Mind, a leading mental health charity, is today calling for the Government and NHS England to put an end to life-threatening face down, or prone position restraint of people with mental health problems in healthcare settings.
Prone restraint has been proved to increase the risk of death during restraint through a condition known as postural/positional asphyxia. By restricting the ability of the chest and diaphragm to move, a person’s ability to breath is greatly reduced. In addition, the increase in oxygen required by the body during incidents of restraint, combined with the internal organs being pushed up toward the chest cavity by contact with the floor means breathing is dangerously inhibited.
You may recall the news article of the 50 year old man that attempted to rob a betting shop in Plymouth, January 2013, and died at the scene after two men tackled and pinned the man to the floor. It is believed that as they pinned him to the floor for a prolonged period of time, the robber was unable to breath effectively, thus falling unconscious and later dying at the scene.
So, if we have agreed that prone restraint is a potential killer, why are NHS trusts still using it? There are other options available. Why are they not being taught? Why are techniques that restrict breathing still being taught? More worryingly, a staggering 22% of care staff interviewed by MIND hadn’t received any refresher restraint training in excess of 12 months! This is nothing short of unacceptable.
When I was an Officer in HM Prison Service, prone restraint was widely taught, but it was reiterated time and time again that this was a last resort and only to be used to regain control and/or apply handcuffs. As soon as control was regained or cuffs were applied, the prisoner was to be stood up as soon as possible. Additionally, there was always a member of Healthcare staff at the scene trained in advanced life support, First Aid and the use of a Defibrillator.
I cannot stress enough just how dangerous prone restraint can be, particularly if suitable control measures and fit for purpose conflict management, restraint and physical skills training are not implemented.