An overhung mute suspect died during restraint – Is this a case of positional asphyxia?
Introduction
Positional asphyxia is a specific type of mechanical asphyxia characterized by common signs of asphyxia and occurs when a person is trapped in a position that does not allow for adequate ventilation, resulting in respiratory dysfunction or upper airway obstruction.1, 2 According to literature reports, this particular mode of asphyxiation is usually accidental.3 Positional asphyxia can occur in a variety of ways. For example, forced positioning of the head, neck, or rib cage in a restricted space or position can trigger asphyxiating mechanisms by blocking the respiratory tract and compressing or immobilizing the thorax or neck.4 In practice, the cause of death in cases of positional asphyxia is often difficult to identify. Although deaths have clearly occurred in individuals placed in different restraint positions, the role of body position and positional asphyxia in these situations is controversial. When explaining the deaths of these individuals, factors other than asphyxiation from body positioning, such as intoxication, over-stress, trauma, hyperthermia, muscle-fatigue, or exhaustion, should not be ignored. Some cases are better defined from a pathophysiological perspective, such as the head-down position.5, 6, 7 In addition to the specific body position, other criteria have been proposed for the diagnosis of positional asphyxia. These criteria include a body position that obstructs normal gas exchange, evidence that circumstances prevented the individual from escaping the fatal body position, and other causes of natural or violence-related death being excluded prior to making a diagnosis.
In the field of forensic medicine, the cause of a sudden unexpected death compared to torture is difficult to diagnose due to the paucity and lack of specificity of the anatomical-pathological findings.
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Case report
A 30-year-old mute male, who was suspected of theft, was questioned with the assistance of a teacher specializing in communicating with mute individuals. Subsequently, he ate food and drank water and then was sent to the detention room alone. To prevent him from escaping from the room and to restrict his violent resistance, he was handcuffed with his hands above his head and attached to a steel bar in a window, with his toes touching the ground. During this period, he was recorded to
Discussion
Death caused by positional asphyxia is a specific type of mechanical suffocation death. In China, a number of case reports of death caused by “specific position” suffocation have been described, and these reports may be categorized as suffocation by positional asphyxia.8 In international journals, there have been more reports describing cases of positional asphyxia.9, 10, 11 These specific suffocation cases have attracted the attention of forensic pathologists due to the unusual manner in which
Conflicts of interest
The authors do not have any possible conflicts of interest.
Funding
None.
Ethical approval
None.
Acknowledgments
The authors thank Zhong Li, YunjuGu, and Zhenzhong Shi for their technical help. This study was funded by the National Natural Science Foundation of China (No. 81373242).
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