During Physical Restraint Cause Respiratory Compromise? |
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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! HERE THEY GO AGAIN!!!
Sorry! I cannot help but be ... "flippant" ... when it comes to yet another unhelpful study being
devised and promoted by three of it's authors (folkz who know how truly unhelpful it is!);
Vilke, Neuman, and Chan – a.k.a., the "Misrepresentation Kings!"
I pity poor Michalewicz and Kolkhorst for becoming associated with these guyz.
Likely, they didn't know any better – OR they couldn't avoid the association.
Reportedly, one of them is a UCSD student, and this is her/his "doctorial thesis!"
Dear Michalewicz and Kolkhorst ;
Sincerely Yours, CHAS
This most-recently published "weight study" item is NOT a full study report. It is the ABSTRACT contained within a poster (and/or oral) presentation delivered by one of the authors (I know not which one) at the May, 2005, Annual Meeting of the Society for Academic Emergency Medicine. The Society published all of these paper/poster presentation abstracts in a SUPPLEMENT to the May issue of their journal, Academic Emergency Medicine.
A downloadable PDF version of all the 2005 Annual Meeting Abstracts' text can be found HERE.
But, don't go there yet!
I'm going to put the whole abstract of this paper on THIS PAGE, after I explain it's provenance.
I include this EXTERNAL link (and others, offered later) only in case someone wants to independently CHECK the accuracy of my REPORTING. (Such a person may have to PAY to obtain the original documents, however – as I had to.)
AND, although the "old" version of this paper remains on this page,
in January, 2006, I created a PDF FILE for this paper.
TO PRINT THIS PAPER, it is easiest to do so from THE PDF FILE I created in January 2006!:
If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.
If ever this study is published as a full REPORT, I will obtain it and post it in this library. Hopefully, however, responsible publishers will recognize its inadequacy, and refuse to publish it. (It took Chan four years to find a publisher STUPID enough to publish his first "weight study" report.)
LASTLY:
If you wish to understand the pulmonary function testing terminology used in all the "Weight Force" papers (and the September-2004-published report), PRINT OUT and study the following REFERENCE FILE I randomly obtained from the Internet. It contains relatively simple explanations of the pulmonary function testing terminology.
Pulmonary Function Testing
CHAS' REVIEW of this ENTIRELY UNHELPFUL STUDY's ABSTRACT
follows its posting below.
CLICK HERE to SKIP to CHAS' REVIEW!
Here is the "old" version, beginning with the Heading & Initial Section
of all the 2005 Annual Meeting Abstracts' Supplement text:
ACAD EMERG MED * May 2005, Vol. 12, No. 5, Suppl. 1 * www.aemj.org
2005 SAEM ANNUAL MEETING ABSTRACTS
The editors of Academic Emergency Medicine are pleased and privileged to present the Original Research Abstracts from the Annual Meeting of the Society for Academic Emergency Medicine, May 22–25, 2005, New York City. ...
This year, 1006 research abstracts were submitted and 502 were selected for presentation at the Meeting (not including the 86 Innovations in Emergency Medicine Education Exhibits, which were submitted separately). Each abstract was independently reviewed by up to six designated topics experts who were blinded to the authors. Final determination for scientific presentation was made by the Scientific Subcommittee, chaired by Debra Houry, and the SAEM Program Committee, chaired by Judd Hollander. The decision for presentation was based on the final review score and the space available for presentation at the meeting.
We present these abstracts as they were received electronically from the authors, who are solely responsible for their content. They appear as they were received; we have done only minimal proofreading of these abstracts. Any questions you may have on their content should be directed to their authors.
Clearly, this study and its methods could not be seriously reviewed by the Society prior to acceptance for presentation or publication, as their reviewers had no more information about the subject (and the authors) than the SPARSE stuff of the ABSTRACT submitted to them.
Here is the address of the Academic Emergency Medicine Supplement's Table of Contents:
http://www.aemj.org/content/vol12/5_suppl_1/
But, don't go there unless you want to CHECK my reporting!
I don't know whether or not you'll have to PAY to view it.
Here is the address of the Academic Emergency Medicine Supplement's ABSTRACT LINK for that paper:
http://www.aemj.org/cgi/content/abstract/12/5_suppl_1/16
But, don't go there unless you want to CHECK my reporting!
HERE IS THE ABSTRACT:
Does Weight Force During Physical Restraint Cause Respiratory Compromise?
Gary M. Vilke, Betty Michalewicz, Fred W. Kolkhorst, Tom Neuman, and Theodore C. Chan
University of California, San Diego: San Diego, CA, San Diego State University: San Diego, CA
ABSTRACT
Background: Violent patients often require physical restraint by emergency department (ED), out-of-hospital, and law enforcement personnel. Concern has been raised that weight force, commonly applied during the restraining process, can compromise respiratory function, placing individuals at risk for asphyxiation.
Objective: To determine the impact of heavy weight force on pulmonary and respiratory function on restrained human subjects. We hypothesized that weight force would result in changes in pulmonary and respiratory parameters.
Methods: 10 volunteers completed a randomized crossover, controlled trial in an exercise physiology laboratory. Subjects were placed in 5 positions in random order: sitting, prone hobble restraint, prone with light weight (LW: either 75 or 50 lb depending on subject body weight) on the back, prone with medium weight (MW: 150 or 125 lb), and prone with heavy weight (HW: 225 or 200 lb). While in these positions, maximal voluntary ventilation (MVV) measurements were performed in following ATS criteria for reproducibility within 5% variability on 3 repeated measures. Raw data were converted to percent predicted values for subject race, height, and gender as per standard practice for pulmonary function tests allowing comparison with known population clinical normal values. Data were compared utilizing ANOVA (p < 0.05) and 95% confidence intervals (CIs).
Results: Mean % predicted values for MVV were significantly higher in the sitting position (122%; 95% CI = 103.5% to 140%) compared with all other positions, including the restraint position (100%; 95% CI = 98.7% to 101.6%), LW (107%; 95% CI = 97.3% to 117.4%), MW (96%; 95% CI = 87.2% to 102.8%), and HW (85%; 95% CI = 71.6% to 97.5%). However, only the HW position resulted in a CI that fell below 100% of predicted for subjects and none of the mean % predicted values fell below the standard 80% threshold for clinical abnormality.
Conclusions: Significant weight force in the prone position decreases MVV; however, we did not detect decreases below known clinical thresholds for abnormal pulmonary function.
CHAS' REVIEW:
Hey! I have no more information about this study than the SPARSE stuff cited in it's ABSTRACT. But, even so, it can CLEARLY be determined that
IN SUMMARY:
This is yet ANOTHER ENTIRELY UNHELPFUL STUDY.
I really wish that the Chan et al bunch would stop wasting my time, as well as wasting the time of all OTHERS who truly need REAL information about the causes of restraint asphyxia – people such as emergency medical service providers, law enforcement and security personnel, as well as care providers for developmentally disabled or mentally ill CHILDREN and adults.
Every time Chan et al perform a study such as this one, they simply make it more time-consuming and confusing to explain to emergency responders why their study is entirely UNHELPFUL to the development of safe and effective protocols for dealing with REAL LIFE situations wherein restraint is needed.
I especially wish that Chan et al would have the moral and ethical wherewithal to refrain from perverting the MEDICAL STUDENTS they are (apparently) responsible for educating!
I don't know how Chan, Vilke, Neuman (and their ilk) can sleep at night, knowing that they continue to PROMOTE the restraint asphyxia deaths of children and adults who are "guilty" of nothing more than being victims of an altered level of consciousness. Apparently, Chan et al are more interested in maintaining the MYTH that they are "credible restraint practices researchers" (and/or more interested in earning money as restraint practices "Expert Witnesses") than they are interested in preventing entirely unnecessary deaths due to forceful-prone-restraint.
To read my Comprehensive Review of Chan et al's previous "Weight Study"
To read my Comprehensive Review of OTHER Chan et al studies,
To learn WHY RESTRAINT ASPHYXIA HAPPENS (explained in ENGLISH!),
None of the study subjects had any kind of health problems (as do most individuals who generate emergency responses and who are subjected to restraint in REAL LIFE).
In REAL LIFE, individuals who are subjected to ANY form of forceful-prone-restraint ALL experience a significant amount of physical exertion prior to being restrained.
In REAL LIFE, individuals who are subjected to ANY form of forceful-prone-restraint ALL STRUGGLE AGAINST the RESTRAINT while it is being employed. In fact, they struggle until they are DEAD – when they are finally "released" from restraint.
The RIBCAGE is specifically designed to PREVENT compression of the vital organs dwelling within it: the lungs, the heart, and the great blood vessels. Thus, when studying the effect of "weight force" applied to a prone-positioned individual, if you put the weight on top of the RIBCAGE, you are NOT studying the effects of Forceful-Prone-Restraint. You are studying the ribcage's ability to prevent compression of the lungs, heart, and great vessels within the chest.
Furthermore, in REAL LIFE situations, it is not "chest compression" that causes death due to forceful-prone-restraint! It is ABDOMINAL COMPRESSION that causes the victim's inability to mechanically get air in and out of his body. Thus, this study likely has absolutely NO relationship to the effects of forceful-prone-restraint performed in REAL LIFE situations!
If my anticipation of the WEIGHT PLACEMENT LOCATION employed for this study proves to be wrong, I will write an ENORMOUS APOLOGY to these authors!!!
And, it comes as no surpriZe to this reviewer (or any other individual knowledgeable about this subject) that this study was "DIRECTED" or "OVERSEEN" (possibly even DESIGNED) by the Chan et al bunch.
I really wish that Chan et al would stop putting SO MANY PEOPLE AT RISK FOR DEATH, by continuing to PROMOTE the use of forceful-prone-restraint – a form of restraint that has been consistently linked with causing death since the late '80s.
Unfortunately, Chan et al seem to consider ANY person who requires emergency application of restraint to be someone who "deserves" to suffer the risk of death due to the manner in which they are restrained – be they a diabetic, or a person with a seizure disorder, or a head-injury victim, or whatever!
(a review that is ENTIRELY RELATED to this "NEW" STUDY), go to
Part Three of that Review Series.
CLICK HERE!
That is the Main Page of the 3-part series.
go to my Restraint Asphyxia – Silent Killer Article.
To Return To Wherever You Came From
OR Use the Following Links:
Email Charly at: c-d-miller@neb.rr.com
(Those are hyphens/dashes between the "c" and "d" and "miller")