EXHIBIT 1

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A National Institute of Justice Program

U.S. Department of Justice

Office of Justice Programs

National Institute of Justice

June 1995

Bulletin

National Law Enforcement

Technology Center

Positional Asphyxia—Sudden Death

Police, sheriffs, and correctional officers

have a limited and largely inadequate set

of tools to use to safely subdue violent

and aggressive subjects. Through NIJ’s

National Law Enforcement Technology

Center (NLETC), the Federal Government is working to identify and support

the development of a range of less-thanlethal technologies—from those suitable

for one-on-one encounters to those that

might be used for stopping fleeing

vehicles. In a recent analysis of incustody deaths, we discovered evidence

that unexplained in-custody deaths are

caused more often than is generally

known by a little-known phenomenon

called positional asphyxia.

This NLETC bulletin presents information relevant to positional asphyxia—i.e.,

death as a result of body position that

interferes with one’s ability to breathe—

as it occurs within a confrontational

situation involving law enforcement

officers. We offer this information to help

officers recognize factors contributing to

this phenomenon and, therefore, enable

them to respond in a way that will ensure

the subject’s safety and minimize risk of

death.

The bulletin identifies factors found to

precipitate positional asphyxia, and

provides recommendations for ensuring a

subject’s safety and advisory guidelines

for care of subjects. Information regarding the collection of potential evidence in

cases involving positional asphyxia is

also included. Through officer awareness

and resultant action, it is anticipated that

deaths attributable to this cause will be

reduced.

Sudden in-custody death is not a new

phenomenon—it can occur at any time,

for a variety of reasons. Any law enforcement agency may experience a sudden incustody death, and while rare, such

deaths appear to be associated most often

with the following variables:

■ Cocaine-induced bizarre or frenzied

behavior. When occurring while

confined by restraints, cocaineinduced excited delirium (an acute

mental disorder characterized by

impaired thinking, disorientation,

visual hallucinations, and illusions)

may increase a subject’s susceptibility

to sudden death by effecting an

increase of the heart rate to a critical

level.

■ Drugs and/or alcohol intoxication.

Drug and acute alcohol intoxication is

a major risk factor because respiratory

drive is reduced, and subjects may not

realize they are suffocating.

■ Violent struggle extreme enough to

require the officers to employ some

type of restraint technique. Subjects

who have engaged in extreme violent

activities may be more vulnerable to

subsequent respiratory muscle failure.

■ Unresponsiveness of subject during

or immediately after a struggle.

Such unresponsive behavior may

indicate cardiopulmonary arrest and

the need for immediate medical

attention.

It is important to understand how

preexisting risk factors, combined with

the subject’s body position when subdued

or in transit, can compound the risk of

sudden death. Information contained in

this bulletin may help to alert officers to

those factors found frequently in deaths

involving positional asphyxia.

Basic Physiology of

a Struggle

A person lying on his stomach has

trouble breathing when pressure is

applied to his back. The remedy seems

relatively simple: get the pressure off his

back. However, during a violent struggle

between an officer or officers and a

suspect, the solution is not as simple as it

may sound. Often, the situation is

compounded by a vicious cycle of

suspect resistance and officer restraint:

■ A suspect is restrained in a face-down

position, and breathing may become

labored.

■ Weight is applied to the person’s

back—the more weight, the more

severe the degree of compression.

Major portions of this bulletin are drawn from a report prepared by the International Association of Chiefs of Police for the National Institute of

Justice (NIJ), based on research conducted by Dr. Charles S. Petty, Professor of Forensic Pathology, University of Texas, and Dr. Edward T.

McDonough, Deputy Chief Medical Examiner, State of Connecticut, and reviewed by the Less-Than-Lethal Liability Task Group.

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■ The individual experiences increased

difficulty breathing.

■ The natural reaction to oxygen

deficiency occurs—the person

struggles more violently.

■ The officer applies more compression

to subdue the individual.

Predisposing Factors to

Positional Asphyxia

Certain factors may render some individuals more susceptible to positional

asphyxia following a violent struggle,

particularly when prone in a face-down

position:

■ Obesity.

■ Alcohol and high drug use.

■ An enlarged heart (renders an individual more susceptible to a cardiac

arrhythmia under conditions of low

blood oxygen and stress).

The risk of positional asphyxia is

compounded when an individual with

predisposing factors becomes involved in

a violent struggle with an officer or

officers, particularly when physical

restraint includes use of behind-the-back

handcuffing combined with placing the

subject in a stomach-down position.

Advisory Guidelines for

Care of Subdued Subjects

To help ensure subject safety and

minimize the risk of sudden in-custody

death, officers should learn to recognize

factors contributing to positional asphyxia. Where possible, avoid the use of

maximally prone restraint techniques

(e.g., hogtying). To help minimize the

potential for in-custody injury or death,

officers should:

■ Follow existing training and policy

guidelines for situations involving

physical restraint of subjects.

Officer Subduing a Violent Suspect and How It Can Interfere With Breathing

■ As soon as the suspect is handcuffed,

get him off his stomach.

■ Ask the subject if he has used drugs

recently or suffers from any cardiac or

respiratory diseases or conditions such

as asthma, bronchitis, or emphysema.

■ Monitor subject carefully and obtain

medical treatment if needed.

■ Be trained to recognize breathing

difficulties or loss of consciousness

and immediately transport the individual to the emergency room, or call

for an emergency medical team

(EMT) unit if such signs are observed.

■ Obtain medical care upon subject’s

request.

■ If the subject is turned over to a

detention facility, inform the facility’s

custodians of any preexisting medical

conditions (cardiac, respiratory) or

that the subject requested or needed

medical treatment because of respiratory difficulty or because he became

unconscious.

Collection of Potential

Evidence

Officers involved in confrontational

situations should collect information that

may later be of value in a civil or perhaps

criminal action.

A use-of-force report should include

details of how the individual was

Officer subdues violent suspect.

Breathing becomes

labored due to

pressure being

exerted on

subject’s

back.

Subject’s chest

fully extended.

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restrained. The following information

should be included:

■ What was the nature of the postarrest

restraint procedure? Identify whatever

type of restraint (including chemical

incapacitants) was used.

■ How long was the subject face down

and/or restrained?

■ How was the subject transported, and

in what position was the subject

during transport?

■ How long did the transport phase last,

and what observations were made of

the subject’s condition?

To reasonably establish the cause of

death or serious injury, a broad range of

factors must be examined:

■ Nature of the confrontation.

■ Weapon(s), if any, employed by

officers.*

■ Duration of the physical combat.

■ System or type of postarrest restraint

employed.

■ Transportation of the subject: destination, duration, mode of transport, and

position of subject during transport.

■ Emergency room observations and

actions, names of attending medical

personnel.

■ Postmortem examination (autopsy) of

subject: nature of injuries, diseases

present, drugs present, and other

physical factors.

NYPD’s Guidelines to Preventing Deaths

in Custody

■ As soon as the subject is handcuffed,

get him off his stomach. Turn him on

his side or place him in a seated

position.

■ If he continues to struggle, do not sit

on his back. Hold his legs down or

wrap his legs with a strap.

■ Never tie the handcuffs to a leg or

ankle restraint.

■ If required, get the suspect immediate

medical attention.

■ Do not lay the person on his stomach

during transport to a station house or

hospital. Instead, place him in a seated

position.

■ An officer should sit in the rear seat

beside the suspect for observation and

control.

The New York City Police Department

(NYPD) has developed a training tape on

positional asphyxia. The Department has

agreed to make the tape available to interested

law enforcement agencies. To request a

complimentary copy, please send your written

request on departmental letterhead, and a blank

VHS tape, to the Deputy Commissioner of

Training, NYPD, 235 East 20th Street, New

York, New York 10003.

Conclusion

To help minimize the risk of positional

asphyxia, diligent observation and

monitoring of subjects displaying any one

or a combination of the described

indicators are procedurally warranted.

Furthermore, the use of maximal, prone

restraint techniques should be avoided. If

prone positioning is required, subjects

should be closely and continuously

monitored. By implementing such

procedural protocols, the potential for incustody deaths may be lessened.

The National Law Enforcement Technology Center is supported by Cooperative

Agreement #95–IJ–CX–K002 awarded by

the U.S. Department of Justice, National

Institute of Justice.

The National Institute of Justice is a

component of the Office of Justice

Programs, which also includes the Bureau

of Justice Assistance, Bureau of Justice

Statistics, Office of Juvenile Justice and

Delinquency Prevention, and Office for

Victims of Crime.

*If any incapacitant was used (e.g., pepper

spray), the delivery system should immediately be secured for possible analysis.

NLETC Bulletin

The NLETC Bulletin is designed as a forum

for disseminating to the law enforcement

and criminal justice communities the most

current information on technologies

relevant to your needs. We welcome your

comments or recommendations for future

Bulletins.

The National Law Enforcement Technology Center is designing data bases to help

respond to agencies that want to know who

manufactures a specific product and what

other agencies may be using that product.

Your contributions to the Center’s

information network are important. What

technologies or techniques are you using

that you would like to share with colleagues? Please call or write to the National

Law Enforcement Technology Center, P.O.

Box 1160, Rockville, MD 20849,

800–248–2742.

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