A "Restraint Study" Author Sends Me A

Obviously, after posting this correspondence, I'll likely never again receive a "Nasty-Gram" from a journal article Author. (Unless they breeze through my web site and MISS this page! LOL)
But, that's NOT why I'm posting it! I do NOT wish to deter correspondence!
I welcome ANY and ALL correspondence!

I'm posting this correspondence (and all subsequently related correspondence
between this author and myself – should any occur) because it demonstrates how

On Thursday, November 14, 2002, I was sent the following Email from
Paul Schmidt, a co-author of
The Effects of Positional Restraint on Heart Rate and Oxygen Saturation.
J Emerg Med, March, 1999;17:777-82;203(1-2):1-9

FROM: Schmidt, Paul (pschmidt@pd.sandiego.gov)
TO: c-d-miller@neb.rr.com (Me!)
CC: tcchan@ucsd.edu (Theodore C. Chan)
SENT: Thursday, November 14, 2002 10:43 AM
SUBJECT: positional restraint

Mr. Miller,

I find it interesting, if not amusing, how you and others who have financial motives continue to proliferate misinformation related to positional restraint.

You may find it of interest to look at Reay's data from his original study (oxygen saturation and heart rate recovery).

I became interested in this subject when I analyzed Reay's data and discovered that there was not any significant statistical difference in the two tested recovery positions, as was stated in the article.

You are critical of Chan et al, where subjects were exercised at a "low level", but it was far above that of the Reay study that you place some much faith in.

Additionally, you seem to have disregarded our study where we had subjects exercise at a near maximal rate.

You state that the Chan studies are very bias because they use healthy subjects, are you suggesting that we use subjects under the influence or find our subjects in hospital wards?

It appears to me that you make statements related to this issue only to promote your opinion and training program.

Show me the studies that you or others have done to support your statements, not just theory.

(No "Sign-off")

Here is MY reply to Mr. Schmidt:

FROM: c-d-miller@neb.rr.com (Me!)
TO: Schmidt, Paul (pschmidt@pd.sandiego.gov)
CC: tcchan@ucsd.edu (Theodore C. Chan)
SENT: Thursday, November 14, 2002 5:30 PM
SUBJECT: RE: positional restraint

Oh, Paul!

Can we cry out, "Open the floodgates!"? I think we can.

I nearly deleted your Email, thinking it was from some unfortunate care provider who is extremely fearful of, and/or angered by, the continued need for "CHANGE" in our service industry. I don't get such correspondence very often (in fact, I rarely EVER get "nasty-grams" such as yours – maybe ONCE every two or three years). BUT, I long ago learned that you can't help people become better providers unless they WANT to become better providers. And, people interested in becoming better care providers don't send nasty-grams. They send Thank-Yous!

So, I wasn't going to waste time replying to your Email.

BUT! Then I noted that your missive had been copied to CHAN et al. And, THEN, your name seemed a bit familiar to me. What a surpriZe! Just yesterday I was corresponding with a gentleman in the United Kingdom (UK), and a small part of that correspondence involved YOUR study!

[Schmidt P, Snowden T; The Effects of Positional Restraint on Heart Rate and Oxygen Saturation. J Emerg Med, March, 1999;17:777-82;203(1-2):1-9.
BTW: If your Email reference to "our study" relates to a different restraint study, plz let me know. This is the only restraint study I have that is co-authored by you. (I'm not counting the "Pepper Spray's Effects on a Suspect's Ability to Breathe" as a "restraint" study.)]

The UK guy is writing a restraint-associated deaths article that has already been accepted for publication in a major Psychiatric and Mental Health Journal. He asked me to review his current draft. And, I did so (free of charge, by-the-by). So, although I haven't written/posted a review of your study paper on my Web Site, I've just started a file for it!

During my review of UK's paper, I noted his statement: "Research by Schmidt and Snowden (1999) involving 18 subjects also failed to support Reay's initial observations suggesting that although hobble-tying could impair respiration the degree of impairment was marginal and unlikely therefore to be clinically significant."

In review of his statement, here is what I wrote:

You're misinterpreting Schmidt and Snowden's report.

Schmidt and Snowden state on page 781 of their article, "Our findings and that of Chan and associates refute the premise that positional restraint alone produces physiological stress that places healthy persons (disease-, drug-, and alcohol-free) at risk for sudden death."

They don't actually "say" "refute Reay's premise" ... but, because of WHERE they put this statement (in their report), they INFER that their study has "refuted Reay's premise." Thus, you – like almost ALL other readers – fell prey to their erroneous inference.

Reay has never, EVER, stated that hobble (or prone) restraint – by itself – causes restraint asphyxia. That's why Chan et al and Schmidt/Snowden's research does NOT "refute" Reay (and others') premise of the processes that cause restraint asphyxia deaths!

In fact, Chan et al and Schmidt/Snowden's research supports Reay's premise because both studies DID find abnormal results in the "healthy persons (disease-, drug-, and alcohol-free)" that they used for their studies. Thus, if their subjects WERE NOT "healthy persons (disease-, drug-, and alcohol-free)," these abnormal results could no longer be considered "insignificant."


LATER in this article draft, UK again referenced your study (and Chan's) in a manner that (I felt) might further the misinterpretations frequently generated by same. So, I suggested the following rewrite:

Because of the universally-recognized dangers of simulating the actual conditions documented as being associated with restraint asphyxia deaths, it is impossible to safely study the effects of "field-application" of restraint using human subjects. Thus, only "controlled" restraint experiments have been performed, and only clearly non-lethal study methods were employed. Thus, results obtained by these studies are often misinterpreted.

Studies of healthy (disease-, drug-, and alcohol-free) individuals of normal weight, subjected to controlled exertion and application of pseudo-maximal-restraint positions, have produced abnormal respiratory values.(Chan et al., 1997; Schmidt and Snowden, 1999) The authors interpreted the abnormal values as not resulting in "significant respiratory compromise"(Chan et al., 1997) or "clinical restrictions in heart rate or oxygen saturation recoveries"(Schmidt and Snowden, 1999) in the study subjects. Thus, the authors correctly concluded that "healthy individuals are at little risk of suffering life-threatening desaturation"(Schmidt and Snowden, 1999) when subjected to brief periods of forceful-prone-restraint.

However, the authors of these studies readily admit that, "[Our] study did not attempt to duplicate exact field conditions under which restraint position deaths have occurred. ... It is unlikely that [the] period of exercise [used in our study] would simulate all the physiologic alterations that may occur with struggle and agitation. In addition, we did not reproduce the effects of trauma and psychological stress that often occur with apprehended individuals" (Chan et al., 1997). The authors readily admit that the methods used for theses studies "may limit the application of our findings to the general population."(Schmidt and Snowden, 1999) The authors are entirely correct in their admission that these studies do not provide insight or information germane to field-application of restraint to individuals in the situations that require "maximum" restraint.


As you can see, Paul, I have NEVER advocated that you (or others like you) KILL people in order to accurately and authentically study forceful-prone-restraint and restraint asphyxia! You and I both know that; if the field conditions and situations that often require application of "maximal" restraint were authentically and accurately reproduced, and the physiological conditions of restraint asphyxia victims prior to and during restraint were authentically and accurately induced, your study would cause the DEATH of one or more study-subjects (even if they were "healthy" to begin with)!

All I have ever asked of you (and others like you), is that you report your studies in a more responsible manner – a manner that AVOIDS INFERRING or suggesting that restraint asphyxia doesn't exist.

WAIT. That's not entirely true.

If you've read my review of the unpublished paper, "Comparison of Respiratory Function in the Prone Maximal Restraint Position With and Without Additional Weight Force on the Back" by Eisele JW, Chan TC, Vilke GM, you'll know I've also asked something else.

[If you haven't read this unpublished paper, go to:
If you haven't read my review of it, go to:

If you've read my review, you'll know that I've also asked researchers such as yourself to,

"STOP studying healthy subjects, restrained in silly, unrealistic manners! Your studies do not – in any way – obtain information germane to actual field-applications of restraint! Your studies certainly (to date) have NEVER contributed to protection of patients OR emergency responders from incidences of Restraint Asphyxia! Indeed, the manner in which you persist in representing your various studies' findings leads only to confusion, misinterpretation, and the CONTINUED USE of lethal forceful-prone-restraint and prone hobble restraint."

I have NEVER stated that the studies done by Chan et al and yourself are "biased." I have consistently stated that such study results are entirely unrelated to – and not at all germane or helpful to – the situations wherein forceful-prone-restraint is applied in the field. And, my statements are SUPPORTED by what YOU, and Chan et al, have admitted in your own articles!

I've certainly NOT disregarded the fact that your study had subjects exercise at a "near maximal rate." It is entirely because of your "near maximal" qualification (and other, similar, "near-real" but NOT REAL, qualifications) that I object to your study findings being considered applicable to REAL LIFE situations. What part of your own report's statement (that your study methods produced findings of "limited" application) aren't you remembering? A "near maximal rate" of exercise falls FAR short of simulating the physical and physiological conditions individuals requiring "maximal restraint" in the field experience prior to being subjected to forceful-prone-restraint. So, I AGREE with you, Paul! Your study's findings have little to NO application to reality.

As to your Jerry-Maguire-esque request that I "Show (you) The STUDIES!" ... as I've stated before, Because of the universally-recognized dangers of simulating the actual conditions documented as being associated with restraint asphyxia deaths, it is impossible to safely study the effects of "field-application" of restraint using human subjects.

BUT! I CAN help you understand how restraint asphyxia kills people.

Somehow, I doubt that you've bothered to read my article,
Restraint Asphyxia – Silent Killer.
Forgive me if I'm wrong, and you HAVE read it.

But, even BEFORE reading the article, if your purported interest in this subject is truly sincere,
you'll be willing to "ASSUME THE POSITION!"

Once you've had a personal, physical, "taste" of forceful-prone-restraint, and once you've read my article, if you STILL want to argue that my statements are unsupported by relevant fact, write to me again.

For the most part, I AGREE with you, Paul!
This subject IS incredibly "interesting." So, I hope you "bother" to explore it some more.

However, this subject is certainly NOT "amusing." It's not amusing to those who have been devastated by having contributed to restraint-related deaths. It's not amusing to the families who have been devastated by restraint-related deaths.

And, as to your incredible accusation that I have "financial motives" to "proliferate misinformation related to positional restraint" ... You are the very FIRST person to EVER accuse me of being motivated – to do anything – because of an interest in MONEY! If I hadn't been so surpriZed by your accusation, I'd probably have been offended by it. But, after my surpriZe passed, it was entirely obvious to me that your accusation could only have been motivated by YOUR anger and personal aggravation that a person such as myself would have the extreme "audacity" to criticize you. After all, you don't know me. And, you have absolutely NO idea – whatsoever – of how I earn a living.

So, let me help you with that "concern," Paul. I admit it! I make much more money working as an "Expert Witness" (AFTER someone has died due to restraint asphyxia), than I do by providing education to prevent providers from causing restraint asphyxia. Yet, I'm doing everything in my power to END my "Expert Witness" income! I'm doing everything I possibly can to educate providers so that restraint asphyxia deaths STOP occurring! I must be demented, eh?

And, GO FIGURE! I must be TRULY demented to share SLIDES and Educational Information with others – entirely FREE of CHARGE ... TRULY demented to encourage services' use of my information to develop their OWN appropriate restraint educational program, if they can't afford to pay for my travel and lodging expenses, and the pittance I charge as an "honorarium" (Yo! 300 bucks per day!) to personally come and professionally educate them!

So, there you have MY "financial motives."
What are YOUR "financial motives," Paul?

YOU TELL ME, Paul! How is money "better" spent?

Is money "better" spent by investing a few hundred dollars in educational programs designed to prevent the devastating psychological trauma experienced by providers who cause someone's death because they don't know how to safely restrain someone (whether or not they are "successfully" litigated for "wrongful death"!)?

Is money "better" spent by investing a few hundred dollars in educational programs designed to prevent the devastation experienced by the surviving family members of diabetic patients, seizure patients, or psychiatric patients who have died due to restraint asphyxia?

OR, is money "better" spent by investing thousands of dollars to fund research studies that reveal absolutely NOTHING of any significant value to the individuals working in the field, and the individuals who require SAFE intervention?

Thus ends my reply to your brief Email (something you likely spent a whopping 15 minutes writing) – a reply I've spent several hours composing, because I though it IMPORTANT to seize this opportunity to communicate with you AND Chan et al. (Since YOU copied your missive to ME to Chan, I'm consequently empowered to copy my reply to you to Chan – e'en though he long ago advised me that he and his compadres had "no further desire to continue discourse" with me.)

In fact, I think this exchange is so important, that I'm going to post it on my Web Site.
I will be happy to post your next Email on the site, as well.
After all, I am an equal-opportunity Web Mistress!

(BTW: I make NO money for the time I spend working on my web site – I make NO money for the time I spend supplying others with information. I'm "self-employed." And, no one has funded MY work with any "research grant.")

YOURS, CHAS (Ms. Charly D. Miller - - not "Mr."! LOL)

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"

Email Paul Schmidt at: pschmidt@pd.sandiego.gov

Email Theodore C. Chan at: tcchan@ucsd.edu

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This counter started on November 14th, 2002.