Once again prone or "face down restraint" is in the news. An awful lot has been made about how dangerous and degrading this position is, and for the most part- rightly so. Despite guidance to the contrary, it seems it is used far more than it should be.
But with all the focus on "Face down" or Prone Restraint, I wonder... could we be missing the point? Stick with me on this...
My main point in writing this post is to highlight:
- The myth that "prone" is the baddy and everything else is safe.
- The over reliance on prone in some settings.
So lets get clear on what we are talking about
Prone Restraint is simply restraining someone on their stomach- face down. This position has been implicated in the deaths of many, and can lead to "Positional Asphyxia". There has over recent years been a drive to reduce if not eliminate its use as a default or preferred position.
"Positional" or "Restraint Asphyxia" then is:
"Death which results from a body position that interferes with the ability to breathe. When compression of the trunk limits chest movements preventing the diaphragm moving up and down between the chest and the abdomen impairing breathing."
Police Complaints Authority - Policing Acute Behavioural Disturbance - Revised Edition, March 2002.
Several guidance documents like "Positive and Proactive Care" for example, "ban" the use of Prone restraint because of the risk of Positional Asphyxia.
Positive and Proactive Care Para 70 states:
"There must be no planned or intentional restraint of a person in a prone/face down position on any surface, not just the floor."
This is quite rightly, one of the first points commissioners of training will ask us about. And no, we don't teach "Prone Restraint" as part of our standard syllabus.
But is all the focus on Prone missing the point?
1. The myth that "prone" is the baddy and everything else is safe.
It's great that people are more aware of it, but the real danger in restraining someone is whether their breathing is in any way restricted. Regardless of whether they are laying face down, upside down, on their back or in some sort of downward dog lotus hybrid position.
The reality is that no physical intervention is 100% safe.
So whilst you can not deny that prone presents significant risk, so do many other positions which we might assume are safe-because no-one is jumping up and down about them.
By focusing all our attention on prone, are we in danger of missing the moonwalking bear?
In fairness to Positive and Proactive Care, it does very clearly say:
"Staff must not deliberately restrain people in a way that impacts on their airway, breathing or circulation, such as face down restraint on any surface, not just on the floor.
Take for example sitting someone down. You might think this is far safer than pinning someone to the floor, but you would be wrong.
Reader participation time then...(please consult your doctor before attempting this)
- Sit down and place both feet flat on the floor.
- Bend forward at the waist as if going into the "Brace" position in an plane.
- Have a go now... it's not comfortable is it?
Jimmy Mubenga was being deported to Angola from the UK, following a two year custodial sentence for assault. A private security company were contracted to escort him on the plane. He became "upset" and was restrained by three security guards in his seat. He was handcuffed behind his back, and forced into a forward-leaning position that affected his ability to breathe.he repeatedly shouted that he couldn't breathe and that the guards were killing him. They did not ease up, and Mr Mubenga went into cardiac arrest and died. Read the coroners report here.
"...statistically and operationally significant" research, published in 2011 by Dr John Parkes at Coventry University, shows that lung function is reduced by a massive 44.7% when seated and bent forward.
But if you can say "I can't breathe" you are fine!
Having taught self defence and "Control and Restraint" techniques for over 13 years (11 of which as a police trainer) I have lost count of how many times someone would say :"Well, if they can shout and scream then they can breathe!"
Lets try another experiment shall we? (prior medical warning still applies...if you pass out you only have yourself to blame)
In a moment I want you to:
- Breath out as far as you can- until there is no air left in your lungs.
- Without taking a breath, see how many times you can say "I Can't Breathe" out loud.
I can get about 5 or 6 out, how about you?
The amount of air required to rattle the vocal chords is surprisingly little and nowhere near enough to keep your body going. Now imagine you are struggling for your life...not because you want to escape, but because you can't breathe.
The people detaining you may think you are struggling and shouting and therefore increase the amount of force to detain you...making the problem even worse and causing you to fight even harder for your life...literally.
2: Over reliance on Prone in some settings.
"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail."
Abraham Maslow 1966
When people are tragically killed in restraint the spotlight inevitably falls on the restrainers. But in many cases the problem can be traced back to a failure in training. Not only in the techniques themselves, but also in the way training is structured.
I have personally used force to make or assist in arrests for 15 years. My "go to" technique was prone because that is pretty much all I was trained to do. And this is a problem.
Any system that claims to use prone restraint as a last resort should really have alternatives that are taught first and focused on throughout reality based training. Putting staff into situations (in a controlled environment) where they have to think and respond appropriately is absolutely essential.
From the coroner in the Jimmy Mubenga inquest:
"...there was enough concern raised prior to the death of Mr Mubenga about the utility of these techniques in managing a restraint in an aircraft, and related inadequacies in the training, to question their suitability theoretically or in practice."
My interpretation...Does the training reflect reality. If it doesn't (but that's the way we've always done it) what's the point?
Prone as a last resort
We do have to remember however that it may, on rare occasions, be absolutely necessary and reasonable to put someone face down for the shortest time to ensure everyone, including the subject, is safe.
How do you handle someone in crisis who has already deliberately cut their own forearm to the bone, is heavily intoxicated- on drugs, hallucinating and running at his 65 year old mother with a razor blade threatening to kill her?
You can talk all you like, get the bean bags out and light a joss stick or two, even offer free hugs- that person isn't going to stop. I know it may seem far fetched to most, but I have personally experienced just such a case. To safely control a person like that, prone restraint may be the only option.
Lets sum this up then...
So what am I saying...I'm saying that over reliance on prone as the "go to move" to get control is dangerous, and is in my experience, not used as a position of last resort as it should be!
But equally, I believe that all the focus on "Face down restraint", may lead people to believe that we are safe as long as we don't use it. And that's not true.
But then I suppose "Techniques that may interfere with breathing" doesn't role off the tongue as easily "Face Down".