Operational partnerships - Positional asphyxia SoP (O43j)

1. Summary of changes

1.1. This standard operating procedure (SOP) has been reviewed in February 2024 - minor amendments to content made. 

2. What this procedure is about

2.1  The purpose of this procedure is to ensure that officers and staff recognise the heightened risk of positional asphyxia during restraint and are alert to the immediate emergency actions to be taken.

2.2. Positional asphyxia occurs when a person is placed in a posture that prevents or impedes the mechanism of normal breathing. If the person cannot escape from the position, death may occur very rapidly.

Compliance with this SOP and any governing policy is mandatory. 

3. Detail the procedure

3.1. Officers and staff must recognise the risk of positional asphyxia occurring in the following circumstances and be prepared to respond to a medical emergency:

• when a person is restrained, handcuffed or unattended in any position that impedes their ability to breathe normally

3.2. Officers and staff should recognise the heightened risk factors:

• a person is intoxicated with alcohol or drugs
• a person is substantially overweight
• a person is suffering respiratory muscle fatigue (exhaustion)
• there is some form of airway obstruction
• a person is unconscious for whatever other reason

3.3. Officers and staff should recognise the following warning signs of positional asphyxia:

• a person makes gurgling/ gasping sounds with foam or mucus coming from the nose or mouth
• a person shows any visual sign that they are struggling to breathe
• a person makes verbal complaints of being unable to breathe properly together with increased effort (it should be noted that a person suffering breathing difficulties may not be able to complain about their crisis)
• a person who displays a heightened level of aggression during restraint may be a physiological response to fighting for air. Any increased resistance during restraint of a person should be regarded with caution
• a violent and noisy person suddenly changes to a passive quiet and tranquil demeanour
• a person who displays a change in behaviour (both escalative and de-escalative)
• a person presents blue dis-colouration of facial skin (cyanosis)
• a person presents swelling, redness or blood spots to the face or neck
• a person suffers a loss or a reduced level of consciousness

3.4. Officers and staff must take the following actions to reduce the risk of positional asphyxia occurring:

• once handcuffed, a person should be raised to their feet to a seated or standing position that does not impede the mechanism of normal breathing
• care should be taken not to put pressure on the back as breathing can be restricted even if the person is placed in the recovery position
• monitoring the person’s condition continually whilst being restrained, as death can occur suddenly and develop beyond the point of viable resuscitation within seconds rather than minutes
• whenever possible during team restraint, a ‘safety officer’ is to be identified with the responsibility to monitor the health and welfare of the person during restraint
• prisoners must not be transported in the prone position
• the prisoner’s condition should be monitored prior to, during and at the conclusion of the journey

3.4.1. Officers and staff must take the following actions to reduce the risk of positional asphyxia occurring in police custody:

• officers are to inform the custody sergeant and nurse of the nature and circumstances surrounding police involvement
• the officer should alert the custody sergeant and medical staff of any restraint options or equipment used during arrest as well as the method of transporting the individual
• the prisoner should be transferred to hospital if necessary if their condition deteriorates

3.5. Officers and staff must take the following emergency actions in the event that positional asphyxia is suspected:

• call for immediate emergency medical assistance if there is any reason for concern about a person’s condition
• remove all methods of restraint
• place the person in a position that does not impede their breathing
• if consciousness is lost, check airway and breathing
• commence CPR if necessary
• notify a supervisory officer if one is not present. Supervisory officers notified of such incidents must attend the scene immediately
• a full record of the perceived signs of the condition and police response must be made in pocket notebooks or the custody record, as appropriate

4. Equality Impact Assessment (EIA)

4.1. An EIA has been carried out and shows that the proposals in this procedure would have high potential or actual differential impact on grounds of race, ethnicity, nationality, gender, transgender, disability, age, religion or belief or sexual orientation.

5. Risk assessment

5.1. This SOP has been assessed as high risk.

6. Consultation

• Staff Safety Training Unit
• Professional Standards
• Human Resources
• Equality and Diversity
• Estates
• IT Security
• Legal
• Freedom of Information
• Police Federation

7. Monitoring and review

7.1. This SOP will be monitored by the Staff Safety Training Unit. The SOP will be reviewed to ensure accuracy with the most recent College of Policing published information and IOPC ‘learning the lessons’ bulletins. Due to the high risk nature of this topic, this SOP will be reviewed annually with the next review scheduled for February 2026.

8. Other source documents

None listed.

9. Security

9.1. Kent Police have measures in place to protect the security of your data in accordance with our Information Management policy.

10. Retention and disposal of records

10.1. Kent Police will hold data in accordance with our Records Review, Retention and Disposal policy.