Fatalities related to medical restraint devices-asphyxia is a common finding.

A total of seven detailed death investigations is reported where death occurred while being restrained by a belt or a protective cover. The casualties were elderly persons who mostly showed considerable pre-existing diseases, especially dementia and coronary atherosclerosis. Concerning the cause of death, three groups were differentiated: (I) mechanical asphyxia from strangulation. (II) Mechanical asphyxia from thoracic/abdominal compression. (III) Compression of thorax/abdomen without clear signs of asphyxia. Subgroups II and III each involved one case of rib fractures without preceding resuscitation. In subgroup III, the presence of considerable compression of the trunk and the absence of a natural cause of death strongly indicate a causal connection between compression and death, e.g. from a shortened course of fatal asphyxia, endocrine stress reactions or a head-down-position: cardiac arrest in a helpless situation. The method of restraint was inadequate in most cases in that only one device was used which did not restrict the capability to move sufficiently. A good clinical documentation including medical indication, duration and method of restraint and a description/photograph of the original on-site appearance is essential but was not present in most cases. Therefore, prophylaxis is based on a clear medical indication, the proper use of restraint devices, detailed instructions of the nursing personnel and close monitoring. The forensic investigation should aim at a complete reconstruction based on autopsy, histology, toxicology and inspection of the scene and the medical records.