Comparison of Respiratory Function
in the Prone Maximal Restraint Position
With and Without
Additional Weight Force on the Back

The text of this UNPUBLISHED paper was derived from the "book" of papers accompanying the annual meeting of the American Academy of Forensic Science, in Reno, Nevada: February 21-26, 2000.

"PAPER PRESENTERS": John W. Eisele MD, Department of pathology; Theodore Chan MD, Gary Vilke MD, Department of Emergency Medicine; and Jack Clausen MD, Department of Medicine; University of California at San Diego Medical School, 9500 Gilman Drive, La Jolla, CA.

"After attending this presentation, the participant will understand the effects on respiratory function of being placed in the prone, maximal restraint position ("hogtying" or "hobble restraint") without weight on the back and with varying weights placed on the upper back."

Here we go again!

If Eisele et al. used the same "restraint position" that Chan et al. (the co-authors of this paper) used for their 1997 "study" of "a restraint position,"(1) THEY DID NOT STUDY HOBBLE RESTRAINT.(2)
Thus, this presentation paper is NOT RELATED to field use of restraint for agitated and violent individuals, nor are its reported results HELPFUL!

Once AGAIN, only "HEALTHY VOLUNTEERS" were employed for this paper/presentation's study. (They were also not "fat" individuals!)
Thus, this presentation paper is NOT RELATED to field use of restraint for agitated and violent individuals, nor are its reported results HELPFUL!

This paper/presentation's study used a prone restraint position
with "weight" placed on the prone-restrained individual's back!

I was so excited! ...
Until I read about the AMOUNT of weight that was employed:
25 pounds in one session, and 50 pounds in another session.

That really didn't sound like much weight to me. But, I'm not an incredibly accurate estimator of distance or weight! So, in all fairness, I decided I better investigate these weights, before writing my review!

First, I went scurrying around my house looking for "common household items" that might weigh 25 pounds and/or 50 pounds! The best I could come up with was a 40 pound plastic tub of cat litter. (CLEAN cat litter, thank you very much!)

By evaluating that 40 pound tub, I immediately realized that 25 pounds is LIGHT WEIGHT, and entirely UNRELATED to field application of forceful-prone-restraint!

The 40 pound tub of cat litter wasn't "LIGHT," however. It took a bit of effort to pick it up! BUT, it still didn't seem very "heavy!"

SO, I laid down on the ground, on my belly, and had my Mum put the 40 pound tub of cat litter on my back, between my shoulder blades. (The location used in Eisele, Chan et al.'s "prone-position-with-weight-applied" study.)

I was not AT ALL "bothered" by that weight on my back.

NEXT, I considered the "field" situation: In REAL LIFE, if someone is subjected to manually-applied forceful-prone-restraint by an adult individual, at least HALF of the restraining adult individual's weight is applied to the restrained individual's back. (And, that's entirely ignoring the extra "weight" of the "physically-exerted" FORCE, applied by the restrainer).

SO! For "50 pounds" to be realistically considered in relationship to FIELD application of forceful-prone-restraint, the restraining individual would have to weigh ONLY 100 pounds!!!

I don't think I've EVER, in my 15 years working the streets, seen an emergency responder who weighed only 100 pounds. And, certainly, should such a light weight emergency responder exist, she/he would NOT endeavor to restrain an incredibly agitated and violent individual ALL BY HER/HIMSELF! Thus, MORE than half the weight of a 100-pound provider would be applied to the back of any forcefully-prone-restrained individual, in a REAL forceful-prone-restraint situation.

Therefore, I have "scientifically" determined that
the "weights" used in Eisele, Chan et al.'s study, for their
February, 2000, presentation paper, were as
ludicrous and unhelpful
as the methods used in Chan et al.'s 1997 study.

LASTLY (My CAPS and italics!):

"These results indicate that weight placed on the back during maximal restraint DOES cause a DECREASE IN SPIROMETRY PARAMETERS. Data collected to date, however, does not indicate a significant effect on oxygen saturation or end tidal CO2."

AND: "... the amount of weight in this study was limited, BUT THE AUTHORS LACK OF SPECIFIC KNOWLEDGE OF THE EFFECTS OF THIS PROCEDURE MADE THIS A MATTER OF SAFETY FOR THE VOLUNTEERS. These are clearly matters of concern for future studies."

AH!: So. The ludicrously-light weights used in this study DID cause a decrease in "normal" respiration. But, the authors ELECTED TO DETERMINE that the decrease they measured was NOT "significant."

OH!: And, the authors ADMIT that they don't have a CLUE as to what actually happens in the field, when restraint is applied. Thus, they admit that they didn't study ANYTHING that can be related to field application of forceful-prone-restraint. Isn't that special?


PLZ, Dr.s Eisele, Chan, et al.!!! I BEG YOU!

STOP studying healthy subjects, restrained in silly, unrealistic manners! Your studies do not - in any way - obtain information germane to actual field-applications of restraint!

Your studies certainly (to date) have NEVER contributed to protection of patients OR emergency responders from incidences of Restraint Asphyxia!

Indeed, the manner in which you persist in representing your various studies' findings leads only to confusion, misinterpretation, and the CONTINUED USE of lethal forceful-prone-restraint and prone hobble restraint.

Even had you used greater weights in this particular study (such as HALF the weight of a "normal," 200 pound emergency care provider, wearing all the gear and equipment that they respond in), by persisting in your testing of HEALTHY INDIVIDUALS, you PERSIST in NOT BEING HELPFUL!


Ms. Charly D. Miller, Paramedic
EMS Author, Educator, Consultant


  1. .. Chan TC, Vilke GM, Neuman T, Clausen JL. Restraint position and positional asphyxia. Ann Emerg Med 1997; 30:578. (See the Restraint Asphyxia Library)

  2. .. Miller CD. Chan et al.'s 1997 restraint position article is FLAWED. http://www.charlydmiller/LIB/1997chanreview.html. (See the Restraint Asphyxia Library)

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