Asphyxial deaths due to physical restraint. A case series.
OBJECTIVE: To assess the common factors and the pattern of deaths related to the use of physical restraints. DESIGN: Case series. PARTICIPANTS: The chief death investigators of 37 large jurisdictions were sent questionnaires for all cases of restraint-related deaths. Sixty-three questionnaires from 23 jurisdictions were returned. MEASURES: The questionnaires allowed us to determine the restraint type used, the age and sex of the deceased, the furniture type with which restraints were used, the type of facility where the deceased was restrained, and whether the application of restraints was incorrect. RESULTS: We report 63 cases of asphyxial deaths from the use of physical restraints. Ages of decedents ranged from 26 weeks to 98 years. The greatest number of deaths occurred in the 80- to 89-year-old patients. There is a higher frequency for females of all ages, but the distribution for males and females is roughly the same for all age groups. Deaths occurred while the patient was restrained in a chair (wheelchair or geriatric recliner) or a bed. Most chair-related deaths (six of 19) and bed-related deaths (16 of 42) involved the use of vest restraints. Thirteen of the 42 bed-related deaths involved bedrails. The majority of deaths (61%) occurred in nursing homes and 57 of these 63 cases occurred while restraints were properly applied. CONCLUSIONS: Our report of 63 cases is an underrepresentation of the true number of restraint deaths. Our finding that the vast majority of restraint deaths occurred while restraints were correctly applied implies an inherent danger in the use of physical restraints. The safety of restraining patients and the efficacy of physical restraint needs to be examined and alternate means of assuring the safety of patients need to be developed.