Mortality associated with in-custody prone restraint: A review

Sudden and unexpected arrest-related deaths are deeply tragic and have generated widespread concern among the public, medical professionals, and law enforcement agencies. One mechanism that has garnered considerable attention is the use of prone restraint, wherein a subject is placed face-down and controlled in this position. The safety and risks of this technique remain subjects of debate within both scientific literature and legal settings. Supporters of prone restraint's safety frequently cite prospective epidemiologic studies that report no fatalities associated with its use. However, these studies typically involve small cohorts and are conducted over limited timeframes, potentially underestimating rare but serious outcomes. In contrast, retrospective analyses, which assess larger populations over extended periods, have identified multiple cases of fatal outcomes linked to prone restraint. Notably, some of the most comprehensive data on these fatalities come from investigative journalism, which has uncovered patterns and prevalence rates not fully captured in academic or institutional studies. Based on available evidence, we estimate the mortality rate with use of in-custody prone restraint is at approximately 1 per 4.4 million individuals per year, or 0.023 per 100,000 population annually. These findings underscore the need for more rigorous, large-scale, and transparent epidemiological studies to better inform public policy, law enforcement practices, and clinical guidelines. The potential lethality of prone restraint must be recognized, and its use re-evaluated in light of both fatal risk and ethical responsibility.