   Review of the Medical Theories and Research Relating to Restraint Related Deaths
 
2011
Caring Solutions (UK)
University of Central Lancashire
Contents
Acknowledgements 4
Authors 4
ForewordExecutive Summary 5
1.Introduction 7
2.Background to the Review 8
3.Aims and objectives 9
4Methodology 11
14.1 Establishing baseline dataset from the literature review 11
24.2 Gap analysis/expert review 11
34.3 Expert seminars 12
5Results of literature search 13
6Rationales for restraint 16
7De-escalation 17
8Physical restraint training and techniques 19
9Reporting mechanisms on restraint 20
10Incidents of restraint 21
11Sequalae of restraint incidents 23
12National and international variations 24
13Stakeholders’ perspectives 25
413.2 Learning disabilities 25
513.3 Healthcare settings 25
613.4 Custodial settings 27
14Incidents of restraint-related deaths 28
15.Vulnerable populations 30
715.3 Black and Minority Ethnic groups 33
815.4 Individuals with high body mass index 35
16.Medical theories and concepts 37
916.1 Positional asphyxia 41
1016.2 Excited delirium and acute behavioural disturbance 45
1116.3 Pre-existing conditions 48
1216.4 Stress-related cardiomyopathy 51
1316.5 Thromboembolic disease 51
1416.6 Catecholamine hyperstimulation 52
1516.7 Acidosis 52
1616.8 Alcohol abuse 53
1716.9 Neuroleptic medication 55
1816.10 Neuroleptic malignant syndrome 56
2.Current UK research projects 57
3.Characteristics of individuals in UK restraint-related deaths 1999-2010 57
4.Expert opinion 60
5.Gap Analysis 66
6.Implications for practice 68
2021.2 Reporting 69
2121.3 Training 70
2221.4 Risk assessment and management 71
2321.5 Management of acute behavioural disturbance and excited delirium 72
2421.6 Polypharmacy 73
2521.7 Pre-existing conditions 73
7.Conclusions 74
Glossary 76
Appendix 1 Relevant studies 79
Appendix 2 Hierarchy of evidence 88
Appendix 3 Restraint-related deaths 1st Jan 1999- 1st Jan 2010 89
Appendix 4 Expert opinion 96
Appendix 5 Signs and symptoms of medical conditions 97
Appendix 6 Useful links 98
References 99
Figure 1 Multifactorial causes of restraint-related death...................................................................................................................................................37
Figure 2 Process of profound lactic acidosis.......................................................................................48
Figure 3 Continuum of risk in managing violence or aggression........................................................68
Figure 4 Multifactorial model of restraint-related deaths..................................................................69
Acknowledgements
The authors wish to thank the following for their contributions and advice:
Professor Richard Shepherd; Matt Leng (Ministerial Council on Deaths in Custody), Deborah Coles and Victoria McNally (INQUEST), Prof Richard Whittington, Malcolm Rae, Dr Brodie Patterson, Prof Ian Wall.
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