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64-488: Legcuffs are physical restraints used on the ankles of a person to allow walking only with a restricted stride and to prevent running and effective physical resistance. Frequently used alternative terms are leg cuffs , (leg/ankle) shackles , footcuffs , fetters or leg irons . The term "fetter" shares a root with the word "foot". Shackles are typically used on prisoners and slaves . Leg shackles also are used for chain gangs to keep them together. Metaphorically ,
128-455: A foreign body blocks the airway. This obstruction can be located in the pharynx , the larynx , trachea , or lower respiratory tract. The blockage can be either partial (insufficient air passes through to the lungs) or complete (complete blockage of airflow). Foods that are small, round, or hard pose a high risk of choking. Examples include hard candy, chunks of cheese or hot dogs, nuts, grapes, marshmallows, and popcorn. Among children,
192-430: A try to extract it, usually by using a finger sweeping (hopefully from the mouth). Normally, the object would be a food bolus (and not the epiglottis, a cartilaginous flap of the throat). It is also possible to try to extract it when it is deeper and not visible, always carefully: using the fingers to take it, or lifting the victim's chin to form a straight way to the throat while the victim is face up (face down in case of
256-546: A Choking Victim" which were evaluated by the Journal of the American Red Cross Scientific Advisory Council (American Red Cross). This procedure has modifications for infants (babies under 1 year-old) , for the people with problems in the belly as the pregnant or too much obese people , for the disabled victims in wheelchair , for the victims that lay on the bed but are unable to sit down , and for
320-428: A cardiac arrest at any moment, due to several possible causes. So it is convenient to ask around for a defibrillator (AED device), for trying a defibrillation on a victim that remains in cardiac arrest after having extracted the stuck object (if it has been extracted, and only after that). Those defibrillators are easy to use, as they emit their instructions with voice messages. It is crucial to avoid blindingly sweeping
384-430: A cardiac arrest, it will require to perform a normal cardiopulmonary resuscitation (CPR), as described below, but only alternating the 30 compressions and the two rescue breaths. Emergency medical services must be called, if this has not already been done. It can be also convenient that any rescuer asks for a defibrillator around (an AED, as those devices are very common today), just in case it can be necessary to treat
448-422: A delay in diagnosis because there may not be a known history of a foreign body entering the airway. Choking on food is only one type of airway obstruction ; others include blockage due to tumors, swelling and inflammation of the airway tissues (from organic foreign bodies or another reason), and compression of the laryngopharynx , larynx , or vertebrate trachea in strangulation . Foreign bodies can also enter
512-639: A fetter may be anything that restricts or restrains in any way, hence the word "unfettered". The earliest fetters found in archaeological excavations date from the prehistoric age and are mostly of the puzzle lock type. Fetters are also referenced in ancient times in the Bible ( 2 Samuel 3:34 , Job 36:13 , Psalm 149:8 ) A variety of restraint types already existed in Roman times. Some early versions of cup lock shackles existed at this time. These were widely used in medieval times, but their use declined when mass production made
576-407: A finger sweep unless an object can be clearly seen in the victim's mouth to prevent driving the obstruction deeper into the victim's airway. Other protocols suggest that if the patient is conscious they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should place them in the recovery position to allow the drainage of fluids out of the mouth instead of down
640-705: A patient still needs restraints, Japanese psychiatric hospitals keep patients in restraints for a much longer time than hospitals in other countries. According to a survey conducted on 689 patients in 11 psychiatric hospitals in Japan, the average time spent in physical restraints is 96 days. Meanwhile, the average time in most other developed countries is at most several hours to tens of hours. The number of people who are physically restrained in Japanese psychiatric hospitals continues to increase. In 2014 more than 10,000 people were restrained-the highest ever recorded, and more than double
704-736: A person, which are predominantly used by trained police or correctional officers . This less commonly also extends to joint locks and pinning techniques. Physical restraints are used: Restraining someone against their will is generally a crime in most jurisdictions, unless it is explicitly sanctioned by law. (See false arrest , false imprisonment ). Restraint has been misused in special education settings resulting in severe injury and trauma of students and lack of education from spending school hours restrained. The misuse of physical restraint has resulted in many deaths. Physical restraint can be dangerous, sometimes in unexpected ways. Examples include: For these and many other reasons, extreme caution
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#1732848843852768-433: A surface. That surface should be firm enough (it is recommended placing a layer of something on the floor and laying the victim above). A rescuer can then ask for any of the known anti-choking devices that is available, and use it on the unconscious victim. After that, the obstruction would be dislodged, but it could remain into the mouth, which needs a manual removal. If the unconscious victim cannot breath then, or stays in
832-459: A vacuum by direct pressure against the patient's face. However, these products have not been well-studied in clinical trials or pre-hospital settings and literature is relatively sparse given the challenges in trial design. A 2020 systematic review of the effectiveness of the three devices listed discovered "a more detailed review of the studies demonstrated a very low certainty of evidence for its use", and concluded that "there are many weaknesses in
896-490: A woman did not want her medication. "If you are a woman who has been sexually or physically abused, and mental health problems in women often have close links to violence and abuse, then a safer environment has to be just that: safe and not a re-traumatising experience. (...) Face-down restraint hurts, it is dangerous, and there are some big questions around why it is used more on women than men". Choking Choking , also known as foreign body airway obstruction ( FBAO ),
960-445: Is a danger that the patients will harm themselves. The law also states that a designated psychiatrist must approve the use of restraints and examine the patient at least every 12 hours to determine whether the situation has changed and the patient should be removed from restraints. However, in practice, Japanese psychiatric hospitals use restraints fairly often and for long periods. Despite being required to certify every 12 hours whether
1024-523: Is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract . An obstruction that prevents oxygen from entering the lungs results in oxygen deprivation . Although oxygen stored in the blood and lungs can keep a person alive for several minutes after breathing stops, choking often leads to death. Around 4,500 to 5,000 choking-related deaths occur in the United States every year. Deaths from choking most often occur in
1088-937: Is an electronic charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds. Despite a UK government statement in 2013 that it was minded to impose a ban on such techniques in mental health facilities, by 2017 the use of restraints in UK psychiatric facilities had increased. Face down restraints are used more often on women and girls than on men. 51 out of 58 mental health trusts use restraints unnecessarily when other techniques would work. Organisations opposed to restraints include Mind and Rethink Mental Illness . YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients especially women and girls who have previously been victims of physical and/or sexual abuse. The charities sent an open letter to health secretary, Jeremy Hunt showing evidence from 'Agenda,
1152-410: Is convenient that one hand supports the victim's chest. Then the back blows are performed by delivering forceful slaps with the heel of the hand on the victim's back, between the shoulder blades. The back slaps push behind the blockage to expel the foreign object out. In some cases, the physical vibration of the action may cause enough movement to clear the airway. Abdominal thrusts are performed with
1216-406: Is coughing, wheezing, and diminished breath sounds, however, a 10-year review showed that this grouping of symptoms was present together in only about 60% of patients. Loss of consciousness may occur if breathing is not restored. In the setting of lower airway aspiration, patients may develop pneumonia like symptoms such as fever, chest pain, foul smelling sputum, or blood in sputum (hemoptysis). In
1280-501: Is needed in the use of physical restraint. Gagging a restrained person is highly risky, as it involves a substantial risk of asphyxia , both from the gag itself, and also from choking or vomiting and being unable to clear the airway. In practice, simple gags do not restrict communication much; however, this means that gags that are effective enough to prevent communication are generally also potentially effective at restricting breathing. Gags that prevent communication may also prevent
1344-408: Is quite similar to any other CPR, but with some modifications: In a first step, a series of 30 chest compressions are applied on the lower half of the sternum (the bone that is along the middle of the chest from the neck to the belly) at an approximate rhythm of nearly 2 per second. After that series, the rescuer looks for the obstructing object and, if it is already visible, the rescuer makes
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#17328488438521408-564: Is routine". Government guidelines state that face down restraint should not be used at all and other types of physical restraint are only for last resort. Research by Agenda found one fifth of women and girl patients in mental health units had suffered physical restraint. Some trusts averaged over twelve face down restraints per female patient. Over 6% of women, close to 2,000 were restrained face-down in total more than 4,000 times. The figures vary widely between regions. Some trusts hardly use restraints, others use them routinely. A woman patient
1472-783: Is seen in 25%. People may be unable to speak, attempt to use hand signals to indicate they are choking, attempt to force vomiting, or clutch at their throat. An observed or recalled episode of choking, with sudden onset of any of the below respiratory and skin signs and symptoms while eating or handling small objects, is seen in around 90% of choking episodes. Initial episodes typically last seconds to several minutes, but can be followed by symptom improvement that can be mistaken as resolution. Initial respiratory symptoms can include involuntary cough, gurgling, gagging, shortness of breath, labored breathing, or wheezing. Children often present with excessive drooling and stridor (high pitched breathing sounds). Classic triad of choking symptoms in children
1536-440: The victims that lay on the floor but are unable to sit down . In scenarios when the first aid procedures are not resolving the choking, it is necessary to call to emergency medical services , but administration of first aid should be continued until they arrive. Choking can change the colour in the victim's faces due to lack of oxygen. If they lose consciousness and fall to the ground, it is recommended to avoid panic and begin
1600-556: The American Red Cross and the Mayo Clinic, recommend the use of back blows (back slaps) to aid a choking victim. This technique is performed by bending the choking victim forward as much as possible, even trying to place their head lower than the chest, to avoid the blows driving the object deeper into the person's throat (a rare complication, but possible). The bending is in the back, while the neck should not be excessively bent. It
1664-466: The CPR procedure must pass to the next step and continue until the victims can breathe by themselves or emergency medical services arrive. In the next step of the CPR, the rescuer applies a rescue breath , pinching the victim's nose and puffing air inside of the mouth. Rescue breaths would usually fail while the obstructing object is blocking the entrance of air. Anyway, it is recommended, additionally, tilting
1728-566: The Heimlich maneuver. In advanced airway management , complex clinical methods are used. Basic treatment of choking includes several non-invasive techniques to help remove foreign bodies from the airways. For a conscious choking victim, most institutions such as the American Heart Association, the American Red Cross and the NHS, recommend the same general protocol of first-aid: encouraging
1792-536: The U.S. from the late 19th century onwards many new designs were invented and produced before handcuffs and leg irons of the Peerless type became the standard several decades ago. One type of shackle, called an "Oregon Boot" or "Gardner Shackle", was patented in 1866 by the warden of the Oregon State Penitentiary, J. C. Gardner. The shackle consisted of an iron band supported by braces which went down and under
1856-577: The UK restraint related deaths would appear to be reported less often. The evidence for effective staff training in the use of medical restraints is at best crude, with evaluation of training programmes being the exception rather than the rule. Vast numbers of care staff are trained in 'physical interventions' including physical restraint, although they rarely employ them in practice. It is accepted that staff training in physical interventions can increase carer confidence. Japanese law states that psychiatric hospitals may use restraints on patients only if there
1920-453: The abdomen or chest, depending on the victim), 5 times of each technique and repeat ("five and five"). As of October 22, 2024, The American Red Cross has updated its guidelines to include antichoking devices which highlighted the LifeVac for its effectiveness in clearing the airway passages. The scientific analyses of the LifeVac revealed a dislodgement rate of 94% during the first attempt, 99.6% on
1984-567: The airway unless there is direct visualization of the airway – in fact, these procedures are advised only to be performed in more controlled environments such as an operating room. In unconscious choking victims, the American Medical Association has previously advocated sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions. Many modern protocols suggest other treatment modalities are superior. Red Cross procedures also advise rescuers not to perform
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2048-616: The alliance for women and girls at risk', revealing that patients are routinely restrained in some mental health units while others use non-physical ways to calm patients or stop self-harm. According to the letter over half of women with psychiatric problems have suffered abuse, restraint can cause physical harm, can frighten and humiliate the victim. Restraint, specially face down restraint can re-traumatise patients who previously suffered violence and abuse. "Mental health units are meant to be caring, therapeutic environments, for people feeling at their most vulnerable, not places where physical force
2112-517: The appropriate anti-choking resuscitation for unconscious victims or unconscious babies (under 1 year-old) . Each one of the techniques in the first aid protocol against choking are detailed below: If the choking victim is conscious and can cough, the American Red Cross and the Mayo Clinic recommend encouraging them to stay calm and continue coughing freely. Many associations, including
2176-589: The available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations." Some anti-choking devices like Act Fast Anti Choking Trainer are used as training devices by healthcare providers as well as schools in CPR training courses. A choking victim who becomes unconscious must be gently caught before falling and placed lying face-up on
2240-406: The case of long term foreign body aspiration, patients may present with signs of lobar pneumonia or pleural effusion. The time a choking victim is still alive without brain damage can vary, but typically brain damage can occur when the patient remains without air for approximately three minutes (it is variable). Death can occur if breathing is not restored in six to ten minutes (varies depending on
2304-450: The communication of distress that might otherwise prevent injury. A survey in the US in 1998 reported an estimated 150 restraint related deaths in care environments (Weiss, 1998). Low frequency fatalities occur with some degree of regularity. An investigation of 45 restraint related deaths in US childcare settings showed 28 of these deaths were reported to have occurred in the prone position. In
2368-686: The countries of the European Union have banned exporting leg irons into non-EU countries. The countries that continue to make prisoners wear fetters long-term now tend to manufacture their own restraints. Physical restraint Physical restraint refers to means of purposely limiting or obstructing the freedom of a person's or an animal's bodily movement. Usually, binding objects such as handcuffs , legcuffs , ropes , chains , straps or straitjackets are used for this purpose. Alternatively different kinds of arm locks deriving from unarmed combat methods or martial arts are used to restrain
2432-454: The importance for widespread dissemination of the appropriate anti-choking techniques for these age groups. In fact, it has been shown that increased parental education may decrease choking rates among children. For infants under 1 year-old, the American Heart Association recommends adapted procedures. The size of the children's body is the most important aspect in determining the correct anti-choking technique. So children who are too large for
2496-629: The initial episode, choking can lead to an obstruction of the airway that prompts further diagnostic steps. For choking episodes that require emergent evaluation by a doctor, several tools can be used for diagnosis, each with their advantages and drawbacks. Airway management is used to restore a person's ventilation which consists of severity assessment, procedural planning, and may consist of multiple treatment modalities to restore airway. Treatments will vary based on severity and stage of airway blockage. In basic airway management , treatment generally consists of anti-choking first aid techniques , such as
2560-405: The jejunum, diaphragmatic herniation, among others. When abdominal thrusts cannot be performed on the victim (serious injuries, pregnancy, or belly size that is too large for the rescuer to effectively perform abdominal thrust technique), chest thrusts are advised instead. Chest thrusts are performed with the rescuer embracing the chest of the choking victim from behind. Then, the rescuer closes
2624-423: The manufacture of locks built into restraints affordable. Simple fetter types continue to be used, like puzzle lock shackles as the typical slave iron, or irons riveted shut for prisoners being transported to overseas prison camps. The first built-in locks often were of a simple screw-type, but soon developed into the "Darby" type. In Europe these continued to be used into the middle of the 20th century, whereas in
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2688-514: The most common causes of choking are food, coins, toys, and balloons. In one study, peanuts were the most common object found in the airway of children evaluated for suspected foreign body aspiration . Small, round non-food objects such as balls, marbles, toys, and toy parts are also associated with a high risk of choking death because of the potential to completely block a child's airway. Children younger than age three are especially at risk of choking due to lack of fully developed chewing habits, and
2752-561: The number a decade earlier. It is thought that some of that increase includes older patients with dementia. As a result, the Japanese Ministry of Health, Labour and Welfare has revised its guidelines for elderly people in nursing homes to have more restrictions against body restraints. The changes will take effect on 1 April 2018. Deaths have been reported from their use, including that of Kelly Savage , an Assisted Language Teacher from New Zealand, in 2017. The Millfields Charter
2816-453: The obstructing object if it is not visible (a blind extraction), because of the risk to sink it deeper by accident, and because the compressions could move the object outside by themselves (in some cases). Moreover, if any removal is tried and is taking too much time, it may require alternating it with the chest compressions at some moments, without hindering to the extraction. And, whether the object has been found and removed in this step or not,
2880-442: The own dominant hand and grasps it with the other hand. This can produce several kinds of fists, but any of them can be valid if it can be placed on the victim's chest without sinking a knuckle too painfully. Keeping the fist with both hands, the rescuer uses it to press forcefully inwards on the lower half of the chest bone ( sternum ). The pressure is not focused on the very endpoint (named xiphoid process ) to avoid breaking it. When
2944-447: The patient's nose and mouth. The current models of anti-choking devices are quite similar: a direct plunger tool (LifeVac and Willnice) and a vacuum syringe (backward syringe) that also keeps the tongue in place by inserting a tube in the mouth (Dechoker). All three of them have received certification, and they have been reported to be effective in real cases. Other mechanical models are in development, such as Lifewand, which creates
3008-425: The person). However, life can be extended by using cardiopulmonary resuscitation for unconscious victims of choking (see more details further below). The face could turn blue ( cyanosis ) from lack of oxygen if breathing is not restored. Cyanosis may also be seen on the fingertips. In a healthy child or adult, this sign is highly sensitive , but is only observed in 15-20% of choking episodes. Choking occurs when
3072-438: The prisoner's foot. The shackle's weight hobbled the prisoner's movements to prevent escape, and long-term use would cause severe injury to the wearer. Use of this type of shackle was ended by the mid-20th century. In comparison to handcuffs, the wearing of leg irons may be found less restrictive. Thus, the prison authorities in several countries deem their long-term use acceptable. To avoid condoning this controversial practice,
3136-418: The reparatory tract through the chest wall, such as in the setting of a gunshot injury. Recognition and diagnosis of choking primarily involves identification of the signs and symptoms like coughing and wheezing (see Signs and Symptoms). Immediate recognition of the symptoms is important, but based on the short length of some episodes, diagnosis during the first 24 hours only occurs in 50–60% of cases. After
3200-454: The reported events, 80% occur in people under 15 years of age, and 20% occur in people older than 15 years of age. Worldwide, choking on a foreign object resulted in 162,000 deaths (2.5 per 100,000) in 2013, compared with 140,000 deaths (2.9 per 100,000) in 1990. Choking victims may present very subtly, especially in the setting of long term foreign body aspiration. Cough is seen in 80% of foreign body aspiration cases, and shortness of breath
3264-427: The rescuer embracing the belly of the choking victim from behind. Then, the rescuer closes their own dominant hand, grasps it with the other hand, and presses forcefully with them on the area located between the chest and the belly button of the victim, in a direction of in-and-up. This method tries to create enough pressure upwards to expel the object that obstructs the airway. The strength is not focused directly against
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#17328488438523328-407: The ribs, to avoid breaking them. If the first thrust does not solve the choking, it can be repeated several times. The use of abdominal thrusts is not recommended for infants under 1 year of age due to risk of causing injury, so there are adaptations for babies (see more details further below), but a child that is too big for the babies' adaptations would require normal abdominal thrusts (according to
3392-412: The second attempt, and a 100% success rate on the third attempt. There has so far been no known side effects due to the LifeVac device according to these studies. According to the findings, the evaluation on PubMed records from September 2019 through March 2023 which identified nearly 4,000 documents relating to the study which was significantly lead by the document "LifeVac: A Novel Apparatus to Resuscitate
3456-598: The size of the body). Besides, abdominal thrusts should not be used when the victim's abdomen presents problems to receive them, such as pregnancy or excessive size; in these cases, chest thrusts are advised (see more details further below). Although it is a well known method for choking intervention, the Heimlich Maneuver is backed by limited evidence and unclear guidelines. The use of the maneuver has saved many lives but can produce deleterious consequences if not performed correctly. This includes rib fracture, perforation of
3520-457: The tendency to insert object in their mouth as they explore the environment. Because a child's airway is smaller in diameter than that of an adult's, smaller objects can more often cause airway obstruction in children. Additionally, infants and young children generate a less forceful cough than adults, so coughing may not be as effective in relieving airway obstruction. Risk factors of foreign body airway obstruction for people of any age include
3584-456: The trachea due to gravity. There is also a risk of causing further damage (inducing vomiting, for instance) by using a finger sweep technique. There are no studies that have examined the usefulness of the finger sweep technique when there is no visible object in the airway. Recommendations for the use of the finger sweep have been based on anecdotal evidence. The majority of choking injuries and fatalities occurs in children aged 0–4, highlighting
3648-604: The use of alcohol or sedatives , procedures involving the oral cavity or pharynx , oral appliances, or medical conditions that cause difficulty swallowing or impair the cough reflex . Conditions that can cause difficulty swallowing and/or impaired coughing include neurological conditions such as stroke, Alzheimer's disease , or Parkinson's disease . In older adults, risk factors also include living alone, wearing dentures , and having difficulty swallowing. Children and adults with neurological, cognitive, or psychiatric disorders are at an increased risk of choking and may experience
3712-499: The very young (children under three years old) and in the elderly (adults over 75 years). Foods that can adapt their shape to that of the pharynx (such as bananas, marshmallows, or gelatinous candies) are more dangerous. Various forms of specific first aid are used to address and resolve choking. Choking is the fourth leading cause of unintentional injury death in the United States. Many episodes go unreported because they are brief and resolve without needing medical attention. Of
3776-406: The victim is a woman, the zone of the pressure of the chest thrusts would normally be above the level of the breasts. If the first thrust does not solve the choking, it can be repeated several times. Since 2015, several anti-choking devices were developed and released to the market. They are based on a mechanical vacuum effect, without a power source. Most use an attached mask to make a vacuum from
3840-426: The victim to cough, followed by hard back slaps (as described forward). If these attempts are not effective, the procedure continues with abdominal thrusts (the Heimlich maneuver) or chest thrusts if the victim cannot receive abdominal pressure (as described forward). If none of these techniques are effective, protocol by various institutions recommend alternating the series of back slaps and series of thrusts (these on
3904-500: The victim's head up and down, to reposition it trying to open an entrance for the air, and then giving another rescue breath . After the rescue breaths, this resuscitation returns to the 30 initial compressions, in a cycle that repeats continually, until the victim regains consciousness and breathes, or until the object is extracted but a defibrillation is needed to solve a cardiac arrest (read below). Defibrillation can also be needed, because an unconscious victim of choking can suffer
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#17328488438523968-440: The victim's heart. Anyway, a choking victim that is already unconscious needs to receive (even with no more delay) an anti-choking cardiopulmonary resuscitation (CPR) for unconscious adults and children. It is not valid for infants less than one year old, who require a special adaptated CPR for unconscious babies (described further below). The anti-choking cardiopulmonary resuscitation (CPR) for unconscious adults and children
4032-400: The victim's tongue obstructs too much, or on a side with a base under the head) and then grasping or sweeping the stuck object with tools: thin kitchen tweezers, scissors (these used with care), forks and spoons (in a reverse position: introducing their handle) or even a toothpick (if other instruments were too much big for the case); but, anyway, the current protocols do not recommend extracting
4096-419: Was in several hospitals and units at times for a decade with mental health issues, she said in some units she suffered restraints two or three times daily. Katharine Sacks-Jones director of Agenda, maintains trusts use restraint when alternatives would work. Sacks-Jones maintains women her group speak to repeatedly describe face down restraint as a traumatic experience. On occasions male nurses have used it when
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