Ms. Charly D. Miller’s
RESTRAINT ASPHYXIA

LIBRARY

Plz Note: NEW HOST in 2014!
Our old webhost suffered a catastrophic meltdown in the fall of 2013 and we had to move to a new host.
If something is missing, PLZ Email Charly. Thanks!

Charly’s Email address CHANGED in October, 2010
Due to the vast number of pages and documents posted on CharlyDMiller.com, only the
MAIN PAGES of this website have the NEW EMAIL ADDRESS:
chas@novelholiday.com

The “KEY” for the RA LIBRARY Directory’s
Animated Icons, Symbols, and Text Color:

This icon indicates a Note or Article (or Article Collection) that is particularly “IMPORTANT”

An animated Pink-Push-Pin Icon indicates an “old” or “updated” article that was recently added.

NAVY Colored TEXT indicates QUOTES from the article.

BLUE Colored TEXT indicates CHAS’ COMMENTS about the article.
(Especially when a full “REVIEW” isn’t needed.)

A BLUE asterisk (*) following the Article’s RA Library LINK indicates that
CHAS’ FULL REVIEW of it is has been Written and Posted with the article.

A RED asterisk (*) following the Article’s RA Library LINK indicates that
CHAS would like to write a review, but hasn’t found time to do so.
(If you need a Review I haven’t written, Plz Email Me.)

As of 2006, many articles linked from this Library’s Directory Page are PDF files.
If you don’t have an Adobe Acrobat PDF file reader program, download a FREE version HERE.

Links to Pages from FORENSIC TEXTBOOKS can be found at
the “bottom” of this Library Directory Page.

RESTRAINT ASPHYXIA LIBRARY

LINKS to RA LIBRARY SUBDIRECTORIES:

A Collection of Studies Performed By ANESTHESIOLOGISTS
Regarding the Effects of PRONE POSITIONING

YEARS of Unbiased Clinical Evidence demonstrating that: Because it interferes
with abdominal excursion, the Prone Position interferes with Breathing!
This article Collection was started in February, 2006.

A Collection of TASER-RELATED ARTICLES
If you’re researching a case involving TASER use, you’ll find what you need here!
This Collection was started on January 24, 2006.

Minneapolis Pays $3 Million in Police Misconduct Case
CITATION: Furst, R. “May 25: Minneapolis pays $3 million in police misconduct case.”
Star Tribune Minneapolis. June 1, 2013.
Article Link
The Hennepin County medical examiner’s office said Smith died of “mechanical
asphyxia” caused by prone restraint. He ruled Smith’s death a homicide.

This article includes a VIDEO online! Use the Article Link above to go there.
The TITLE PDF linked above contains only the article’s content.

This article was originally posted here on June 19, 2013.

Physical Restraint and Near Death of a Psychiatric Patient
CITATION: Nissen T, Rørvik P, Haugslett L, and Wynn R. Physical Restraint and Near Death of a
Psychiatric Patient. J Forensic Sci. Early Online View: October 15, 2012.
doi: 10.1111/j.1556-4029.2012.02290.x
From the available data, we assume that the patient developed asphyxia secondary to the
physical restraint. The compression of the torso (i.e., the thorax and the abdomen) was
probably more important than the prone position itself in causing the asphyxia.

[Clearly, these authors have never ASSUMED THE POSITION!
Had they done so, they’d not discount the impact of prone positioning.]

This case illustrates a situation where physical restraint in the prone position seemed
unavoidable, and almost ended fatally. Close monitoring of the patient’s clinical status,
rapid release of the restraint when the patient showed signs of asphyxiation, and
immediate implementation of CPR prevented a more negative outcome. Actually, the
mere release of the restraint might in itself have been sufficient.

[Mere release from forceful-prone-restraint is only “sufficient” to survival if it
ocurrs PRIOR TO respiratory arrest. Furthermore, without implementation of artificial
ventilation PRIOR to CARDIAC arrest, this man would be dead.]

This article was originally posted here on October 15, 2012.

Sudden Cardiac Arrest and Death Associated with Application of
Shocks from a TASER Electronic Control Device

CITATION: Zipes DP. Sudden cardiac arrest and death associated with application of shocks
from a TASER electronic control device.
Circulation 2012; DOI:10.1161/?CIRCULATIONAHA.112.097584.
Available at: http://circ.ahajournals.org
CONCLUSIONS–ECD stimulation can cause cardiac electrical capture and provoke cardiac
arrest due to ventricular tachycardia/ventricular fibrillation. After prolonged ventricular
tachycardia/ventricular fibrillation without resuscitation, asystole develops.
… Alternate explanations such as excited delirium would be more relevant when
there was a significant time delay between ECD deployment and loss of consciousness
/responsiveness or death. However, when loss of consciousness/responsiveness occurs
during/immediately after an ECD chest shot … it becomes difficult to exonerate the
effects of the shock. It is also possible that combinations exist.

I disagree with Zipe’s blanket theory that loss of consciousness reported immediately
following Taser deployment rules-out excited delirium. (Reports provided by those who Taser,
regarding the time that loss-of-consciousness occurred, are often … inaccurate.) But, I’m
happy that researchers are finally identifying Taser/ECD deployment as being potentially
lethal– NOT something entirely safe to deploy.

PLEASE NOTE: This article was posted in the TASER COLLECTION and HERE,
because of its relationship to Excited Delirium studies.
This article was originally posted here on May 2, 2012.

Respiratory and Cardiovascular Response During Electronic Control Device (ECD) Exposure in Law Enforcement Trainees
CITATION: VanMeenen KM, Lavietes MH, Cherniack NS, Bergen MT, Teichman R, ServatiusRJ.
Respiratory and cardiovascular response during Electronic Control Device (ECD) exposure in law enforcement trainees.
An unpublished report of a study funded by the U.S. Department of Justice, received by the National Criminal Justice Reference Service (NCJRS) in December, 2011, and posted on the NCJRS website.
https://www.ncjrs.gov/pdffiles1/nij/grants/236952.pdf
https://www.ncjrs.gov
This is the first study to examine breathing patterns during ECD exposure with the resolution to detect changes. In contrast to reports suggesting respiration is unaffected by ECDs, present evidence suggests that voluntary inspiration is severely compromised.
Comments of the individual who sent this report to the RA Library: I have for a long time fretted about the shell game that directs our attention to cardiac effects so thoroughly that it conceals the effects of shock on volitional and automatic respiration. Canada is currently spending up to half a million on an expert panel to evaluate taser research and identify holes – they have 14 experts, not one is a respiratory specialist.
Please Note: This article was posted in the TASER COLLECTION and HERE, because of its relationship to Excited Delirium studies.
This article was originally posted here on January 29, 2013.

Effect of Position and Weight Force on Inferior Vena Cava Diameter–
Implications for Arrest-Related Death

CITATION: Ho JD, Dawes DM, Moore JC, Caroon LV, Miner JR. Effect of position
and weight force on inferior vena cava diameter–implications for arrest-related death.
Forensic Sci Int. 2011 Oct 10;212(1-3):256-9. Epub 2011 Jul 27.
Prior to this study, there was no work examining the effects of restraint on central venous return. … The effects of the restraint process on central venous return have not been examined. While the etiology of these unexpected, arrest related deaths is likely multi-factorial, the decreased central venous return with certain methods of restraint may have a role. Our study indicates that thoracic compression does reduce the size of the IVC perhaps reducing central venous return.
Ho et al found that the IVC decreased in size merely when subjects were moved from standing to a prone position. When 100 and 147 lbs of weight were applied to the subjects’ torso, significantly greater IVC size decrease occurred with each weight.
Had this study found little IVC compression occurring, I would have complained that the light amount of weight used didn’t come close to representing the weight applied to an individual’s prone torso during arrest procedures. Instead, Ho et al’s findings demonstrate that prone positioning–by itself–is enough to add IVC compression to the LIST of potentially lethal side effects of prone restraint techniques.

This article was originally posted here on December 28, 2011.

Charly Finally Responds To The Lies and Falsely Negative Innuendos
Posted By Quack and Crackpot Bloggers

In order to help OTHERS who have similarly been attacked by Anonymous Aliases,
Quack and Crackpot Bogus Bloggers, I have decided to Respond to the Misinformation
and Lies that have been posted on the Internet About Me – ONCE!!!
Here.
In Plain English.
Using small words, so that those with small minds can understand it.
This Opinion Paper was originally posted on March 31, 2010.

The Undeniably BOGUS and SHAM Website That Falsely
Claims To Offer the “Truth” About Prone Restraint Techniques

When he created it, Bruce Chapman attempted to hide his relationship to this website,
most likely because he is the President and Founder of a company that continues to train
people to perform … [insert drum roll here]Forceful PRONE Restraint.
It is My Opinion that; Chapman’s Bogus and Sham Website is nothing more
than an atrociously SleaZy Internet INFOMERCIAL!
However, unlike glamorous hair “Bump-Its” and super-absorbent “Sham Wows,”
the product Chapman promotes is potentially LETHAL.

The Original Version of this Opinion Paper was posted here on May 25, 2009.
An Updated Version was posted on June 19, 2009.

Ronald S. Federici Promotes the Use of Potentially Lethal
Forceful-Prone-Restraint Techniques for Restraining Children
(An Opinion Paper)

CITATION: Miller CD. Ronald S. Federici promotes the use of potentially lethal forceful-prone-restraint
techniques for restraining children (An Opinion Paper). Restraint Asphyxia Library; February, 2009.
Updated in May of 2009. Updated and REWRITTEN in June of 2010.
http://www.charlydmiller.com/LIB13/2009FebFedericiPage.html
In February of 2009, I was advised that Ronald S. Federici was actively promoting the performance
of FORCEFUL-PRONE-RESTRAINT for the purpose of restraining CHILDREN – encouraging Parents
(and others) to subject CHILDREN to such potentially LETHAL means of restraint, in spite of
numerous CLINICAL MEDICAL RESEARCH reports and INVESTIGATORY articles that clearly
CONTRAINDICATED the performance of FORCEFUL-PRONE-RESTRAINT when restraining ANYONE!
After reviewing Federici’s EGREGIOUS restraint techniques,
I wrote and posted this OPINION PAPER.

This Opinion Paper was originally posted here on February 24th, 2009.
It was updated in May of 2009. It was updated and REWRITTEN in June of 2010.

School is Not Supposed to Hurt:
Investigative Report on Abusive Restraint and Seclusion in Schools

A Report Released by the National Disability Rights Network
WASHINGTON (January 13, 2009) – The National Disability Rights Network
(NDRN) today unveiled a disturbing national report on seclusion and restraint in
U.S. schools. The report shows an unsettling use of seclusion and restraint tactics,
which resulted in physical and emotional injuries as well as deaths, in schools
affecting students from grades K-12. The report documents cases that range from
students being locked in rooms or even boxes for hours to students who were
encouraged to release their aggression by wrestling in “WWF Rooms.”

This report was originally posted here on February 4, 2009.

Faith Finley Died After Being Restrained in Controversial Position
This PDF contains 3 articles about Faith Finley’s death, written in January, 2009.
Gov. Ted Strickland has called for a single statewide policy on the use of restraints like the
one that contributed to the death of a 17-year-old at a center for troubled children last month.
John Martin, director of the Department of Mental Retardation and Developmental Disabilities,
which banned the dangerous face-down restraint last year, will head the effort. …
Cuyahoga County Coroner Frank Miller said she suffocated while being held in the restraint.
Her death has been ruled a homicide.

This article collection was originally posted here on February 4, 2009.

A Tragic Result of a Failure to Act;
The Death of Angellika Arndt

CITATION: Prepared and Published by Disability Rights Wisconsin
http://www.disabilityrightswi.org/
[Although dated Nov 26, 2008, the “final” copy was distributed in Jan, 2009
Hence its ORDER in the Library.]
The autopsy and related medical reports indicated that Angie died from complications
of chest compression asphyxia. … She had hemorrhages of the pancreas, colon, stomach,
and duodenum from abdominal trauma from the hold. … The Medical Examiner ruled
Angie’s death a homicide because the restraint impaired her ability to breath.

She was only SEVEN (7) Years Old! This 75-page investigative report provides
information related to the circumstances and events preceding, during, and
following Angellika Arndt’s restraint asphyxia death.

This REPORT was originally posted here on January 29, 2009.

Restraint and Asphyxia; Part Two – Compressional Asphyxia*
CITATION: Restraint and asphyxia; Part two – Compressional asphyxia.
2009 (1) AELE Mo. L. J. 101;
ISSN 1935-0007; Civil Liability Law Section – January 2009.
http://www.aele.org/law/2009all01/2009-01MLJ101.pdf
Police trainers must be aware of [actions that can potentially cause] deaths from compressional
asphyxia. Officers must be taught to avoid putting their body weight on a confined person as
soon as active resistance has ended or the person has been adequately restrained from causing
harm to himself or others.

I highly recommend this AELE article to attorneys seeking to HOLD RESTRAINERS
LIABLE FOR HAVING CAUSED A RESTRAINT ASPHYXIA DEATH.
I also highly recommend this AELE article to EDUCATORS of restrainers,
seeking to ENSURE THAT RESTRAINERS DO NOT EMPLOY RESTRAINT TECHNIQUES
THAT CAN CAUSE DEATH.

This article was originally posted here on January 18, 2009.

Restraint and Asphyxia; Part One – Restraint Ties*
CITATION: Restraint and asphyxia; Part one – Restraint ties.
2008 (12) AELE Mo. L. J. 101
ISSN 1935-0007; Civil Liability Law Section – December 2008.
http://www.aele.org/law/2008ALL12/2008-12MLJ101.pdf
In light of the ruling in Cruz v City of Laramie, Wyoming [239 F.3d 1183 (10th Cir.
2001)] hog-tie restraints are prohibited in all cases. To further ensure compliance with
the Court’s ruling, Department policy shall prohibit binding a subject’s ankles to the
wrists, behind the back, regardless of the length of separation between the ankles and
wrists.” Adopted March 10, 2006.

Part One of this AELE article is NOT HELPFUL to the education of law enforcement personnel
or other restrainers. However. There are several links within this document that attorneys may
find helpful when seeking to hold restrainers liable for having caused a restraint asphyxia death.
Unfortunately, it will take hours and hours of work to sort through them and determine which
links are helpful, and which are NOT.

This article was originally posted here on January 18, 2009.

An Unbelievably Grotesque and DEVIANT Case of Summit County, Ohio,
SHERIFF’S DEPUTIES Sexually Abusing, Hogtying, TASERing, and
Pepper Spraying a Mentally Ill Man While In Custody!

Oh, SurpriZe. Their Victim Died.

This 2006 case didn’t come to my attention until August, 2008, when one of the five Deputies
who participated in these heinous and deviant acts was found not guilty of homicide.
Hence, this link’s order of appearance.

This case article collection was originally posted on August 13, 2008.

A Directory of Public Documents Related to the Texas Medical Board’s
Suspension of Dr. Bryan E. Bledsoe’s License to Practice Medicine,
Due to His Narcotic Addiction.

This Directory Page provides links to a collection of PUBLIC DOCUMENTS obtained from the
Texas Medical Board’s website.
This Public Document Directory Page was originally posted on August 11th, 2008.
It was last updated on November 7th, 2010.

Three Documents Related to the June 2008
Heston Jury Verdict Against TASER International Inc.

were added to the TASER COLLECTION
on July 18, 2008!

RESTRAINT DEEMED EXCESSIVE BY JURY
CITATION: Evans J; Judd E; and Unnamed. (A collection of “SWANSEA.CO.UK
Evening Post news articles regarding the restraint asphyxia death of Kurt Howard.)
2008; June 04 – 28.
A Mumbles-born man who died after being held face down on the floor
at Cefn Coed Hospital for three-quarters of an hour died due to excessive,
prolonged restraint, a jury has decided.

This is the FIRST CASE-OUTCOME news article collection I’ve posted in the RA Library.
Obviously, there have been many similar collections published prior to this.
But, I haven’t previously taken time to create their PDF and post them.
I sincerely HOPE to post ALL subsequently-published article collections of this sort.
And, I HOPE to eventually find time to belatedly post similar article collections, published
in previous years. But, I cannot “guarantee” that I’ll ever manage to do this.
If YOU want to help accomplish this, PLZ let me know!

This news article collection was originally posted on June 30, 2008.

Fatalities Related to Medical Restraint Devices –
Asphyxia is a Common Finding

CITATION: Karger B, Fracasso T, Pfeiffer H.
Fatalities related to medical restraint devices – Asphyxia is a common finding.
Forensic Sci Int; 04 July 2008: V178; Issues(2-3), Pages 178-184.
…prophylaxis is based on a clear medical indication, the proper use of restraint
devices, detailed instructions of the nursing personnel and close monitoring.

Thank you, ANNE, for purchasing and sharing this article with us!
This article’s abstract was originally posted June 17, 2008.
The FULL ARTICLE was posted on April 2nd, 2009.

More TASER-Related Articles Added to The Taser Collection in June, 2008:

Two letters to the editor and the authors’ reply regarding Vilke et al’s Taser study report
(using healthy human subjects), published in the Ann Emerg Med November 2007 issue.

Posted on that journal’s website on June 19, 2008; for 2008 July issue publication.


15-Second Conducted Electrical Weapon Exposure Does Not Cause
Core Temperature Elevation in Non-Environmentally Stressed Resting Adults

A study report published in the APRIL 2008 issue of Forensic Sci Int.

An Alleged “BOOK REVIEW” of A TASER-RELATED BOOK
Citation: New study: TASERs “as safe as weapons can be,” not “instruments of death”
PoliceOne.com June 06, 2008.
This SHAM “book review” contains a LINK to EXCERPTS from the
SHAM BOOK that generated it – as well as my REVIEW of same!

[ “SHAM: Something false or empty that is purported to be genuine; a spurious imitation”]
These PDFs were originally posted on June 27, 2008.

TWO CMAJ Articles Added to The TASER COLLECTION in May
CITATION #1: Stanbrook, MB. Tasers in medicine: an irreverent call for proposals.
CMAJ May, 2008;178(11):1401-2.
CITATION #2: Kumaraswamy N, Massé S, Umapathy K, Dorian P, Waxman S,
Waxman M. Cardiac stimulation with high voltage discharge from stun guns.
CMAJ May, 2008;178(11):1451-7.
These PDFs were originally posted May 20, 2008.

Sudden Death During Restraint: Do Some Positions Affect Lung Function?
CITATION: Parkes J. Sudden death during restraint: do some positions affect lung function?
Med Sci Law 2008 Apr;48(2):137-41.
Participants restrained face down with the body weight of the restraining persons
pressed on their upper torso and/or in a flexed restraint position showed a
significant reduction in lung function

This article ABSTRACT was originally posted on July 18, 2008.

A Knee In The Neck of Excited Delirium
CITATION: Truscott A. A knee in the neck of excited delirium.
CMAJ March 11, 2008; 178 (6).
This is a well written, balanced, news article.
Although nothing “new” is presented in this article, it aptly demonstrates
how those who persist in blaming excited delirium – alone! – for causing
deaths associated with asphyxial forms of restraint (or Taser fires),
STILL FAIL to provide a shred of support for their claims.
One would expect them to HAVE SOME SUPPORT to cite by now,
IF such support could be legitimately documented!

This article was originally posted March 11, 2008.

Blood Factors of Sus scrofa Following a Series of
Three TASER® Electronic Control Device Exposures

CITATION: Jauchem JR, Cook MC, Beason CW. Blood factors of Sus scrofa
following a series of three TASER® electronic control device exposures.
Forensic Sci Int March 2008: V175; Issue2-3, Pages 166-170.
Transient increases in blood glucose, lactate, sodium, potassium, calcium, and pCO2 were
consistent with previous reports … it is unlikely that this would be an indicator of any serious harm.

Like Jauchem et al’s previous Pig study, this one provides NO support for their suggestion
that it is “safe” to subject human beings to Taser fires (whether or not they are being subjected
to forceful-prone-restraint before, during, or after Taser fires).
Thus, I did not BUY this article. If you buy it, PLZ send me its full pdf file, & I’ll post it.

This article’s ABSTRACT was originally posted February 11, 2008, here
and in the
TASER COLLECTION.

Asphyxial Games in Children and Adolescents
CITATION: Andrew TA, Fallon KK. Asphyxial games in children and adolescents.
Am J Forensic Med Pathol; December 2007, 28(4):303-307.
Presented are characteristics of victims of this practice that may help
distinguish these deaths from suicidal asphyxia.

This Article’s Full Text was posted on February 13, 2009 (Thank you, Anne).
This article’s Abstract was originally posted November 29, 2007.

Fatal Positional Asphyxia Associated With Rollover Crashes
CITATION: Conroy C, Eastman AB, Stanley C, Vilke GM, Vaughan T, Hoyt DB,
Pacyna S. Fatal positional asphyxia associated with rollover crashes.
Am J Forensic Med Pathol; December 2007, 28(4):330-332.
Although this is a rare cause of motor vehicle related death, our results
suggest that these are potentially preventable deaths.

This article’s ABSTRACT was originally posted November 29, 2007.

Postmortem Serum Catecholamine Levels in Relation to the Cause of Death
CITATION: Bao-Li Zhu, Takaki Ishikawa, Tomomi Michiue, Dong-Ri Li, Dong Zhao,
Li Quan, Shigeki Oritani, Yasumori Bessho and Hitoshi Maeda.
Postmortem serum catecholamine levels in relation to the cause of death.
Forensic Sci Int; 20 December 2007: V173; Issues(2-3), Pages 122-129.
… significantly higher cardiac blood levels were observed for Adr and Nad in injury
and asphyxiation cases … These findings differed markedly from clinical observations
and suggest that the postmortem serum catecholamine levels may reflect the magnitude
of physical stress responses during the process of death in individual cases.

This article’s ABSTRACT was originally posted November 29, 2007.

July, Aug, Sep & Nov 2007 Articles Added to the TASER COLLECTION
CHAS’ OVERVIEW of these ARTICLES’ HIGHLIGHTS:

Excited Delirium and Sudden Unexpected Death
CITATION: Sztajnkrycer MD, Baez AA. Excited delirium and sudden unexpected death.
Posted on the ACEP website on September 26, 2007.
http://www.acep.org/ACEPmembership.aspx?id=31850
Fatal [excited delirium] appears clinically to consist of 4 distinct phases, which occur
sequentially: elevated temperature, agitated delirium, respiratory arrest, and death. Patients
initially appear agitated to grossly psychotic, and exhibit feats of superhuman strength, especially
during attempts to restrain them. Shortly after being restrained, the violent struggling appears to
cease, and a labored or shallow breathing pattern is noted.

Here are two more allegedly well-educated authors who, for some unknown reason, seem to
feel comfortable promoting the idea that excited delirium – all by itself – can suddenly
result in death! Like others before them, they have absolutely no support for such a suggestion.
No “Sudden Unexpected Death” can legitimately be blamed on excited delirium unless
restraint asphyxia can be entirely ruled out. (Additionally, excessive TASER deployment must
be ruled out!) To this date (Dec., 2008), there still has never been a documented case study that
clearly shows excited delirium having caused sudden death in the absence of an asphyxial form
of restraint having been employed.

This article was originally posted here on December 9, 2008.

Sudden Death due to Sickle Cell Crisis During Law Enforcement Restraint*
CITATION: Channa Perera SD, Pollanen MS. Sudden death due to sickle cell crisis
during law enforcement restraint. J of Forensic Legal Med V 14, Issue 5 (July 2007); pgs 297–300.
In summary, we have presented a case of sudden death from vaso-occlusive sickle
cell crisis due to hypernatremic dehydration in a schizophrenic patient with sickle cell
trait. This case indicates that not all deaths occurring during restraint are necessarily due
to mechanical asphyxia or excited delirium leading to cardiac arrhythmia, but may be due
to a previously undiagnosed condition that is fatal.

Channa Perera & Pollanen did NOT present a case study clearly identifying an episode of
Sickle Cell Crisis having been the “cause” of a death that occurred during restraint.
In fact, with this report, Channa Perera & Pollanen have quite clearly demonstrated their
membership in the ranks of dishonorable individuals seeking ONLY to absolve restrainers
from being held responsible for killing children and adults
when they persist in employing
unsafe methods of restraint
.

This article was originally posted on July 2, 2007.
The review was originally posted on July 11, 2007.

The REFERENCES section of CHAS’ Review also serves as a
DIRECTORY OF SICKLE CELL TRAIT
& RESTRAINT-RELATED ARTICLES

AFTER WE LOST ANDREW
A care provider merely “associated” with a restraint asphyxia death describes the
TRAUMA suffered by RESTRAINERS who kill someone.

CITATION: Ebel DC. After we lost Andrew. The Hartford Courant’s Northeast Magazine,
January 11, 1999. Posted on the Author’s Den website Friday, July 13, 2007.
http://www.authorsden.com/visit/viewarticle.asp?id=31466&AuthorID=50532
“The reality of what had happened overwhelmed me, and I was consumed by feelings
I had suppressed all day – sadness, despair, fear, horror, confusion. I began sobbing the
first tears of many that would flow for many months. I didn’t sleep that night. …
The day after Andrew’s death we were no longer permitted to use the kind of restraint
that had been used on him. Unfortunately, we were provided with neither an alternative
nor sufficient staff to compensate…”

If YOU haven’t been ADEQUATELY EDUCATED as to WHAT restraint techniques are
UNSAFE, and WHAT restraint techniques are SAFE, STAND UP AND DEMAND
TO BE EDUCATED!!! Even if you never are subjected to “suffering” a law suit after
you’ve participated in restraining someone to death, you will NEVER again be the SAME.

Although this article was originally published in 1999, it came to my attention when it was
posted on the Internet in 2007. Thus, this article’s ORDER in the Restraint Asphyxia Library.

The above page link also includes:

Staff Writer. Connecticut examines use of restraint holds on psychiatric patients
after death of boy, 11.
New York Times; March 30, 1998.
http://query.nytimes.com/gst/fullpage.html?sec=health&res=990DE0DA133BF933A05750C0A96E958260

Weizel, R. A child dies in state’s custody. New York Times; April 26, 1998.
http://query.nytimes.com/gst/fullpage.html?res=950DE1D7143FF935A15757C0A96E958260&sec=health&spon=&pagewanted=print

Aggressive Behavior and Posterior Cerebral Artery Stroke.*
CITATION: Botez SA, Carrera E, Maeder P, Bogousslavsky J. Aggressive behavior and
posterior cerebral artery stroke. Arch Neurol. 2007 (June);64: 1029-33.
2007JulyCerebralArteryRestraint.pdf
The patients became agitated and aggressive when they were stimulated by the
environment, and they responded to solicitations by their relatives or medical personnel
by shouting obscenities and hitting and biting others. In all of the 3 cases, temporary
physical restraint was required and neuroleptics were administered.

This ABSTRACT ONLY was originally posted on July 10, 2007.

Letter to the Editor Regarding; Acidosis, Lactate, Electrolytes,
Muscle Enzymes, and Other Factors in the Blood of Sus Scrofa [Pigs]
Following Repeated TASER® Exposures.

CITATION: Miller CD. Letter to the editor regarding; Acidosis, lactate, electrolytes,
muscle enzymes, and other factors in the blood of Sus scrofa following repeated
TASER® exposures. [And an Article Author’s REPLY]
Forensic Sci Int; 03 May 2007: V168; Issue(1), Pages e17-e18[e19]
I had to pay $30 to obtain the PUBLISHED version of my own letter! That document
did not include an Article Author’s REPLY page. Since there is no way in HELL that I’m
going to pay another $30 to buy the published version of an Article Author’s reply, I
have posted the “Article In Press” version of Jauchem’s reply. (There is no reason to suspect
that his reply would have been changed in any way prior to publication.)

My REVIEW of Jauchem’s REPLY is included in this PDF document!
The “Article In Press” version of my Editor Letter was originally posted in February 2007.
The final (May-published) version of my letter was posted in June 2007.

Existence of 'Excited Delirium' Debated in Nevada
CITATION: Goldman A. Existence of excited delirium debated in Nevada.
Las Vegas Sun, April 27, 2007:
http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5256
"It's a person who is manifesting very bizarre, violent behavior, who struggles and
then dies suddenly for no apparent explainable reason," said John Peters, president of the
Institute for the Prevention of In-Custody Deaths, a Henderson, Nev. consulting firm that
trains law enforcement to recognize and respond to excited delirium. "They exhaust
themselves to death, that's basically what happens."

Peters’ company makes money training law enforcement officers how to avoid being
held responsible for causing restraint asphyxia death, rather than training them how to
avoid causing restraint asphyxia deaths. IPICD is also “in bed with” Taser
International. (They have TASER’s attorney, Michael Brave, providing presentations
about “important legal theories and cases about sudden and in-custody deaths.”
Additionally, Brave is the President of LAAW International, Inc – one of IPICD’s
two “sponsors”!!!) Still, the “bottom line” hasn’t changed. Until an “excited delirium
death” occurring in the absence of an asphyxial form of restraint is documented,
excited delirium cannot legitimately be blamed for a restraint-related death.

This article was originally posted on July 11, 2007.

Restraint Asphyxia in In-Custody Deaths;
Medical Examiner’s Role in Prevention of Deaths

CITATION: Sathyavagiswaran L, Rogers C, Noguchi TT. Restraint asphyxia in in-custody deaths;
Medical examiner’s role in prevention of deaths. Legal Medicine 9 (2007) 88–93.
The role of the Medical Examiner is not only to determine the cause and manner of
deaths, but also to take action in informing the appropriate agencies to reduce
unnecessary deaths and suggest appropriate actions for correction.

The majority of suggestions offered by these authors are excellent. However, the
“undetermined” manner of death classification parameters they arrived at during a
“joint meeting with the DA and police chiefs” are disingenuous – at best.

This article was originally posted on July 2, 2007.

Sudden Death in Epilepsy (SUDEP) Recorded in Ambulatory EEG
CITATION: McLean BN, Wimalaratna S. Sudden death in epilepsy (SUDEP) recorded in
amublatory EEG. J. Neurol. Neurosurg Psychiatry published online 27 Mar 2007;
doi:10.1136/jnnp.2006.088492.
We postulate that abrupt irreversible Cerebral Electrical Shutdown (CES)
during a seizure may be the primary mechanism of SUDEP.

This article was originally posted on July 2, 2007.

'Excited Delirium' a Debatable State
CITATION: Lawrence-Turner J. Excited delirium a debatable state.
Spokesman Review (Spokane, WA), March 28, 2007:
http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5088
Even if medical experts dispute "excited delirium" as a valid physical state,
Spokane County's first responders have decided to consider it real. …
Dr. Sally Aiken, the county's medical examiner, cited two deaths where excited
delirium may have been a factor. In February 2006, John W. Stanley, 52, died in a motel
room following a fight. He had been restrained by five people. Otto Zehm, a mentally ill
janitor, died in March 2006 after being hogtied and placed on his stomach following a
scuffle with several police officers.

Until an “excited delirium death” occurring in the absence of an asphyxial form
of restraint is documented, excited delirium cannot legitimately be blamed for a restraint-related death.

This article was originally posted on July 11, 2007.

Handcuffing Procedures & Preventing Restraint Asphyxia
CITATION: Campbell RK; HandcuffingProcedures
Miller CD; Preventing Restraint Asphyxia
“The Journal” Spring 2007; pgs 79-81.
RK CAMPBELL QUOTES:
“Proper handcuff use is important, a mistake may have lethal consequences. …
A caution is to be especially careful in handcuffing obese offenders. On one
occasion a female offender who slipped out of the cuffs injured me.”

I can’t find this POLICE journal online, and the story of how I received this segment
of its “Spring 2007” issue is rather BIZARRE!
Basically, this Journal’s editor slightly EDITED and then PUBLISHED my material –
without asking my permission to do so! I never would have learned of this (I don’t
subscribe to this journal and it isn’t online). But, after publication, the editor received an
Email from an attorney who had read The Journal, and wished to speak me about my
material! So, the editor contacted me to accomplish that, and only THEN did I learn
that they’d published my material!
Since the essence of my Two Vital Tips remained unchanged, I didn’t grouse about their
unauthorized publication. Furthermore, RK Campbell entirely failed to address prone
handcuffing procedure dangers. So, it is good that my material was added to his! LOL

This article is in PDF form, and was originally posted in June, 2007.

Ventilatory and Metabolic Demands During
Aggressive Physical Restraint In HEALTHY Adults
*

Oh YEAH. Chan et al have been AT IT AGAIN!
On the page linked above, you’ll FIRST be offered the CHAS REVIEW!
REVIEW CITATION: Miller CD. A comprehensive review of the January 2007 Chan et al
‘aggressive physical restraint’ study report and questions that will ‘defeat’ those who cite it.
November 2007; http://www.charlydmiller.com/LIB11/2007JanChanArticleReview.pdf
THEN you’ll be given a link to the CHAN et al ARTICLE:
Michalewicz BA, Chan TC, Vilke GM, Levy SS, Neuman TS, Kolkhorst FW.
Ventilatory and metabolic demands during aggressive physical restraint in healthy adults.
J Forensic Sci, January 2007, Vol. 52, No. 1; pgs 171-175.
This article AND its REVIEW were originally posted in November, 2007.
(Yes! I found it rather LATE in the game, and it took me a while to Review. Sue me! LOL)

Learning From Tragedy: A Survey of
Child and Adolescent Restraint Fatalities.

CITATION: Nunno MA, Holden MJ, Tollar A. Learning from tragedy: A survey of child and
adolescent restraint fatalities. Child Abuse & Neglect Vol 30,12(December 2006); pgs 1333–1342.
This descriptive study examines 45 child and adolescent fatalities related to
restraints in residential (institutional) placements in the United States from 1993 to 2003.
… All restraint positions were represented in this sample and all positions can be lethal,
especially when misapplied or misused.

This article was originally posted on July 2, 2007.

Acidosis, Lactate, Electrolytes, Muscle Enzymes, and Other Factors in the
Blood of Sus Scrofa [PIGS] Following Repeated TASER® Exposures
*

CITATION: Jauchem JR, Sherry CJ, Fines DA and Cook MC.
Acidosis, lactate, electrolytes, muscle enzymes, and other factors in the
blood of Sus scrofa following repeated TASER® exposures.
Forensic Sci Int; 10 August 2006: V161; Issue(1);pgs 20-30.
This study discovered that rested and anesthetized pigs suffered:
• “severe acidemia” for at least an hour after TASER exposure
• “increases in hematocrit, potassium, and sodium” for at least 30 minutes
post TASER exposure
• “significantly decreased” oxygen saturation “immediately after” being TASED,
that “returned to pre-exposure levels within 30 min.”
Considering those very important findings, imagine how much MORE
acidemia, electrolyte imbalance, and decreased oxygen saturation would be suffered by a
TASED HUMAN BEING who had been extremely exerting her/himself prior to TASER
exposure, AND extremely exerting her/himself during the struggle and forceful restraint
that occurred after being shot with a TASER!

This article was originally posted in August of 2006.
It was linked both HERE and in the TASER COLLECTION directory.

Motion Passes In June of 2006! Dr. Neuman Is PRECLUDED From Testifying
That The Prone Position Is “Physiologically Neutral” Because The Chan et al
Studies’ Findings Are “IRRELEVANT” To Real Life Situations.

CITATION: Miller CD. Motion passes in June of 2006! Dr. Neuman is precluded from testifying that the prone
position is “physiologically neutral” because the Chan et al studies’ findings are “irrelevant” to real life situations.
http://www.charlydmiller.com/LIB09/2006JUN26ChanEtAlPrecluded.html
I was able to convince the judge to preclude Dr. Neuman from testifying that the prone position is
“physiologically neutral” on the basis that his studies are irrelevant.
I am told that this was the first time that he was so-precluded.

Happily, Mr. McManus (the attorney quoted above) contributed the motion he wrote
to accomplish this landmark action to this library, so that it could be shared with others.

This article was originally posted in April, 2007.

The May 2006 version of Conner’s 2002 “Excited Delirium” article.
Citation: Conner MG. Excited Delirium, restraint asphyxia, positional asphyxia and ‘in-custody death’ Syndromes:
Controversial theories that may explain why some children in treatment programs die when restrained.
Originally published on the Struggling Teens Website (http://www.strugglingteens.com on November 15, 2002)
This is an allegedly “updated” version of the 2002 article. But, just like it’s 2002 and 2005 versions,
this article STILL is of little to NO merit. In fact, I still can’t find a single “updated” part of it!
Even in 2006, Conner ENTIRELY FAILS to caution against the use of forceful-prone-restraint
when children and teens are being restrained. Apparently, Conner STILL doesn’t have a CLUE!

This article was originally posted in July 2006.
It is a PDF file. There is no “return link” to here from there.

Does Physical Restraint Impact
Metabolic Oxygen Consumption During Exertion?
*

CITATION: Chan TC, Vilke GM, Michalewicz BA, Neuman T, Levy S, Kolkhorst F.
Does physical restraint impact metabolic oxygen consumption during exertion?
Acad Emerg Med May 2006;13 S46.
http://www.aemj.org/cgi/content/abstract/13/5_suppl_1/S46?etoc
“During the 60-second test, subjects were asked and encouraged
to struggle and maximally exert themselves…”

This report is of YET ANOTHER entirely UNHELPFUL study designed and implemented by
the Chan et al types. I've lost count. Is this the 4th or 5th (or more!) entirely unhelpful
study they've wasted hundreds of hours and thousands of dollars on?

To understand the VALIDITY of the statement above, be SURE to see the collection of
Anesthesiologist Studies (coming NEXT) … AND, be SURE to read my 2005
“Comprehensive Review of Frequently Misinterpreted & Misrepresented Restraint Research”!

This article was originally posted May 1, 2006.

A Collection of Studies Performed By ANESTHESIOLOGISTS
Regarding the Effects of PRONE POSITIONING

WOW!!! On February 6, 2006, I discovered that “ANESTHESIOLOGISTS” have performed
and published LOADS of clinical studies consistently documenting the FACT that,
If a position interferes with abdominal excursion, it interferes with breathing.
Furthermore, they PROVED this FACT long before Reay et al began their research (1988)!
Most importantly; this collection clearly and concretely demonstrates that
ALL the “CHAN ET AL” studies & opinions related to prone positioning
are ENTIRELY WITHOUT MERIT!

This article Collection Directory was started in February, 2006.

Sickle Cell Anaemia and Deaths in Custody in the UK and the USA
CITATION: Dyson SM, Boswell G. Sickle cell anaemia and deaths in custody in the UK and the USA.
The Howard Journal. February 2006, Vol 45; No 1: pp. 14–28
http://www.sicklecellsociety.org/pdf/SCDeathCustody.pdf
Justice authorities have misused sickle cell trait to explain away ten sudden deaths
This article was posted in relationship to CHAS’ review of
Sudden Death due to Sickle Cell Crisis During Law Enforcement Restraint

This article was originally posted on July 2, 2007.

Tasers Implicated in Excited Delirium Deaths
(Part Two of a two-part news report about excited delirium. Part One is below.)
[For some unknown reason, I couldn’t create a PDF file from the MSWord doc I
cut-&-pasted the info from this article’s website to! So, I had to create one from the
WEBPAGE. All the ADS and extraneous LINKS are in this document. If you print it,
do NOT print the pages with only that kind of krappe.]

CITATION: Sullivan L. Tasers implicated in excited delirium.
NPR: All Things Considered, Feb 27, 2006:
http://www.npr.org/templates/story/story.php?storyId=7622314
Civil-liberties groups fear that the diagnosis is being used to cover up police
abuse — and to protect companies like Taser International from lawsuits. … As
several officers hold Williams down, he is stunned six more times. A few minutes later,
the officers realize Williams is not breathing. … Taser International spokesman Steve
Tuttle acknowledges that each year, his company sends hundreds of pamphlets to
medical examiners explaining how to detect excited delirium.

Even though these are “news reports,” and don’t clearly discuss the manner of
restraint employed, they do a pretty good job of demonstrating the motivations of people
who seek to absolve restrainers from responsibility for causing asphyxial death.

This article was originally posted on July 11, 2007.

Death by Excited Delirium: Diagnosis or Coverup?
(Part One of a two-part news report about excited delirium. Part Two is above.)
[For some unknown reason, I couldn’t create a PDF file from the MSWord doc I
cut-&-pasted the info from this article’s website to! So, I had to create one from the
WEBPAGE. All the ADS and extraneous LINKS are in this document. If you print it,
do NOT print the pages with only that kind of krappe.]

CITATION: Sullivan L. Death by excited delirium: Diagnosis or coverup?
NPR: All Things Considered, Feb 26, 2006:
http://www.npr.org/templates/story/story.php?storyId=7608386
Balaban charges that police officials are using the diagnosis "as a means of white-
washing what may be excessive use of force and inappropriate use of control techniques
by officers during an arrest." … According to Dr. Vincent Di Maio, "What these people
are dying of is an overdose of adrenaline." … He says the condition typically arises
after officers have wrestled down an uncooperative suspect.

Riiiight. Adrenaline overdose that “arises” after some form of restraint asphyxiates
someone. Sure, Dr. DiMaio, that makes loads of sense. (NOT!) The “BOTTOM LINE”
remains the same. Until an “excited delirium death” occurring in the absence of an
asphyxial form of restraint is documented, excited delirium cannot legitimately be
blamed for a restraint-related death. Dear Dr. DiMaio cannot cite even a single case
of death occurring solely due to excited delirium!

This article was originally posted on July 11, 2007.

A Collection of TASER-RELATED ARTICLES
This collection includes Charly D. Miller’s “The Truth About Tasers” article.
If you’re researching a case involving TASER use, you need to read these articles!
This Collection of TASER-RELATED ARTICLES (published between 2004 and 2006)
was originally posted in this LIBRARY on January 24, 2006.

Excited Delirium and its Medical Status*
CITATION: Lawrence C. Excited delirium and its medical status.
Police One dot Com: Jan 20, 2006, Beat 1 Exclusive,
http://policeone.com/legal/articles/121675/
My experience over the past six years leads me to wonder if medical
specialization may be hampering the appreciation of ED and sudden deaths.

Oh, WOW – do I agree with that!
This article was originally posted February 13, 2006.

The Varied Faces of Excited Delirium*
CITATION: Lawrence C. The varied faces of excited delirium.
Police One dot Com: Oct 28, 2005; Beat 1 Exclusive,
http://policeone.com/writers/columnists/clawrence/articles/120458/
The classic signs of ED arise during the altercation, at a time when it is
difficult for the officer to assess the totality of the situation.

This article was originally posted February 13, 2006.

The October 2005 version of Conner’s 2002 “Excited Delirium” article.
Citation: Conner MG. Excited Delirium, restraint asphyxia, positional asphyxia and ‘in-custody death’ Syndromes:
Controversial theories that may explain why some children in treatment programs die when restrained.
Originally published on the Struggling Teens Website (http://www.strugglingteens.com on November 15, 2002)
This is an allegedly “updated” version of the 2002 article. But, just like it’s original 2002 verson,
this article STILL is of little to NO merit. In fact, I can’t find a single “updated” part of it!
Even in 2005, Conner ENTIRELY FAILS to caution against the use of
forceful-prone-restraint when children and teens are being restrained.

This article was originally posted in July 2006.
It is a PDF file. There is no “return link” to here from there.

A Comprehensive Review of Frequently Misinterpreted and
Misrepresented Restraint Research

CITATION: Miller CD. A comprehensive review of frequently misinterpreted and misrepresented
restraint research. THREE PARTS, posted in February, March, & August, 2005
http://www.charlydmiller.com/LIB05/2005chasresearchreview.html
Misinterpretation and misrepresentation of research and review articles can have deadly
consequences. The primary purpose of this THREE-PART review is to assist others to
understand the TRUE content of three particular articles.
This is accomplished by providing accurate explanations of each article’s CONTENT;
and by providing substantiated BACKGROUND INFORMATION relevant to the
authors’ “MOTIVATION” for performing the studies and reviews that generated these
articles: information NOT available to the majority of readers – information not even
available to many professionals who subscribe to the journals that published these articles!

PART ONE was originally posted in February, 2005.
PART TWO was originally posted in March, 2005.

PART THREE was posted on August 1st, 2005.
A PDF FILE of all 3 parts and the reference list was finally posted in December, 2005!
It can be accessed from any of the pages in this collection.

A Father's Quest: A Lawyer Sues His Former Client
– A School For Troubled Kids –
When His Own Son Dies Under Questionable Circumstances

CITATION: Kotb, H. A father's quest: A lawyer sues his former client – a school for troubled kids –
when his own son dies under questionable circumstances. A DATELINE NBC Story; July 31, 2005.
This is a terrifically SAD story. But, it is a story that clearly demonstrates the LACK OF JUSTICE
(and the LACK OF CHANGE) commonly accomplished by the US Legal System –
specifically when it comes to restraint asphyxia deaths, and the litigation they generate.

This article was originally posted August 2nd, 2005.

Medical Investigations of Homicides of Prisoners of War in Iraq and Afghanistan
Citation: Miles SH; Medical investigations of homicides of prisoners
of war in Iraq and Afghanistan. Medscape General Medicine July 5, 2005;7(3)
http://www.medscape.com/viewarticle/507284_1
Incidents are discussed of “Homicide by torture method (eg, asphyxia) that was not recognized
as cause of death.”
; as well as an incident specifically described as, “It seems likely that Mr. Kenami died
of positional asphyxia because of how he was restrained, hooded, and positioned.” …
;
and, an incident of an individual who was “beaten, stuffed headfirst into a sleeping bag,
and sat on until he died. A paramedic could not resuscitate him; a military surgeon declared
death by natural causes.”

This article concretely documents how “Several Defense Department practices
facilitate obstructing the medical evaluation of a death so that investigators are less likely
to substantiate that a homicide occurred.”
; and makes it very clear that,
“Our national reputation and interests were harmed by these failures.”
How can we expect those who capture American soldiers to honor the Geneva Convention,
when AMERICA DOESN’T HONOR IT?

This article was originally posted here September 6th, 2005.

Sudden Unexpected Death in Epilepsy;
Is Death by Seizures a Cardiac Disease?
*

CITATION: P-Codrea Tigaran S, Dalager-Pedersen S, Baandrup U, et al.
Sudden unexpected death in epilepsy: is death by seizures a cardiac disease?
Am J Forensic Med Pathol, Jun 2005, 26(2) p99–105.
I really wish that researchers performing reviews of potential “SUDEP” deaths would finally
begin to include investigation of the possibility that positional asphyxia forms of death are
occasionally misidentified as SUDEP deaths.

This article was originally posted in June, 2005.

Does Weight Force During Physical Restraint Cause Respiratory Compromise?*
CITATION: Vilke GM, Michalewicz B, Kolkhorst FW, Neuman T, Chan TC;
Does weight force during physical restraint cause respiratory compromise?
Acad Emerg Med May 2005;12(5 Supplement 1): page 16.
GADZ! They’re at it AGAIN!!!
This is yet ANOTHER entirely UNHELPFUL “study” supervised (if not designed)
by the Chan et al bunch (aka, the “Misrepresentation Kings”).

This article was originally posted in September 2005.

TWO JEMS ARTICLES:
A Rational Response to Taser Strikes AND Don’t Be Shocked*
[Either of the above links will take you to the same page.]
CITATIONS:
Whitehead, S. A rational response to Taser strikes. JEMS 2005 May; 30(5):pgs 56-66.
Heightman AJ; From the editor; Don’t be shocked. JEMS 2005 May; 30(5):pgs 12,32.
In “A Rational Response to Taser Strikes,” Whitehead presented a terrifically
IRRATIONAL discussion of Taser stikes and restraint-asphyxia-related deaths.
In “From the Editor; Don’t Be Shocked,” A.J. Heightman’s statements were SHOCKING!!!

This article was originally posted September 2nd, 2005.

Cocaine, Excited Delirium and Sudden Unexpected Death*
Citation: Sztajnkrycer MD, Baez AA. Cocaine, excited delirium and sudden
unexpected death. Emerg Med Serv, Apr 2005, 34(4) p77-81
“Placing restrained individuals in a prone position has the potential to physically interfere with
diaphragm movement. … Current data neither support nor refute positional asphyxia secondary
to prone positioning and use of hobble restraints in the initial arrest of these patients.”

This is the “BEST” excited delirium article I've ever read! BUT … ONLY because these authors:
• Rightly attributed “diaphragm movement” interference for causing the asphyxia
• Came closer than any others (so far) to clearly identifying that there has NEVER
been a case report published of an "excited delirium" death occurring in the absence
of an asphyxial form of restraint application.

This article was originally posted in October 2005.

Death Due to Positional Asphyxia Under Severe Alcoholisation:
Pathophysiologic and Forensic Considerations

CITATION: Padosch SA, Schmidt PH, Kröner LU and Madea B; Death due to positional asphyxia under severe
alcoholisation: pathophysiologic and forensic considerations. Forensic Sci Int, 20 April 2005, 149(1); pgs 67-73.
No “restraint asphyxia” information is included, so only the article’s Abstract is posted.
This abstract was originally posted in February, 2005.
[I have NO IDEA how I managed to post it BEFORE it was supposedly PUBLISHED!]

Sudden Unexpected Death in Epilepsy; A Retrospective Study*
CITATION: Lear-Kaul KC, Coughlin L, Dobersen MJ:
Sudden unexpected death in epilepsy; a retrospective study.
Am J Forensic Med Pathol March, 2005;26(1): 11–17.
If SUDEP researchers wish to see the term “SUDEP” become more frequently employed as a
cause of death, they will have to better substantiate SUDEP as a specific cause of death,
entirely independent from OTHER causes of death – such as positional asphyxia
or restraint asphyxia. That means, positional asphyxia & restraint asphyxia must first be
ruled-OUT before considering SUDEP as the cause of death.

This article originally posted in March, 2005.
Reposted with a “better” review in June, 2005.

Sudden In-Custody Death Syndrome*
CITATION: Robison D, Hunt S. Sudden in-custody death syndrome.
Top Emerg Med; Jan-March, 2005; Vol. 27, No. 1, pp. 36-43.
Overall, multiple factors have been associated with sudden death when a person is
restrained and is in an excited delirium state. These individuals are at a high risk for
sudden death. Law enforcement officers and hospital personnel should be aware of the
risks associated with restraints in subjects/patients in an excited delirium state. …
By implementing procedural protocols, the potential for SICDS may decrease.

Besides being a very well-researched and well-written article, this is one of
the most unbiased articles I’ve ever read on this subject!

This article was originally posted in August, 2006.

Traumatic Asphyxial Deaths Due to an Uncontrolled Crowd*
CITATION: Gill JR, Landi K: Traumatic asphyxial deaths due to an uncontrolled crowd.
Am J Forensic Med Pathol December, 2004;25: 358–361
I am extremely concerned that so many medical examiners and forensic pathologists continue
to entirely disregard the importance of abdominal excursion to breathing. Considering the
consistent absense of rib trauma demonstrated by victims of crowd-related traumatic
asphyxia (“riot crush” victims), it is far more likely that the cause of death in these cases
was abdominal compression – not “chest compression.”

This article was originally posted in January, 2005.

Weight Force During Prone Restraint and Respiratory Function*
CITATION: Chan TC; Neuman T; Clausen J; Eisele J; Vilke GM.
Weight force during prone restraint and respiratory function.
Am J Forensic Med Pathol 25(3):185-189, September 2004.
More than FOUR YEARS after the study that generated this “report” was performed,
Chan finally found someone to publish HIS VERSION of its findings! Although all the
study subjects were perfectly healthy and completely rested individuals, their
ventilation volumes were identified as being “significantly lower” after simply
having been placed in a prone position – even before perfectly silly (light) amounts
of weight were placed BETWEEN THEIR SHOULDERS. But, Oh SurpriZe! Check out
Chan’s wording of the study article’s “CONCLUSION”:

“We found that weight force of 25 and 50 lbs did not result in evidence of hypoxia
or hypoventilatory respiratory compromise in our study subjects.”

Go figure! What part of the “LIGHT WEIGHT” and the “RIB CAGE PLACEMENT”
study parameters are Chan et al hoping we’ll MISS?! ALL of them. That’s what.
Furthermore, Chan et al are hoping that we’ll MISS the perfectly healthy and
completely rested study subject parameters. Why are they hoping this? Because,
they hope we’ll regard their study findings as being important to the evaluation of
REAL LIFE situations – when their study findings clearly are NOT applicable!

This article was originally posted on September 6, 2004.

Reenactment of Circumstances in Deaths Related to Restraint*
CITATION: O'Halloran, Ronald L. MD.
Reenactment of circumstances in deaths related to restraint.
Am J Forensic Med Pathol 25(3):190-193, September 2004.
“Since initial investigative reports often do not provide sufficiently specific information
about the asphyxial potential of the restraint process, specific questions of restrainers and
witnesses should be asked after the autopsy. The sooner the questions are asked, the
more likely that the recollections will be accurate. Videotaping a reenactment of the
restraint episode is an efficient way to collect and store useful information.”

This article was originally posted on September 6, 2004.

Understanding The Dynamics of Positional or Restraint Asphyxia
CITATION: Stone MP; Understanding the dynamics of positional or restraint asphyxia.
Police-Defense.com Training Bulletin, March 2004; Vol. VII, Issue No. 3.
http://www.police-defense.com/bulletins/V7_I3_TBUNDERSTANDING.pdf
[Any] restraint procedure that forces the trunk and upper legs, and the lumbar and thoracic parts
of the back of a prone person downward and inward, bear an impermissible risk of asphyxia.
This includes the “gang-tackle” and “swarm” techniques. …
This scenario demonstrates that in-custody deaths from restraint asphyxiation can
occur even without any restraint methods or hardware applied. The problem is that sufficient
compression of the trunk, legs, abdomen and chest can make it impossible to breathe.

This excellently written Training Bulletin was issued by Michael P. Stone, PC.
Formerly a police supervisor and police attorney, Mr. Stone is the founder and principal partner
of a law firm that limits its practice to the defense of “federal, state and local law enforcement
members and agencies” in California.

This article was originally posted here on January 18, 2009.

Drug-Induced Rhabdomyolysis
CITATION: Coco TJ, Klasner AE: Drug-induced rhabdomyolysis.
Curr Opin Pediatr April 2004; 16(2):206-210.
“Drug-induced rhabdomyolysis is a common syndrome that is complex and potentially
life threatening. … The presenting symptoms may be discrete and misleading. ...
With early recognition and a high index of suspicion
[as long as “the airway, ventilation, and perfusion” are ensured],
most patients with rhabdomyolysis will have an excellent prognosis.”

This article was originally posted in January, 2005.

Criteria for the Interpretation of Cocaine Levels in Human
Biological Samples and Their Relation to the Cause of Death
*

CITATION: Stephens BG, Jentzen JM, Karch S, Mash DC, Wetli CV:
Criteria for the interpretation of cocaine levels in human biological samples and their
relation to the cause of death. Am J Forensic Med Pathol (March) 2004;25: 1–10.
“Ideally, the investigation into the death starts at the scene. … the investigator looks for and
notes the … original position of the deceased at the time of death, … the presence of any
restraints … The nature and the anatomic location of the restraint are noted. … If the
person was restrained, what position was he/she in, and what were the conditions and the
duration of the restraint? … Other pathology always is considered
before making a decision that cocaine is the cause of death.”

This article was originally posted February 25 2004.

National Association of Medical Examiners Position Paper
on the Certification of Cocaine-Related Deaths
*

CITATION: Stephens BG, Jentzen JM, Karch S, Wetli CV, Mash DC:
National association of medical examiners position paper on the certification of cocaine-
related deaths. Am J Forensic Med Pathol (March) 2004;25: 11–13.
“The National Association of Medical Examiners Committee on Cocaine-related Deaths
recommends that the following guidelines be applied in the process of documenting,
interpreting, and certifying potential cocaine-related fatalities. … Currently, when all
other causes of death have been reasonably eliminated, the recommendation is that
cocaine related deaths be certified as accidental. … In cases of sudden death related to
police actions, the involvement of cocaine as a cause of death should be made with caution
.”

This article was originally posted February 25 2004.

LETTERS REGARDING the NAME POSITION PAPER and the
DEATH-RELATED COCAINE LEVEL CRITERIA article:

Response to the NAME position paper
on the certification of cocaine-related deaths.

CITATION: Wecht CH. Response to the National Association of Medical Examiners
position paper on the certification of cocaine-related deaths.
Am J Forensic Med Pathol (December) 2004;25: 362-363.
“… the adamant refusal of some of our colleagues to even consider
police misconduct and brutality as the underlying feature of such cases is
most regrettable and, in my opinion, morally and ethically indefensible.”

This letter was originally posted in January, 2005.

Response to the NAME position paper
on the certification of cocaine-related deaths – AND
Criteria for the interpretation of cocaine levels in human
biological samples and their relation to the cause of death.

CITATION: Miller CD. [Type-in all of the above title.]
February 25, 2004; Internet Restraint Asphyxia Library page:
http://www.charlydmiller.com/LIB05/2004febNAMEemail.html
Sent February 25, 2004 to NAME and the Am J Forensic Med Pathol
Editor, et al; but disregarded by all recipients.

Although the authors of these two articles provided many GREAT points
and directives, they MISSED some very important considerations.

This letter was originally posted on the March 2004 NAME position paper page,
following that paper’s PDF file link, on February 25, 2004. A separate Library page
was posted when Dr. Wecht’s letter came to light, in January, 2005.

Positional Asphyxia: Inadequate Oxygen, or Inadequate Theory?*
CITATION: Glatter K, Karch SB. Positional asphyxia: inadequate oxygen, or inadequate theory?
[a “Letter To The Editor”] Forensic Sci Int May, 2004; 141(2-3):201-202.
Published in a journal that does NOT contain ANY article related to restraint asphyxia, these
authors appear to be responding to the “NAME” position paper published in the March
2004 issue of Am J Forensic Med Pathol. Consequently, this letter is posted here.

This is yet ANOTHER example of presumably-intelligent individuals who either accidentally
MISINTERPRETED
clinical study findings, OR purposefully MISREPRESENTED them.

This letter was originally posted in January, 2005.

Comparison of Heart Mass in Seizure Patients Dying of Sudden Unexplained
Death in Epilepsy to Sudden Death due to Some Other Cause
*

CITATION: Davis GG, McGwin Jr G: Comparison of heart mass in seizure patients dying of
sudden unexplained death in epilepsy to sudden death due to some other cause.
Am J Forensic Med Pathol (March) 2004;25: 23–28.
“The diagnosis of SUDEP [Sudden Unexplained Death in Epilepsy] is a diagnosis of
exclusion. Like SIDS, any anatomic, toxicological, or scene finding that
accounts for death precludes a diagnosis of SUDEP”

This article was originally posted February 27, 2004.

Negligent Homicide by Traumatic Asphyxia*
CITATION: Miyaishi S, Yoshitome K, Yamamoto Y, et al.
Negligent homicide by traumatic asphyxia. Int J Legal Med Jan 14 2004.
“A 58-year-old man was restrained in the prone position by six prison officers.
… the victim died solely from traumatic asphyxia caused
not by disaster but by intentional restraint.”

This article was originally posted on February 6, 2004.

Death Following Atypical Compression of the Neck
CITATION: Di Nunno N, Vacca M, Costantinides F, Di Nunno C.
Death following atypical compression of the neck.
Am J Forensic Med Pathol December, 2003;24: 364–368).
The authors present 3 cases of asphyxia caused by atypical compression of the neck
caused by bed-side metal bars for prevention of falling out of bed.

This article was originally posted in January, 2005.

Excited Delirium*
CITATION: Stewart J: “Excited Delirium” A Dec. 10, 2003 news article found on the CBS NEWS.com
Website: http://www.cbsnews.com/stories/2003/12/09/60II/printable587569.shtml.
Some restraint asphyxia death cases attributed to excited delirium are presented.
Excited delirium is appropriately identified as, “a blame-shifting phrase. It is a phrase
that shifts the blame from the person exerting the force to the person that dies”

This article was originally posted February 9, 2004.

Cause and Manner of Death in Drug-Related Fatality:
An Analysis of Drug-Related Deaths Recorded by Coroners in
England and Wales in 2000
*

CITATION: Webb L, Oyefeso A, Schifano F, et al.: Cause and manner of death
in drug-related fatality: an analysis of drug-related deaths recorded by coroners in
England and Wales in 2000.
Drug Alcohol Depend (Ireland), Oct 24 2003, 72(1) p67-74.
“This study investigated causes and manner of drug-related fatalities recorded in 2000 in the
United Kingdom, measuring the 'masked' manner of death in cases typically recorded as
overdose. … Whilst 802 cases were identified as direct acute overdose, representing
77% of the total accidental deaths, 23% of 'overdose' fatalities were caused by asphyxiation…”

This article was originally posted February 11, 2004.

Does Weight Force During Physical Restraint Cause
Respiratory Compromise?
*

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.
This is a REPEAT of OLD study information, originally presented at the
Am Academy of Forensic Science’s February 2000 conference, as;

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

HERE, however, is the version Chan presented it at the October, 2003 Am College of Emergency
Physicians conference in Boston. The “author” order has been altered, and the abstract TEXT slightly
changed (in a rather interesting manner, considering this is a report of the SAME STUDY).
See CHAS’ 2005 Restraint Asphyxia Research Review
The full text of this REPEAT research abstract presentation was originally
posted on this Website October 11, 2003.

Positional Asphyxia: Reflection On 2 Cases*
CITATION: Belviso M, De Donno A, Vitale L, et al.
Positional asphyxia: reflection on 2 cases.
Am J Forensic Med Pathol, Sep 2003, 24(3) p292-297
The 2 cases discussed in this article are one of positional asphyxia, and one of traumatic asphyxia.
So, although this is an interesting article, it is not one of any significant consequence
to “restraint asphyxia” research.

This article was originally posted in January, 2005.

Inflicted Compressional Asphyxia of a Child*
CITATION: Kohr RM. Inflicted compressional asphyxia of a child.
J Forensic Sci, Sep 2003, 48(5) p1148-1150
The author presents the case of a two-year-old girl who was forcefully-prone-restrained to death
because she wouldn’t take a nap. From the way this case study is written, the author
appears to be seeking an “excuse” for contributing to this homicide going practically unpunished.

This article was originally posted in January, 2005.

An Evaluation of Four Programs for the Management
of Aggression in Psychiatric Settings
*

CITATION: Morrison EF, Carney-Love C; An evaluation of four programs for the management
of aggression in psychiatric settings. Arch Psychiatr Nurs Aug 2003, 17(4) p146-55.
This article provides invalidly-researched (and suspiciously biased) “reviews” of four
patient restraint techniques programs. But, it generated a flurry of attention, so here it is.

[I’ve long wanted to write a review that specifically explains why this article
represents “invalidly-researched (and suspiciously biased)” information.
As of August, 2006, I still haven’t done so. (Too many more important things demand
my attention!) So, I may never get it written. HOWEVER!
If you read all the restraint asphyxia information identified by a
you shouldn’t NEED me to tell you why this article is so WORTHLESS!
This article was originally posted on this Website in October, 2003.

RHABDOMYOLYSIS
CITATION: Lane R; Phillips M: Rhabdomyolysis.
BMJ (England), Jul 19 2003, 327(7407) p115-6.
“SEVERE OR UNACCUSTOMED EXERTION, particularly in extremes of heat
… prolonged seizures … [or the effects of some] drugs … can induce rhabdomyolysis,
as can … STATES OF EXTREME AGITATION

In Jan/Feb 2004, I began posting several RHABDOMYOLYSIS articles because
of my growing recognition of the frequent occurrence of rhabdomyolysis being caused
during restraint asphyxia incidents. Although this editorial was written in response to
another article, it provides a QUICK OVERVIEW of what rhabdomyolysis IS, and how
rhabdomyolysis can be caused by incidents that also result in restraint asphyxia.

This article was originally posted February 10, 2004.

Sudden Death During Arrest and Phencyclidine Intoxication*
CITATION: Pestaner JP, Southall PE. Sudden death during arrest and phencyclidine intoxication.
Am J Forensic Med Pathol, Jun 2003, 24(2) p119-122
This article was originally posted February 25, 2004.

Custody-Related Deaths in Durban, South Africa 1998-2000
CITATION: Bhana BD. Custody-related deaths in Durban, South Africa 1998-2000.
Am J Forensic Med Pathol, Jun 2003, 24(2) p202-207
According to this article, “There were no deaths associated with substance abuse,
the use of choke holds, or other restraint positions.”

I find this incredibly difficult to believe. But, even though
restraint-related deaths are not discussed in this article, I decided to post it …
to keep my library as “varied” as possible.

This article was originally posted January, 2005.

Adverse Effects Associated With Physical Restraint*
CITATION: Mohr WK, Petti TA, Mohr BD: Adverse effects associated with
physical restraint. Can J Psychiatry June, 2003;48:330–337.
“The third author has encountered several clinical situations in which staff members attributed
a patient's struggles to belligerence
, when they were in fact [due to] agitation caused by hypoxia.

CHAS’ brief review precedes the article’s PDF file link.
This article was originally posted on January 27th, 2004.

OOOH! A NASTY-GRAM is RECEIVED & REPLIED TO!
On Tuesday, January 27, 2004 – within TWO HOURS of POSTING the above article and my
review of same – I received a terrifically NASTY Email from Wanda Mohr, RN, PhD,
the article’s “lead” co-author.
[This has GOT to be some kind of “record” for an Internet-posting generating a response!]
As with the last “NASTY-GRAM” I received from an article co-author, (way back in
November of 2002), this correspondence demonstrates how even “educated” individuals
(folks with big fat initials like “MS” or “PhD” or “MD” following their name) can harbor
inappropriate attitudes, and offer unsupported complaints about having their work criticized!
This Nasty-Gram was originally (finally) posted on February 26, 2004.

Caring for Our Patients & Ourselves; Count Your Fingers;
More Stuff on Restraints
*

AUTHORS: Perry D, Dick T.
JEMS, May 2003; Vol.28, No.5; pgs 22-23.
In this article, Doug Perry & Thom Dick appropriately RETRACTED Dick's January 2003
"Tricks of the Trade" suggestion of using a choke-hold-like (or "sleeper"-hold-like)
maneuver for "stabilizing the patient's head and neck." Instead, they described a manner
of “HEAD RESTRAINT” that I’ve advocated for YEARS: Forceful application
of a “JAW-THRUST AIRWAY MANEUVER.”
And! They finally managed to admit that OXYGEN ADMINISTRATION via
a nonrebreather MASK was the ONLY medically-appropriate form of “spit shield” to use.
Unfortunately, after that, Perry & Dick degenerated into (entirely unsuccessful)
attempts to provide “justification” for the potentially lethal baskethold-like form of
medical patient restraint advocated within Dick’s 2003 article.
What can I say? I win a few. And, a few take longer to win.

This 2-page column wasn’t posted here until September 15, 2004.

Managing the Combative Patient: Techniques Used by EMS Providers*
The abstract of a scientific study paper, obtained from the Prehospital Care Research Forum
Supplement to the March, 2003 issue of JEMS; page S-17.
AUTHORS: Dunn T, Martin P, Dunn WW
This abstract was originally posted on March 31, 2003.

A Survivor's Story: Saved By A Pileup
CITATION: Crowley CF. A survivor's story: Saved by a pileup.
The Providence Journal; March 10, 2003.
http://www.projo.com/extra/2003/stationfire/archive/projo_20030310_mike10.95e7b.html
This is the amazing story about a guy who survived “RIOT CRUSH”
(a form of “positional asphyxia”) by moving to his side and curling up “into the fetal
position” when he became trapped beneath a pile of bodies.

This article was originally posted in August, 2006.

Deaths Associated With Restraint Use in Health and
Social Care in the UK. The Results of a Preliminary Survey.

CITATION #1 of 2 Citations(!): Paterson B, Bradley P, Stark C, et al.
Deaths associated with restraint use in health and social care in the UK.
The results of a preliminary survey.
J Psychiatr Ment Health Nurs (England), Feb 2003, 10(1) p3-15.
“A number of case reports have suggested that restraint procedures may,
in some circumstances, be linked with serious injuries and deaths.”

TWO pdf versions of this article originally posted February 9, 2004.

Management of the Violent Patient*
CITATION: Brice JH, Pirrallo RG, Racht E, Zachariah BS, Krohmer J:
Management of the violent patient. Prehosp Emerg Care 2003 Jan-Mar;7(1):48-55.
This article’s information was outdated even before its publication.
But, HEY – it’s HERE!

This article’s abstract originally posted in April, 2003.
Its FULL TEXT originally posted in January, 2004.

JEMS 2-Part “Use of Restraint – Tricks of the Trade” Column*
“Tie-Downs; Use of Restraints, PART 1;” JEMS December 2002 • Volume 27 • Number 12
“Straight Shot; Use of Restraints, PART 2;” JEMS January 2003 • Volume 28 • Number 1

AUTHOR: Thom Dick, EMT-P
Part 1’s text and PIX from Part 2, were posted on January 23, 2003.
Part 2’s TEXT was originally posted on February 3, 2003.

CHAS’ REVIEW of this 2-Part Column
I’m reasonably confident that Thom Dick is a caring, and responsible, EMS provider and educator.
But, when I read Part 2 of his JEMS “Tricks of the Trade” column about restraints,
and saw the pix that accompany it, I was … AGHAST!!!
DICK is clearly promoting LETHAL methods of Restraint!
This review was written and originally posted in January, 2003.
UPDATED on March 15, 2003.

Letters to the JEMS EDITOR About Dick’s Restraint Columns
Whether or not JEMS prints them, if you send them to me, I will post them!
This directory was started on March 31, 2003.

Sudden Unexpected Death in Epilepsy: Neuropathologic Findings
CITATION: Shields LB, Hunsaker DM, HunsakerJC, Parker JC.
Sudden unexpected death in epilepsy: neuropathologic findings.
Am J Forensic Med Pathol, (Dec) 2002, 23(4):307–314.
“Sudden unexpected death in epilepsy [SUDEP] refers to sudden death of an
individual with a clinical history of epilepsy, in whom a postmortem examination fails to
uncover a gross anatomic, toxicologic, or environmental cause of death. … Deaths
resulting from a seizure occurring in hazardous settings resulting in fatal trauma, …
deaths due to status epilepticus, and deaths resulting from fatal asphyxia … [can be]
excluded from this definition.”

This article was originally posted February 27, 2004.

Another “In-Custody Death” Article*
Published on the Struggling Teens Website
http://www.strugglingteens.com on November 15, 2002
AUTHOR: Michael G. Conner, Psy.D
CHAS’ Review Posted at the END of the Article
[This article is NOT of great “importance,” one way or another. This article, and my review, is
here only because parents of developmentally disabled individuals kept Emailing me about it.]

This article was posted on November 22, 2002.

Patient Restraint in Emergency Medical Services Systems*
Published in the journal of Prehospital Emergency Care
The official journal of the National Association of EMS Physicians (NAEMSP)
Prehosp Emerg Care July/September 2002;6(3):340-345
AUTHORS: Kupas DF; Wydro GC
This article was posted on August 2nd, 2002.

Chan et al’s Letter to the Editor Re: PATIENT RESTRAINT IN EMS
and the AUTHORS’ REPLY
*

CITATIONS:
Vilke GM, Chan TC, Neuman T: Letter to the Editor Re; Patient restraint in EMS.
Prehosp Emerg Care July/September 2003;7(3):417-418.
Kupas DF, Wydro GC: Reply by the Authors of Patient restraint in EMS.
Prehosp Emerg Care July/September 2003;7(3):418-419.
Yet another stupid letter by Chan et al. BUT, this one includes a somewhat NEW
incredibly-stupid argument on their part. THANKFULLY, the Patient restraint in EMS
Authors soundly thrash ALL of Chan et al’s silly business in their reply!

This article was finally first posted February 26, 2004.

Low-dose Carbicarb improves cerebral outcome
after asphyxial cardiac arrest in rats

CITATION: Katz LM, Wang Y, Rockoff S, et al.;
Low-dose Carbicarb improves cerebral outcome after asphyxial cardiac arrest in rats.
Ann Emerg Med (United States), Apr 2002, 39(4) p359-365.
This is a medical scientific study article important to professionals understanding
the effects of severe acidosis caused by asphyxial-restraint-related struggle.

This article was originally posted on this Website in April, 2003.

The Lethal Hazard of Prone Restraint:
Positional Asphyxiation

CITATION: Morrison L, Duryea PB, Moore C, Nathan-Shinn A.
The lethal hazard of prone restraint: Positional asphyxiation.
Protection & Advocacy, Inc., Oakland, California, Investigations Unit; April, 2002:
http://www.pai-ca.org/pubs/701801.pdf
An investigatory report: “One PAI investigator summarized the dilemma.
'Staff did everything by the book. The problem is the book is wrong.'”

This report was originally posted on this Website in January, 2004.

New Thoughts About What Causes Cocaine Toxicity
CITATION: [I don’t have the AUTHORS’ names yet!
I’m working on getting them!] New thoughts about what causes cocaine toxicity.
Forensic Drug Abuse Advisor (April) 2002;14(4):17-8.
“Much of the literature on cocaine cardiotoxicity consists of anecdotal data and case reports,
which then get incorporated into peer reviewed papers, which then get cited as proven
data. It is refreshing to see someone actually do the science, and even more exciting
when something that ‘everyone knows is true’, turns out to be wrong.”

A graphic example of how information MISREPRESENTATION
can lead to “EXPERT” opinions based upon invalid information.

This article was originally posted in OCTOBER 2005.

Rhabdomyolysis
CITATION: Sauret JM, Marinides G, Wang GK: Rhabdomyolysis.
Am Fam Physician (United States), Mar 1 2002, 65(5) p907-12.
This article provides an IN-DEPTH explanation (mostly in “Plain English,” thank you!)
of what RHABDOMYOLYSIS IS, and the variety of things that can cause it.
Although it doesn’t specifically address the association of restraint asphyxia deaths with
rhabdomyolysis, it promotes the development of a CLEAR understanding of how the
extreme physical exertion that precedes – and occurrs during
application of an asphyxial form of restraint, can cause rhabdomyolysis.

This article was originally posted February 10, 2004.

Exercise Restraint*
Published in The Journal of Emergency Medical Services (JEMS)
March, 2002 Issue, Vol. 27, No. 3, pages 84 – 104.
AUTHORS: Maggiore WA, Palmer RB
This article was originally posted on this Website June 01, 2002.


CHAS’ REVIEW of “Exercise Restraint”
This article isn’t terrifically “BAD!” It’s simply, terrifically INADEQUATE.
Yet, because it contains a LOT of very ineffective restraint technique
PHOTOGRAPHS (even though the restraint techniques photographed were
erroneously represented as being “effective” and “appropriate” to medical care),
this article has been VERY helpful to NEW SLIDE development –
providing a plethora of PIX of Stuff NOT to DO!!!

This Review FINALLY written and posted on this Website January 25, 2003!


Letter To the Editor of JEMS Regarding “Exercise Restraint”
AUTHOR: Jim Baird, Fairlawn, Ohio
JEMS July, 2002: Vol. 27, No. 7; pages 12, 14
This is a MARVELOUS letter! I’ve long wanted to write a “review” of it
but it doesn’t look like I’ll ever get around to doing so.

The full text of this letter was originally posted on August 04, 2002.

The Effect of Oleoresin Capsicum "Pepper" Spray
Inhalation on Respiratory Function
*

CITATION: Chan TC; Vilke GM; Clausen J; Clark RF; Schmidt P; Snowden T; Neuman T.
The effect of oleoresin capsicum "pepper" spray inhalation on respiratory function.
J Forensic Sci, Mar 2002, 47(2) p299-304
The ABSTRACT of this article (all I was willing to access and post, since I surely wasn’t
going to PAY to obtain a repeat of the relatively worthless National Institute of Justice
December 2001 article – posted below – written by the SAME authors!)

was originally posted in January, 2005.

The National Association of Medical Examiners’
Guide For Manner of Death Classification

Approved by the NAME Board of Directors in February 2002, a link to the Guide’s location on
the Internet is provided, as well as an excerpt wherein these Medical Examiners officially
identify restraint asphyxia deaths as “HOMICIDE!
This excerpt was originally posted on this Website November, 2003.

CRUZ v CITY OF LARAMIE, WYOMING*
CITATION: UNITED STATES COURT OF APPEALS, TENTH CIRCUIT;
Cruz v. City of Laramie, 239 F.3d 1183 (10th Cir. 2001).
A Legal Summary Report obtained from AELE Legal Publications
http://www.aele.org/99-8045.html

“Hog tie [of] suspects with diminished capacity considered excessive force
The CRUZ v LARAMIE case has helped to “correct” some of the damage caused by the
PRICE v SAN DIEGO case (a prime example of a grotesque “miscarriage of justice”).
However, very few (if ANY) of the people who STILL jump to cite the PRICE v SAN DIEGO
case care to mention the CRUZ v LARAMIE case.Oh, surpriZe!

This legal summary was originally posted in March, 2005.

Pepper Spray’s Effects on a Suspect’s Ability to Breathe*
Published by the National Institute of Justice (NIJ)
In the December, 2001 Issue of their Research in Brief Series.
AUTHORS: Theodore C. Chan, Gary M. Vilke, Jack Clausen, Richard Clark,
Paul Schmidt, Thomas Snowden, and Tom Neuman
This article was originally posted on this Website June 15, 2002.

Death by Overlaying and Wedging:
A 15-Year Retrospective Study

CITATION: Collins KA; Death by overlaying and wedging: a 15-year retrospective study.
Am J Forensic Med Pathol (United States), Jun 2001, 22(2) p155-69.
A forensic medicine scientific study article.
“Wedging occurs when an infant’s body or face is compressed within a narrow space, resulting in
asphyxia from interference with chest wall movements or obstruction of the airway. …
Like SIDS victims, overlaying and wedging victims usually have a completely negative autopsy.”

This article was originally posted on this Website in April, 2003.

Morphologic Determinants of Asphyxia in Lungs.
A Semiquantitative Study in Forensic Autopsies

CITATION: Delmonte C, Capelozzi VL; Morphologic determinants of asphyxia in lungs:
a semiquantitative study in forensic autopsies.
Am J Forensic Med Pathol, Jun 2001, 22(2) p139-49.
A forensic medicine scientific study article.
This article was originally posted on this Website in April, 2003.

Factors Associated With Sudden Death of
Individuals Requiring Restraint for Excited Delirium
*

Published in the American Journal of Emergency Medicine May 2001 Issue
AUTHORS: Stratton SJ, Rogers C, Bricket K, Gruzinski G.
Am J Emerg Med 2001;19:187-191
This article was originally posted on this Website June 30, 2002.

Sudden Death Following Neuroleptic Administration
Due to Hemoperitoneum Resulting From Physical Restraint
*

CITATION: Raju GV, Kumar TC, Khanna S. [A letter to the Editor]
Sudden death following neuroleptic administration due to
hemoperitoneum resulting from physical restraint.
Can J Psychiatry (Canada), May 2001, 46(4) p372-373
I think that this case-report letter highlights a whole HELLUVALOT MORE
than just the need for a thorough “post-mortem” investigation!

This article was originally posted in OCTOBER 2005.

Agitated Delirium and Sudden Death: Two Case Reports
Published in the journal Prehospital Emergency Care
The official journal of the National Association of EMS Physicians (NAEMSP)
CITATION: Park KS, Korn CS, Henderson SO; Agitated delirium and sudden death: Two case reports.
Prehosp Emerg Care 2001 Apr-Jun;5(2):214-216.
This article was posted on August 2nd, 2002.

A Letter by Chan & Vilke RE:
Agitated Delirium and Sudden Death
*

CITATION: Vilke GM, Chan TC; Agitated delirium and sudden death.
Prehosp Emerg Care Apr-Jun 2002, 6(2) p259; Author Reply 259-60.
The Authors’ reply soundly thrashes Chan et al’s letter!
This article originally posted in April, 2003.

Cocaine-Excited Delirium and Severe Acidosis
CITATION: Allam S, Noble JS. Cocaine-excited delirium and severe acidosis.
Anaesthesia (England), Apr 2001, 56(4) p385-386.
“The prompt administration of hyperventilation, passive cooling, sodium bicarbonate and dantrolene
led to a remarkably swift correction of the acidosis and a successful outcome in this case.”

Oh, surpriZe! A victim of cocaine-induced excited delirium who was severely ACIDOTIC,
yet SURVIVED both cocaine use (intoxication) and a state of excited delirium
because he wasn’t restrained in an asphyxial position! GO FIGURE!

This article was originally posted in OCTOBER 2005.

The Medical-Legal Issues Surrounding Patient Restraint
A Report of Winnie Maggiore’s (JD, EMT-P)
2001 JEMS EMS Today Conference Presentation,
March 13-17, 2001; Baltimore, Maryland.
AUTHOR: Elizabeth A. Criss, RN
This article was posted on January 24th, 2003.

Death of a Psychiatric Patient During Physical Restraint.
Excited delirium – A Case Report
*

Citation: Morrison A, Sadler D; Death of a psychiatric patient during physical restraint.
Excited delirium – A case report. Med Sci Law
(Medicine Science and the Law)
2001 Jan;41(1):46-50.
This article was originally posted August 1st, 2002.

CHAS’ REVIEW of Death of a Psychiatric Patient During Physical
Restraint. Excited Delirium – A Case Report

Citation: Miller CD. Review of Death of a psychiatric patient during
physical restraint. Excited delirium – A case report. March, 2005.
http://www.charlydmiller.com/LIB05/2001psychcasereview.html
“This case report seems like yet another attempt to erroneously
attribute a Restraint Asphyxia death to Excited Delirium.”

This review was originally posted in March, 2005.

Mechanisms of Injury and Death Proximal to Restraint Use
Published in the journal, Archives of Psychiatric Nursing
Arch Psychiatr Nurs 2000 Dec 14:285-95
AUTHORS: Mohr WK, Mohr BD
This article was posted on August 1st, 2002.

Asphyxial Deaths and Petechiae: a Review
CITATION: Ely SF, Hirsch CS. Asphyxial deaths and petechiae: a review.
J Forensic Sci. (Nov) 2000; 45: 1274-1277.
Absence of petechiae does NOT “rule out” asphyxial death!:
“Despite the common knowledge that they are neither predictable findings
in all asphyxial deaths nor rare in natural, nonaphyxial deaths, the belief persists that
petechiae are corroborative evidence of asphyxia. We suggest that a clear,
physiologically based understanding of the pathogenesis of petechiae of the head is
critical for their appropriate interpretation.”

This article was originally posted February 27, 2004.

Sickle Cell Anemia: A Case Study Approach
to Teaching High School Genetics.

CITATION: Chowning JT. Sickle cell anemia: A case study approach to teaching high school genetics.
BioLab, Seattle, WA; in partnership with “The GENETICS Project,”
University of Washington, Department of Molecular Biotechnology: October, 2000.
http://genetics-education-partnership.mbt.washington.edu/Download/file.html
This article was posted because of its relationship to CHAS’ review of
Sudden Death due to Sickle Cell Crisis During Law Enforcement Restraint

This article was originally posted on July 2, 2007.

Restraint-Related Fatalities in Mental Health Facilities:
Report of Two Cases

CITATION: Siebert CF, Thogmartin JF. Restraint-related fatalities in mental health
facilities: Report of two cases. Am J Forensic Med Pathol (Sep) 2000, 21(3);210-212.
“Deaths associated with … restraint devices, as well as manual restraint
techniques such as the therapeutic basket hold, carotid sleeper, and various other "holds,"
have been reported”

This article was originally posted on May 21, 2003.
In February 2004, a WORD TEXT version was finally posted.

Blood Cocaine and Metabolite Concentrations, Clinical Findings,
and Outcome of Patients Presenting to an ED

CITATION: Blaho K, Logan B, Winbery S, Park L, and Schwilke E; Blood cocaine and metabolite
concentrations, clinical findings, and outcome of patients presenting to an ED.
Am J Emerg Med. 2000 Sep;18(5):593-8.
Blood cocaine and metabolite concentrations should be interpreted with caution
because they vary widely and do not predict the severity of clinical findings, the
incidence of adverse effects, outcome, or need for interventional therapy.

This article was originally posted in February, 2005.

Death In Custody*
Published in the Police Magazine July 2000 Issue
© The Police Federation of England & Wales
This is NOT a reprint of Dr. Reay’s 1998 article of the same title.
This article was originally posted on this Website June 15, 2002.

Cocaine Metabolism In Hyperthermic Patients With Excited Delirium*
CITATION: Blaho K, Winbery S, Park L, et al.
Cocaine metabolism in hyperthermic patients with excited delirium.
J Clin Forensic Med (Scotland), June 2000, 7(2) p71-76.
“Measurements of cocaine concentrations in the two hyperthermic
cocaine abusers with excited delirium suggest that in the living, the half-life of cocaine
is not significantly altered by elevated body temperature.”

If NOT subjected to a form of potentially asphyxial restraint, a victim of
Cocaine-Intoxication-Induced Excited Delirium can SURVIVE excited delirium!

This article was originally posted in OCTOBER 2005.

Custody Restraint Asphyxia; A letter to the Editor*
CITATION: Patel F. Custody restraint asphyxia.
Am J Forensic Med Pathol, Jun 2000, 21(2) p196-197.
Patel’s grossly misinformed statements are addressed in CHAS’ 2005
Restraint Asphyxia Research Review

This article was originally posted in January, 2005.

Asphyxial Death During Prone Restraint Revisited:
A Report of 21 Cases

CITATION: O’Halloran RL, Lewman LV. Asphyxial death during prone restraint
revisited: A report of 21 cases. Am J Forensic Med Pathol (March) 2000, 21(1);39-52.
“A reasonable diagnosis of restraint asphyxia can usually be made after ruling out
other causes and collecting supportive participant and witness statements in a timely
fashion. Common elements in this syndrome include prone restraint with pressure on the
upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation”

This article was originally posted on June 15, 2002.
In February 2004, a WORD TEXT version was finally posted.

Letter to the Editor RE: Asphyxial Death During
Prone Restraint Revisited & the Article Authors’ Reply

CITATIONS: Gulino SP, Young TW. Letter to the Editor; Asphyxial death during
prone restraint revisited. Am J Forensic Med Pathol (Dec) 2000, 21(4);420.
O'Halloran RL, Frank JG. Authors’ Reply to Letter RE: Asphyxial death during prone
restraint revisited. Am J Forensic Med Pathol (Dec) 2000, 21(4);420-422.
Article Authors’ Reply: “We believe [the letter authors] missed the point of the article. …
In the case of prone restraint with weight applied to the back, the question isn't really
whether a person could die from asphyxia; sufficient weight applied to the
back for a sufficient time will kill the healthiest of individuals.”

I entirely AGREE!!! In fact, the Article Authors’ Reply is probably
the BEST letter of its kind, that I’ve EVER read!

This letter first posted on January 31, 2003.
In February 2004, a WORD TEXT version of the letter was finally posted.

CRIES OF ANGUISH: A Summary of Reports of
Restraints & Seclusion Abuse Received Since the October 1998
Investigation by The Hartford Courant

Compiled by the National Alliance for the Mentally Ill (NAMI) Through March 2000
Since The Hartford Courant published its "Deadly Restraint" investigative series in
October 1998, NAMI has received a steady stream of reports of both recent and past
abuse of restraints and seclusion, including more deaths.

The PDF file of this report was originally posted on August 29, 2006.

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

An UNPUBLISHED paper, presented at the annual meeting of the
American Academy of Forensic Science, in Reno, Nevada: February 21-26, 2000.
AUTHORS: Eisele JW, Chan TC, Vilke GM
The full text of this unpublished research abstract was originally
posted on this Website June 01, 2002.

READ CHAS’ 2005 REVIEW of this UNPUBLISHED Paper
Chas’ OLD review of this unpublished paper can be still be viewed
By Clicking HERE.
The full text of the original review was posted on June 01, 2002.

The Autism National Committee: Position On Restraints
Published on The Autism National Committee Website.
[http://www.autcom.org/restraints.html]
Approved for publication on September 3rd, 1999.
The full text of this position paper was posted on August 07, 2002.

Cocaine-Associated Rhabdomyolysis and Excited Delirium:
Different Stages of the Same Syndrome
*

CITATION: Ruttenber AJ, McAnally HB, Wetli CV. Cocaine-associated
rhabdomyolysis and excited delirium: different stages of the same syndrome.
Am J Forensic Med Pathol; June 1999; 20(2), pp 120-127.
CHAS' OPINION of this old (and erroneous) report is reflected in her
2005 Paper: Restraint Asphyxia Research Review

This article was originally posted in January, 2005.

Metabolic Acidosis in Restraint-associated Cardiac Arrest: A Case Series*
Citation: Hick JL, Smith SW, Lynch MT.
Metabolic acidosis in restraint-associated cardiac arrest: a case series.
Acad Emerg Med. March, 1999; 6:239-43.
Abstract originally posted on this Website August, 1999.
The full text of this article was posted on May 31, 2002.
A PDF file of the article was posted January, 2006.

COMMENTS about Metabolic Acidosis
in Restraint-associated Cardiac Arrest

Two letters to the Editor, and a REPLY from Hick, Smith, and Lynch,
Published in the journal of Academic Emergency Medicine
October 1999, Volume 6, Number 10, pages 1075-1077
Comments originally posted on this Website July 8, 2002.
A PDF file of these letters was posted January, 2006.

The Effects of Positional Restraint on Heart Rate and Oxygen Saturation
Published in the, J Emerg Med
March, 1999;17:777-82;203(1-2):1-9
AUTHORS: Schmidt P, Snowden T
This article was posted on August 1st, 2002.
A PDF file of the article was posted in December, 2005.

OOOH! A Nasty-Gram is RECEIVED and REPLIED TO!
On Thursday, November 14, 2002, I was sent a rather NASTY 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
.
This correspondence demonstrates how even “educated” individuals
(folks with big fat initials like “MS” or “MD” following their name)
can harbor entirely INAPPROPRIATE attitudes!
This material originally posted here on November 14th, 2002.

Drug Abusers Who Die During Arrest Or In Custody
Published in the, J Royal Soc Med
March, 1999;92:110-113
AUTHORS: Karch SB, Stephens BG
This article was posted on August 1st, 2002.

Fatal Incidences During Arrest of Highly Agitated Persons*
Published in the journal, Arch Kriminol
1999 Jan-Feb;203(1-2):1-9
ABSTRACT ONLY
This 4-case-study article is only available in GERMAN. So, I’m not going to hunt it down to post it here.
The abstract, however, is in English – short, interesting, and kind of fun to read!
This ABSTRACT was originally posted on this Website June 30, 2002.

Factors Associated With Excited Delirium Deaths in Police Custody*
Published in the journal of Modern Pathology
November, 1998 Issue [Mod Pathol 1998;11(11):1127-1137]
AUTHOR: Darrell L. Ross, PhD.
If you want to JUMP TO CHAS’ REVIEW: CLICK HERE
Abstract originally posted on this Website August 27th, 1999.
The full text of this article was posted on June 03, 2002.

Restraint and Sudden Death From Asphyxia
Published in the journal, Nurs Times
1998 Nov 4-10;94(44):62-4 (ISSN: 0954-7762)
AUTHORS: Paterson B; Leadbetter D; McComish A
This article was posted on August 1st, 2002.

Preventing Restraint Deaths*
Published in the, Sentinel Event Alert paper of the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Issue Eight, November 18, 1998
This article originally posted on August 2nd, 2002.

DEADLY RESTRAINT
Articles generated by an extensive Investigative Report, by Eric M. Weiss, et al.,
published in The Hartford Courant, beginning on October 11, 1998.
A Five-Part SERIES of articles about restraint deaths in the U.S. … plus a
DATABASE identifying 142 restraint-related deaths, the states and facilities they occurred in.
A LINK to this EXTERNAL article originally posted July, 2002.
The entire SERIES (& EXTRA stuff!) coded and posted HERE in March, 2005.

Reexamination of Custody Restraint Position and Positional Asphyxia*
Published in The American Journal of Forensic Medicine and Pathology
September, 1998 Issue.
AUTHORS: Chan TC, Vilke GM, Neuman T
Abstract originally posted on this Website July 1st, 1998.
Poorly-scanned pages of this article were posted on May 31, 2002.
An html-coded version of the article’s full text was posted in March, 2005.

Go to CHAS’ 2005 Opinion Paper related to this article:
A Comprehensive Review of Frequently Misinterpreted
and Misrepresented Restraint Research

Go To Letters To The Editor Re: Reexamination of Custody Restraint
Position and Positional Asphyxia

Reay & Howard write, “We still have concern regarding deaths that occur during restraint.
Chan et al reply, “We share their concern, that the pathophysiology of these deaths remains
poorly understood and the issue clouded by a multitude of ‘preconceived conjectures.’

Poorly-scanned pages of these letters were posted on May 21, 2003.
An html-coded version of these letters’ full text was posted in March, 2005.

Unexpected Death Related to Restraint for Excited Delirium:
A Retrospective Study of Deaths in Police Custody and in the Community
*

Published in the Canadian Medical Association Journal (CMAJ) June, 1998 Issue.
AUTHORS: Pollanen MS, Chiasson DA, Cairns JT, Young JG
Also Posted on This Page:
An Editorial Letter from the same CMAJ issue:
Milliken D. Death by restraint. CMAJ, Jun 1998; 158(12): 1611-12.
AND a newly-posted (Sep/04) Letter to the Editor about Pollanen et al’s 1998 article,
that was published in July of 1999:
Roggla G, Roggla M. Death in a hobble restraint. CMAJ, July 1999;161(1):21
This article’s ABSTRACT was originally posted on this Website August 31st, 1999.
Its full text was posted on June 03, 2002.
PDF files of all THREE offerings were posted on September 15, 2004.

The Prone Restraint – Still a Bad Idea*
From a “POLICY REVIEW” Newsletter Published by the
International Association of Chiefs of Police, National Law Enforcement Policy Center
Volume 10, Number 1; Spring, 1998.
A SURPRISINGLY REASONABLE (realistic and accurate)
assessment of the January 1998 Price v. San Diego ruling, and
the November 1997 Chan et al Annals study article, published by the IACP!

The full text of this article was originally posted in November, 2003.

Death In Custody
CITATION: Reay DT. Death in custody.
Clin Lab Med March 1998, 18(1) pgs1-22.
AUTHOR: Donald T. Reay, MD.
The article’s ABSTRACT was originally posted on this Website July 6th, 1999.
The full text of this article was originally posted on June 03, 2002.
A PDF file of this 22-PAGE article was finally posted on August 3, 2006.

UNITED STATES DISTRICT COURT, San Diego, California:
Ann PRICE et al., v. County of San Diego et al. January 8, 1998.
*

This case was clearly a GROTESQUE TRAVESTY OF JUSTICE. Worse than that;
the medical-study-misrepresentation testimony offered under-oath by Dr. Neuman
(o’ the Chan et al bunch) CONTINUES – even in 2005 – to be a contributing factor in ALL
of the restraint asphyxia deaths that have occurred, everywhere in the world, since 1998!!!

This report was originally posted in January 2005.

CHAS REVIEW OF Ann PRICE et al., v. County of San Diego et al.
This review was originally posted in January 2005.

Restraint Position and Positional Asphyxia*
Published in the Annals of Emergency Medicine
November, 1997 Issue.
AUTHORS: Chan TC, Vilke GM, Neuman T, Clausen JL
This article was originally posted on this Website July 1st, 1998.

The Following SEVEN links are RELATED to the above Article!

(1) Reay’s Letter to the Editor of Annals Of Emergency Medicine
Published in the July, 1998 Issue.
Forensic Pathologists Donald T. Reay and John D. Howard
discuss their opinions about Chan et al’s
November, 1997, Annals of Emergency Medicine article,
its research methods, and its conclusions.
This article was originally posted on this Website August 1st, 1998.

(2) A Comprehensive Review of Frequently Misinterpreted and
Misrepresented Restraint Research

This is the 2005 version of CHAS’ review of this article.

However, if you wish to read the OLD version of CHAS’ review, here it is:
Chan et al.’s 1997 Restraint Position Article is FLAWED
The OLD review was originally posted on August 5th, 1998.
Edited, updated, and re-posted in June, 2002.
And ultimately REPLACED by the 2005 review.

(3) “Police Hogtie Restraint Doesn’t Kill, Evidence Now Shows”*
The miserably inaccurate January 14, 1998 San Diego Union-Tribune newspaper article that’s been
interfering with adoption of appropriate restraint practices ever since the pathetic thing was published!
This article was originally posted on this Website July 1st, 1998.

(4) Hog-Tied Revisited
Dr. Donald T. Reay (Seattle, Washington, King County Chief Medical Examiner)
responds to the FALSE accusations that he has “Retracted” his Research!
This letter was originally posted on this Website July 1st, 1998.
A PDF file of this letter, containing Dr. Reay’s NOTARIZED SIGNATURE,
was posted in January, 2006.

(5) An EXCERPT from The Prone Restraint – Still a Bad Idea
From a “POLICY REVIEW” Newsletter Published by the
International Association of Chiefs of Police, National Law Enforcement Policy Center
Volume 10, Number 1; Spring, 1998.
[The FULL TEXT of this Newsletter is linked above, and another link to same is provided
at the end of this excerpt. However, as its content is important to this collection of postings,
I elected to offer this EXCERPT separately, as well.]
A SURPRISINGLY REASONABLE assessment of the January 1998 Price v. San Diego ruling,
and the November 1997 Chan et al Annals study article, published by the IACP!

This excerpt originally posted on this Website in November, 2003.

(6) Dangerous Misinformation Published
Charly’s opinion paper about the San Diego Union-Tribune article.
This material originally posted on this Website July 1st, 1998.

(7) An Example of what Dangerous Misinformation Can Do!*
The dangerous San Diego County “News Release” spawned by the misinformation-laden San Diego
Union Tribune article. (An PERFECT example of what MISINFORMATION can accomplish.)
This material originally posted on this Website July 21st, 1999.
Updated on April 13th, 2001.

Acute Excited States and Sudden Death
An EDITORIAL LETTER, published in the, British Medical Journal
BMJ November, 1997;315:1107-1108
AUTHORS: Farnham FR; Kennedy HG (Forensic Psychiatrists)
The full text of this letter was posted on August 1st, 2002.

Published Letters Generated by this Editorial Letter:

Death After Restraint Can Be Avoided
An EDITORIAL LETTER, published in the, British Medical Journal
BMJ April, 1998;316:1171
AUTHOR: Pounder D (Professor of Forensic Medicine)
The full text of this letter was posted on August 1st, 2002.

Acute Excited States Are Not Caused By
High Blood Concentration of Cocaine

An EDITORIAL LETTER, published in the, British Medical Journal
BMJ April, 1998;316:1171
AUTHORS: Karch SB (Assistant Medical Examiner);
Stephens BG (Chief Medical Examiner)
City and County of San Francisco, CA, USA
The full text of this letter was posted on August 1st, 2002.

Acute Excited States and Sudden Death – Authors Reply
An EDITORIAL LETTER, published in the, British Medical Journal
BMJ October, 1998;317:1154
AUTHORS: Farnham FR; Kennedy HG (Forensic Psychiatrists)
The full text of this letter was posted on August 1st, 2002.

Ambulance Transport Death Results in Questioning of Techniques
EMS Professionals, July-August 1997;6-8.
This article was originally posted on this Website August 4th, 2002.

Cardiorespiratory Consequences To Hobble Restraint
Wien Klin Wochenschr 1997 May 23;109(10):359-61
AUTHORS: Roeggla M, Wagner A, Muellner M, Bur A,
Roeggla H, Hirschl MM, Laggner AN, Roeggla G.
This article’s Abstract was originally posted on June 01, 2002.
The full text of this article was posted on August 6, 2002.
A PDF file of this article was posted in December, 2005.

“An Awkward Position”*
Published in The Journal of Emergency Medical Services (JEMS)
March, 1997 Issue, pages 88 – 94.
AUTHOR: Deanna Abdon-Beckman
This article was originally (BELATEDLY!)
posted on this Website July 05, 2002.

Suspect Restraint and Sudden Death
I found this paper on the FBI’s web site!
Published in May of 1996 as an FBI Law Enforcement Bulletin, this is an adaptation of a paper by
Dr. Reay which was originally published in the Bulletin of the National Law Enforcement
Technology Center
, National Institute of Justice, in June, 1995.
This paper was originally posted on this Website July 1st, 1998.

A Case of Death By Physical Restraint:
New Lessons From A Photograph.

Published in the, Journal of the American Geriatric Society
J Am Geriatr Soc 1996 Mar;44(3):291-2 (ISSN: 0002-8614)
AUTHOR: Miles S
This article was posted on August 2nd, 2002.

Rhabdomyolysis Due to Mania
CITATION: Manchip SM, Hurel SJ: Rhabdomyolysis due to mania.
Br J Psychiatry; 1995 (July);167:118-9.
“To our knowledge, this is the first reported case of rhabdomyolysis due to
excessive exertion and dehydration secondary to an acute manic episode though we
suspect that mild cases may remain undetected.”

This article further emphasizes the fact that rhabdomyolysis can result “merely” from
extremely agitated states (such as “mania”), especially when such states are accompanied
by extreme and unaccustomed exertion – such as the states that consistently
precede and COINCIDE WITH forceful restraint application.

This article was originally posted February 7, 2004.

Sudden Death in Individuals in Hobble Restraints
During Paramedic Transport

Published in the Annals of Emergency Medicine
May, 1995 Issue.
AUTHORS: Stratton SJ, Rogers C, Green K
This article was originally posted on this Website July 1st, 1998.

Letter To The Editor RE:
Sudden Death in Individuals in Hobble Restraints
During Paramedic Transport
*
Written by SB Karch and CV Wetli
Published in the Annals of Emergency Medicine December, 1995 Issue.
The Article Authors’ REPLY is posted at the END of this page!
CHAS’ Review o’ this LETTER is posted between IT and the Authors’ Reply!
The full text of these two letters & Chas’ Review were belatedly
posted on this Website February 24th, 2003.

Wichita Police Department Training Bulletin: In-Custody Sudden Deaths
Published by the Wichita, Kansas Police Department; March 30, 1995
The full text of this bulletin was originally posted on this Website June 28, 2002.

Chicago Police Training Bulletin on Positional Asphyxia
A Training Bulletin released by The Chicago Police Department in February, 1995
Published by The Chicago Reporter in March, 1999.
Originally posted on this Website August, 1999.

Exercise-Induced Rhabdomyolysis
CITATION: Senert R, Kohl L, Rainone T, Scalea T:
Exercise-induced rhabdomyolysis.
Ann Emerg Med June 1994;23:1301-6.
“To describe the syndrome of exercise-induced rhabdomyolysis
and to investigate the relation between exercise-induced rhabdomyolysis
and the development of acute renal failure.”

This article was originally posted February 7, 2004.

Restraint Asphyxiation In Excited Delirium
Published in The American Journal of Forensic Medicine and Pathology
1993;14(4):289-295.
AUTHORS: O’Halloran RL, Lewman LV
Thank you, Dr. O’Halloran, for the BETTER COPY of this article!
This article was originally posted on this Website June 28, 2002.

Letter to the Editor RE: Restraint Asphyxiation In Excited Delirium
& the Article Authors’ Reply

Published in The American Journal of Forensic Medicine and Pathology
1994;15(3):266, 348.
Letter Author: Charles S. Hirsch, M.D.; Chief Medical Examiner; City of New York.
“I believe it prudent and appropriate for medicolegal officials to consistently classify
[restraint asphyxia deaths] as homicide …”

I agree!!!
This letter first posted on January 31, 2003.

Positional Asphyxia During Law Enforcement Transport
Published in The American Journal of Forensic Medicine and Pathology
13(2):90-97, 1992.
AUTHORS: Reay DT, Fligner CL, Stilwell AD, Arnold J
This article was originally posted on this Website June 15, 2002.

The Perils of Investigating and Certifying Deaths in Police Custody
Published in The American Journal of Forensic Medicine and Pathology
13(2):98-100, 1992.
AUTHORS: Luke JL, Reay DT
This article was originally posted on this Website June 15, 2002.

Positional Asphyxia in Adults: A Series of 30 Cases from the Dade and
Broward County Florida Medical Examiner Offices from 1982 to 1990

Published in The American Journal of Forensic Medicine and Pathology
13(2):101-107, 1992.
AUTHORS: Bell MD, Rao VJ, Wetli CV, Rodriguez RN
This article was originally posted on this Website March 16, 2003.

Effects Of Positional Restraint On Oxygen Saturation
And Heart Rate Following Exercise.

Published in The American Journal of Forensic Medicine and Pathology
1988;9(1):16-18.
AUTHORS: Reay DT, Howard JD, Fligner CL, Ward RJ
I hope to obtain a better copy than the one I have first-posted here!
This article was originally posted on this Website June 28, 2002.

Risks In Physical Restraint
CITATION: Fidone GS. Risks in physical restraint; a letter to the editor.
Hospital & Community Psychiatry; February 1988; Vol.39, No.2, pg 203.
[This journal was the precursor to Psychiatric Services,
a Journal of the American Psychiatric Association.]
We speculate that holding the patient’s arms so that they encircle the chest
while the back is being firmly pressed to the ground imposes a mechanical limitation
on ventilation, venous return to the heart, and cardiac output.

Granted, chest compression was an entirely unlikely culprit, this letter is important in that
it represents a very EARLY recognition of the dangers of improperly applied restraint.

This article was originally posted in July 2006.
It is a PDF file and does not contain a return link.

Physical Restraint
CITATION: Steinfeld J. Physical restraint; a letter to the editor.
Hospital & Community Psychiatry; July 1988; Vol.39, No.7, pg 788.
In response to Dr. Fidone’s assertion that a substitute hold is not likely to be found,
I would like to point out that restraint in a prone position is, in my experience,
safer for both staff and patients.

Well! Isn’t that … special?!
This article was originally posted in July 2006.
It is a PDF file and does not contain a return link.

Lactic Acid Concentrations in Vitreous Humor:
Their Use in Asphyxial Deaths in Children

(ABSTRACT only)
CITATION: Sturner WQ, Sullivan A, Suzuki K. Lactic Acid Concentrations in
Vitreous Humor: Their Use in Asphyxial Deaths in Children.
J Forensic Sci 1983;28(1): 222-230.
“Lactic acid concentrations in brain tissue of humans have been
shown to increase with an extended agonal period.”

This abstract was originally posted February 1, 2004.

Death From Law Enforcement Neck Holds
Published in The American Journal of Forensic Medicine and Pathology
September, 1982 Issue.
AUTHORS: Reay DT, Eisele JW
This article was originally posted on this Website June 15, 2002.

The Cardiorespiratory and Biochemical Events During
Rapid Anoxic Death – V. Obstructive Asphyxia

Published in The Texas Reports on Biology and Medicine
1949; Vol. 7; pgs 593-603.
AUTHORS: H. G. Swann and Marshall Brucer
This article was originally posted on this Website March 31, 2003.

FORENSIC
TEXTBOOK PAGES

Pages from Chapter 8: ASPHYXIA*
Of the TEXTBOOK, FORENSIC PATHOLOGY, Second Edition
© 2001 by CRC Press LLC
AUTHORS: Vincent J. DiMaio, Dominick DiMaio
These chapter pages were originally posted on June 11, 2002.
TWO NEW PAGES and a PDF posted on June 30, 2008!

Chapter 22: Sudden Death During or Immediately after a Violent Struggle*
From the TEXTBOOK, FORENSIC PATHOLOGY, Second Edition
© 2001 by CRC Press LLC
AUTHORS: Vincent J. DiMaio, Dominick DiMaio
These chapter pages were originally posted on this Website June 01, 2002.

The RESTRAINT ASPHYXIA NEWZ DIRECTORY

CHAS’ HOME PAGE

Email Charly at: chas@novelholiday.com