Positional Asphyxia

If you work with individuals who get anxious, upset, or sometimes violent, part of your job might include using physical restraint. One of the things you probably think about a lot when it comes to physical restraint is the danger it can present to both you and the individuals in your care.

All physical restraints involve a possibility of injury to you, your coworkers, and the person you’re restraining. One of the most catastrophic risks associated with the use of physical restraint is positional asphyxia, a deadly condition that can occur when a person being restrained can’t get enough oxygen. This lack of oxygen can lead to disturbances in the rhythm of the heart, and death can result.

Reducing the Risks of Restraint-Related Positional Asphyxia

The risks of positional asphyxia and other injuries can be reduced in a number of ways, including:

1. Use the Least Restrictive Intervention.
   Using verbal de-escalation strategies before a situation can turn physical can help you avoid the need to restrain at all.
   
   
2. Get Training.
   Sometimes, when all other efforts to de-escalate a situation fail, an emergency situation may warrant the use of physical intervention as a last resort. When you must use a physical restraint as a last resort, you need to be trained in safer ways of restraining.
   
   CPI's Nonviolent Crisis Intervention^® training program focuses on strategies for preventing the need to restrain, and it teaches safer, less-restrictive physical interventions to be used only as a last resort when a person presents an immediate threat of physical harm to self or others. While considered a last resort, physical intervention procedures are taught as part of the program to provide staff with skills and confidence to safely manage emergency situations.
   
   The training also includes important information on evaluating risk of harm, monitoring a person for signs of distress, and discontinuing the physical intervention as soon as possible. The program emphasizes that the least restrictive intervention should be used whenever possible, and that to optimize safety for everyone involved in a situation, staff should practice on a regular basis the verbal and physical intervention skills they learn in training.
   
   
3. Use Safer Techniques.
   When using physical intervention as a last resort, safer restraint techniques can help reduce the possibility of serious injury or death. In particular, avoid positions that can lead to positional asphyxia. These include, among other positions, facedown (prone) restraints and any position that impairs a person's breathing.
   
   Keep in mind too that there is also a psychological danger with using restraints. Being restrained can be frightening and traumatic for a person. The use of restraints can also interfere with the therapeutic relationship between staff and the people in their care.

Resources for Preventing Positional Asphyxia

• Browse an article about Elyn Saks for her perspective on her experience with being placed in mechanical restraints.
• Read about Trauma-Informed Care.
• Check out the Nonviolent Crisis Intervention^® training program to learn how CPI training can help you reduce the risks of positional asphyxia.