensive Review of Frequently Misinterpreted
and Misrepresented Restraint Research" PART THREE

Besides being "kinder," the 2005 review is much more IN-DEPTH.

Read CHAS' OLD (2002) Review of This Article!

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