Background: Inappropriate Response to Seizures

Misinterpretation of Seizures

A common type of seizure (complex partial seizures) may cloud awareness, block normal communication and produce a variety of undirected, involuntary and unorganized movements.

  • This type of seizure may have symptoms that are erroneously perceived as combative. These may include screaming, running, flailing, unnatural looking movements of the arms or legs, spitting, shouting and abusive statements. All of these are involuntary and unconscious symptoms of seizures.
  • After a seizure (referred to as postictal or post-ictal phase), a person often is tired and dazed as normal brain function returns. This period may last for minutes to an hour or more.
    • A person may become belligerent or aggressive, especially when approached or threatened.
    • They may be easily frightened or upset and unable to communicate.
    • Restraining a person during or after a seizure may make this worse – the opposite of the intended result.
    • As one's resistance to restraint increases, the threat to his or her life similarly increases. 

Regulation of Restraint Use by First Responders

Law Enforcement Officers

The use of restraint by first responders is not regulated at the national level, and it is unclear to what extent it is governed by state or local law. There are no national reporting requirements on injuries or deaths associated with restraint in this situation. Accordingly, there is a lack of national data in this area.

By contrast, the U.S. Centers for Medicare and Medicaid Services has issued detailed standards and reporting requirements concerning "behavioral" restraint use in mental health facilities, hospitals and other healthcare facilities. These rules were issued in the wake of media coverage documenting many deaths in these facilities. The deaths resulted from widespread unregulated physical and chemical restraint and isolation practices used to control patients with mental and developmental disabilities when exhibiting combative behaviors as a result of their conditions.

Recommendations Against use of Prone Restraint

The National Association of EMS Physicians has published a position paper, "Patient Restraint in Emergency Medical Services Systems." The paper states that all EMS systems should adopt a protocol to minimize the use of restraint and ensure the safest practices possible. For instance, the paper states that "Patients should never be transported while hobbled, ‘hog-tied,' or restrained in a prone position with hands and feet behind the back."

The fact that prone restraint may lead to death is well-documented in the law enforcement and mental health fields. See in particular the excellent study prepared by Disability Rights CA (formerly Protection and Advocacy, Inc.), "The Lethal Hazards of Prone Restraint: Positional Asphyxiation" (2002), available at http://www.disabilityrightsca.org/pubs/701801.pdf.

  • The study notes that restraining a person face-down may cause positional asphyxia - blocking a person's away, leads to decreased oxygen in the blood stream, and can result in an abormal heart rhythm (cardiac arrhythmia) and death.
  • The study finds that agitation or aggressive behavior or struggles can increase the need for oxygen.Thus the process of subduing a person makes the whole situation worse. 
  • Restraining a person can also lead to further compression and restriction of the chest. To gain physical control of a struggling person, a knee or hand may be pressed into the back of the individual in prone position or staff may use their weight to lean into the individual's back or thorax. 
Handcuffs in front
  • The study also observes that hog-tying, or binding the individual's hands behind the back (as in the use of handcuffs), places the individual in further danger. This position further compresses the movement of the chest, particularly if the hands are pulled firmly behind the back or if weight is applied to the individual's chest or back.
on: 
Friday, August 3, 2018