CITATION:
Chan TC, Clausen J, Neuman T, Eisele JW, Vilke GM.
Does weight force during physical restraint cause respiratory compromise?
Ann Emerg Med, October 2003;42(4),
ACEP Research Forum Supplement: pS17.
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.
A LINK to CHAS' review of Chan et al's continued efforts to
misrepresent restraint research findings follows their "Research Forum" abstract.
CLICK HERE to SKIP to the REVIEW Link!
Here is the "old" version:
The text of this abstract (the ONLY thing offered) was obtained from the ACEP Research Forum "Supplement" accompanying the October, 2003 issue of Annals of Emergency Medicine. This Supplement contained the abstracts of all oral and poster research presentations provided at the 2003, October 12-13, American College of Emergency Physicians conference in Boston.Chan et al's 2003 ACEP abstract presents information obtained during a study that predated its ORIGINAL abstract presentation: at the annual meeting of the American Academy of Forensic Science, in Reno, Nevada; February 21-26, 2000: Comparison of Respiratory Function in the Prone Maximal Restraint Position With and Without Additional Weight Force on the Back. The American Academy of Forensic Science elected NOT to publish the study's original presentation in their Journal of Forensic Sciences (J Forensic Sci).
In Chan et al's 2003 VERSION of this abstract, the study "author order" has been interestingly altered. Chan has been placed first, and Eisele – the STUDY's "Lead" researcher! – has suddenly been listed next to last! Additionally, the study information has been slightly reworded from Eisele's 2000 abstract.
Still, Chan et al's 2003 VERSION remains an abstract presenting the same (1999) study information. And, the American College of Emergency Physicians (like the American Academy of Forensic Science) elected NOT to publish Chan et al's 2003 VERSION of this 1999 study in their journal, Annals of Emergency Medicine
[Presenters/Abstract "Authors":] Chan TC, Clausen J, Neuman T, Eisele JW, Vilke GM.
University of California--San Diego, San Diego, CA; Forensic Pathology and Medicine, San Diego, CA.
Background: Violent, combative patients often require physical restraint by emergency department, hospital, out-of-hospital, and law enforcement personnel. Concern has been raised that weight force, commonly applied during the restraining process, can compromise respiratory function, placing individuals at risk for asphyxiation.
Study objectives: We sought to determine the impact of weight force on pulmonary and respiratory function in a simulated restrained patient. We hypothesized that weight force would result in changes in pulmonary and respiratory characteristics.
Methods: Ten volunteers completed a randomized crossover, controlled trial in a pulmonary function laboratory. Subjects were placed in the sitting, prone restraint (PR), PR with 25-lb (11.25 kg) sandbag weight (PR+25), and PR with 50-lb (22.5 kg) sandbag weight (PR+50) placed on the back between the scapula. Subjects remained in each position for 5 minutes, during which spiromety was performed at 1 and 5 minutes, and transcutaneous oximetry (02sat) and end-tidal CO2 levels (ETCO2) were monitored continuously. Data were collected on percentage of predicted forced vital capacity (%predFVC), percentage of predicted forced expiratory volume in 1 second (%predFEV1), 02sat, and ETCO2, and compared by repeated measures analysis of variance with post hoc testing (P<.05 significance, SATA software).
Results: At 1 minute, mean %predFVC decreased from 101% to 87.1% to 84.7% to 84.2% and mean %predFEV1 decreased from 98.2% to 83.4% to 82.0% to 80.0% (sitting to PR to PR+25 to PR+50, respectively). Similar results were found at 5 minutes into each position (mean %predFVC decreased from 102% to 86.8% to 82.5% to 80.5%; mean %predFEV1 decreased from 99.3% to 82.2% to 79.5% to 74.7%, respectively). However, mean 02sat remained above 95% and mean ETCO2 levels remained below 45 mmHg throughout the 5-minute period for all positions.
Conclusions: Prone restraint with weight force resulted in decrements in FVC and FEV1 consistent with a restrictive pulmonary function pattern but did not result in evidence of hypoxia or hypercapnia.
Email Charly at: c-d-miller@neb.rr.com