Physical restraint represents an aggressive intervention intended to restrict voluntary activity—without the objective of addressing an underlying medical condition per se. The application of physical restraints in acute and long-term care facilities is variable 1 and in some circumstances remains common place. 2, 3 and 4 Recent attention has been directed towards sudden death arising in the context of short-term physical restraint, particularly under the jurisdiction of law enforcement. The cause of death in these situations may be complicated, and have a number of potential mechanisms, such as: exacerbation of an underlying medical condition, 5 strangulation, 6 drugs/medication, 7 asphyxia, 8 and excited delirium. 9 and 10
Chronic immobility has long been associated with an increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE),11 the outcome of which is not infrequently fatal. Herein we describe three cases of sudden death resulting from PE in psychiatric patients undergoing prolonged physical restraint. The purpose of this report is to contribute to understanding the pathophysiology of sudden death under physical restraint and alert clinicians to this poorly understood, albeit potentially preventable, outcome.