Hall Christine, Votova Kristine, Heyd Christopher, Walker Matthew, MacDonald Scott, Eramian Doug, Vilke Gary M
University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada; Department of Emergency Medicine, Island Health Authority, Victoria, BC, Canada; University of Calgary, Faculty of Medicine, Department of Community Health Sciences, Calgary, Alberta, Canada; Department of Criminology, Simon Fraser University, Vancouver, BC, Canada.
Island Health Authority, Victoria, BC, Canada.
J Forensic Leg Med. 2015 Apr;31:29-35. doi: 10.1016/j.jflm.2014.12.007. Epub 2015 Jan 6.
Little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. We report data from 4828 consecutive use of force events (August 2006-March 2013) in 7 Canadian police agencies in Eastern and Western Canada. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of outcome. Officers prospectively documented: final resting position of the subject (prone or non-prone), intoxicants and/or emotional distress, presence of features of excited delirium, and the use of all force modalities. Our outcome of interest was sudden in-custody death. Our study has 80% power to detect a difference of 0.5% in sudden death between the positions. In over 3.25 million consecutive police--public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). Subjects were usually male (87.5%); median age 32 years; 81.5% exhibited alcohol and/or drug intoxication, and/or emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; but over 2000 subjects remained prone. One individual died suddenly and unexpectedly in the non-prone position with all 10 features of excited delirium. No subject died in the prone position. There was no significant difference in sudden in custody death, in a worst case scenario 99.8% of subjects would be expected to survive being in either the prone or non-prone position following police use of force.
对于猝死的发生率、其潜在的病理生理学机制，或者它与受检者体位的实际关系，人们了解甚少。我们报告了加拿大东部和西部7个警察机构在2006年8月至2013年3月期间连续发生的4828起使用武力事件的数据。纳入了年龄大于18岁、参与警察使用武力事件的连续受检者，无论结果如何。警察前瞻性地记录了：受检者的最终静止体位（俯卧或非俯卧）、是否存在 intoxicants 和/或情绪困扰、是否存在激越性谵妄特征，以及所有武力手段的使用情况。我们感兴趣的结果是在押期间猝死。我们的研究有80%的把握检测出两种体位之间猝死率相差0.5%。在超过325万次连续的警察与公众互动中；4828名受检者使用了武力（占警察与公众互动的0.1%；95%置信区间 = 0.1%，0.1%）。受检者通常为男性（87.5%）；年龄中位数为32岁；81.5%在现场表现出酒精和/或药物中毒，和/或情绪困扰。处于非俯卧体位的受检者明显多于俯卧体位的受检者；但超过2000名受检者处于俯卧体位。1名个体在非俯卧体位突然意外死亡，具有激越性谵妄的所有10项特征。没有受检者在俯卧体位死亡。在押期间猝死没有显著差异，在最坏的情况下，预计99.8%的受检者在警察使用武力后处于俯卧或非俯卧体位时能够存活。
