What is Positional Asphyxiation?

Positional asphyxiation, also known as positional suffocation, occurs when a person’s breathing is restricted due to their body position. This can lead to reduced oxygen intake, unconsciousness, or even death. It is a significant risk during physical interventions or restraints, particularly in care, education, and law enforcement settings.

How Positional Asphyxiation Occurs

Positional asphyxiation happens when the airway is obstructed or the chest cannot expand properly to allow effective breathing. Common contributing factors include:

1. Prone Restraint:
Placing someone face-down can restrict their ability to breathe, especially if pressure is applied to the back.

2. Supine Restraint:
Restraining someone face-up can also limit breathing if their neck or chest is compressed.

3. Bent-Forward Position:
A seated position where the person’s body is forced forward, compressing the chest and abdomen, can impair breathing.

4. Pressure on the Neck or Chest:
Any form of pressure applied to the chest, back, or neck increases the risk of asphyxiation.

5. Underlying Health Conditions:
People with conditions such as asthma, obesity, heart disease, or respiratory issues are at greater risk.

Recognising the Risks

High-Risk Situations

• Using physical restraint during challenging behaviour incidents.
• Prolonged periods in a restrictive position.
• Situations involving individuals who are distressed, struggling, or resisting.

Warning Signs

• Difficulty breathing or gasping for air.
• Cyanosis (blue discolouration of the lips, face, or extremities).
• Weakness, fatigue, or loss of consciousness.
• Panic or distress communicated by the individual.

If these signs occur, it is essential to release the restraint and seek immediate medical attention.

How Positional Asphyxiation Can Affect Your Business

Legal and Financial Consequences
Failure to prevent positional asphyxiation during interventions can lead to serious legal action, including negligence claims and regulatory sanctions.

Reputational Damage
Incidents involving injury or death due to positional asphyxiation can cause significant reputational harm, eroding trust among clients, families, and stakeholders.

Moral Responsibility
As a care or education provider, your organisation has a duty to ensure the safety and dignity of individuals during any intervention.

Best Practices to Prevent Positional Asphyxiation

1. Avoid Prone Restraints
Do not use face-down positions during physical interventions. Prone restraints significantly increase the risk of asphyxiation.

2. Monitor Breathing
Continuously monitor the individual’s breathing and overall condition during any intervention.

3. Limit Duration of Restraints
Any physical intervention should be as brief as possible and released as soon as the risk of harm is reduced.

4. Train Staff
Provide comprehensive training on safer intervention techniques and the risks of positional asphyxiation.

5. Use Positive Behavioural Support
Focus on de-escalation strategies and proactive support to reduce the need for physical interventions.

6. Individual Risk Assessments
Assess individuals for pre-existing conditions or factors that increase their risk of positional asphyxiation.

7. Clear Policies and Procedures 
Establish clear guidelines for physical interventions, including strict prohibitions on dangerous techniques.

8. Immediate Medical Attention 
If there are any signs of distress or difficulty breathing, release the restraint immediately and seek medical assistance.

Training and Awareness

Ensuring all staff are trained to understand positional asphyxiation is critical. Training should cover:

• How to identify high-risk situations.
• Recognising the early signs of distress.
• Approved intervention techniques that minimise risk.
• The importance of communication and teamwork during incidents.

Conclusion

Positional asphyxiation is a preventable risk, but it requires vigilance, training, and a strong commitment to safety. By prioritising de-escalation techniques, limiting the use of physical interventions, and implementing clear policies, your organisation can safeguard individuals and uphold the highest standards of care.

Remember: preserving the dignity, rights, and well-being of individuals should always be at the heart of your practices. Prevention is the best protection.