Judith Davila Cruz, 42

Rosenberg, Texas
February 09, 2008

Agencies: Texas Department of Public Safety | Rosenberg Police Department Internal Affairs Division Texas

Cause of death: Choking

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Last updated: over 3 years ago


The prone position and positional asphyxia

There is an increased risk of causing positional asphyxia when restraining those of particularly small or large build or those who have taken drugs, medications (anti-psychotics) or alcohol. People restrained in the prone position should be placed on their side or in a sitting, kneeling or standing position as soon as practicable. The IAP has issued advice on restraint and the use of force.

Staff working in a custody environment must be trained in managing violence. Training should include tactical communication skills as well as recognising and managing positional asphyxia and ABD, including excited delirium. Staff should also be trained in techniques for moving detainees and repositioning them from the prone position in accordance with the Personal Safety Manual of Guidance.

Officers and staff should avoid using the prone restraint position unless it is proportionate to the threat and necessary in the circumstances. Officers should keep the period for which it is used to a minimum.

When a detainee is restrained in a prone position, a safety officer should be responsible for monitoring the detainee’s conditions, particularly the airway and response, protecting and supporting the head and neck. That person should lead the team through the physical intervention process and monitor the detainee’s airway and breathing continuously. Care should also be taken not to place pressure on a detainee’s chest or obstruct the airways.

Prolonged restraint and struggling can result in exhaustion, reduced breathing leading to build up of toxic metabolites. This, with underlying medical conditions such as cardiac conditions, drugs use or use of certain antipsychotics, can result in sudden death with little warning.  The best management is de-escalation, avoiding prone restraint, restraining for the minimum amount of time, lying the detainee on their side and constant monitoring of vital signs.

Usually there are no outward signs or symptoms of positional asphyxia. An individual may be overtaken so quickly and completely that there are no indications of distress or time to communicate a need for help.

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