[Sudden fatalities in mechanically restrained patients]

We report on 7 nursing home or hospital patients who died suddenly and unexpectedly during physical restraint. Four of the patients were found dead hanging beside their beds, with their waist restraints displaced to the thorax. In spite of a variety of preexisting diseases, asphyxia by thorax compression was the most probable cause of death. Three other patients, when falling out of their beds, were strangulated by the head opening of a nursing bedcover fixed to the bed. In all instances the fatal accidents resulted from improper handling of the restraint devices, namely from the omission of bed rails as well as of the obligatory waist belt lateral fixations. The bedcover type involved in three fatalities is destined for care purposes but not licensed as a restraint device. Physical restraint fatalities can be avoided to a large extent if the producers' instructions are strictly observed, and only especially trained and supervised personnel is admitted to this field of duties.