A man who is dying from positional asphyxiation will not speak at a normal, conversational pace.
He will speak in short, repetitive statements that fade and trail off at the end, in an obvious rhythm matching their short breaths; they are unable to breathe deeply enough to construct a longer sentence.
Typically, they panic and start pleading, their voice cracks and changes pitch, display acute fear and become less coherent over time.
They may make nonsensical statements, begin asking for help from people who are not there, ask for their mother, and so on.
When sudden tranquility follows vigorous resistance, there is an extreme risk of death.
These things emerge consistently during positional asphyxiation, but they are often disregarded or not recognised by police and other workers.
This can happen despite education and training on the matter.
However, the signs are easy to identify once you’ve observed the pattern across multiple incidents in real time and heard it for yourself.
For training and education purposes, this video depicts several instances where men have died in custody after being restrained. Viewers will hopefully notice a pattern emerging in each instance.
On Tuesday 27th May 2025, 24YO Kumanjayi White was arrested after allegedly stealing food and assaulting a security guard who’d confronted him inside a supermarket in Alice Springs. He died in custody a short time later. What really happened, and who is at fault?
We tend to make a lot of assumptions about how people do or do not behave under stress, in a gun fight, after they are shot, and so on.
The “normative assumption” or “presumption of rationality” is the tendency to expect that other people will behave in a reasonable, logical, or rational manner in a given situation. This assumption often leads to misjudgments when others act in ways that are irrational and unpredictable.
This can result in poor tactical and strategic decisions.
You will never be able to understand what motivates some people, or the logic behind their behaviour, and that’s fine. Always leave part of your mind open to the possibility that things could go pear-shaped in an instant.
The gentleman in this video, for example, is completely irrational. You will not make sense of his behaviour. He will not respond to reasonable directions. He is not acting in his own best interest, he is not even responding to a gunshot wound to the chest the way you would expect.
A Leopard 2A4 tank performs a textbook ambush on a column of Russian armoured vehicles.
Typical ambush tactics for a convoy. You kill the last vehicle first, because no one else typically has eyes on it, so everyone will be confused for a few seconds. If you kill the first one first everyone knows what is going on instantly. Killing the rear vehicle is not always feasible, however.
Next you kill the first vehicle. You now have a dead vehicle at the rear, and a dead vehicle in the front, and if the road is narrow enough, you have created a kill zone. The convoy cant reverse without going off road, and it cant advance without going off road, either.
You call in artillery immediately on this kill zone. Or, if you’ve timed your ambush right, you put command detonated explosives on the road side and fuck everyone up as they try to get out of the kill zone.
In this video I break down the errors made by police before the shooting of Elroy Clarke.
Some viewers may find this content disturbing. This video is not intended for entertainment, but for education and training purposes only. My objective is to prevent violence and trauma, not to glorify, encourage, or incite it.
FOR EDUCATIONAL PURPOSES ONLY – CONTENT MAY DISTURB AND OFFEND, VIEWER DISCRETION IS STRONGLY ADVISED.
See bottom of this post for download links to the complete video and printable diagrams.
I give permission for the video and attached documents to be downloaded, played, modified and printed anywhere for free – only for the purpose of education.
TOPICS
00:00 – Intro 03:50 – Excited delirium 05:19 – Why are police involved in the first place if we’re talking about medical issues? 06:12 – Death in custody and sudden unexplained death 07:26 – Monitor your own state of mind when dealing with the patient 08:48 – De-escalation 09:54 – “Super Human Strength” 11:01 – Ability to absorb punishment 11:50 – Pain compliance 12:18 – Pain compliance loop 13:21 – Tasers 13:55 – Positional asphyxiation 14:25 – Do not lay prone for too long 14:55 – “I can’t breathe” 18:07 – Banning pressure – my opinion 19:06 – Examples set by martial artists 19:32 – A personal anecdote 20:12 – Restraint-resistance loop 20:51 – Sudden calm 21:22 – Do not make calmness a condition of your use of force 21:44 – Piling on 22:33 – What we lack in training 22:58 – Minimum force in minimum time 23:34 – Access to risks 24:06 – Caution with handcuffs 24:50 – Biting 25:11 – Position in cell/transport – monitor constantly 25:36 – You are always being recorded 26:31 – You are at the mercy of the world 27:24 – Final thoughts
Text wall incoming: I would like to add some comments here. I am a paramedic in the urban U.S., so I do not know the training or the things that are taught to LEO, but I would offer some alternative perspective. This was a well thought out video, but I would also add some tools/methods that I have used/seen used to help expedite the process.
This was a very thoughtful video, and succinctly emphasizes your position when dealing with psych/overdose/mental health patients in delirium. Which is, in between a rock and a hard place. These people need medical evaluation and intervention, which often Law enforcement is ill equipped to provide. It then becomes a matter of how quickly can you get the ambulance to you to assist. Normally, EMS will not go into active scenes because our defense profile is much less robust than yours. But getting on the radio quickly will ensure that once you have compliance, or even 60-75% compliance, the ambulance is already on the way. Even on your way to the call, if your call notes describe someone who will need an evaluation, just start us. If we get pissy when we get there and its not super serious, thats on us and I hope you dont have that kind of working relationship with your EMS agency, because thats a junk attitude for us to have. Better an easy evaluation and refusal than a cardiac arrest.
There were many clips in this video that show prone positioning, and the continued struggle. OP did a good job of alerting to the cycle of “movement/restraint” that so many of us get into, and how that leads to bad outcomes. If you have to prone someone, then do that, but if the ambulance is coming, there are also safer ways to restrain once we get onscene. The primary intervention is sedation. We all want that person to stop thrashing, so we have to get our drugs onboard. However, once we get there, you now have force multipliers. Do not shy away from using us as help to restrain while the medication takes effect. Limb joint restraint, waist and shoulder control can all be had while prone if need be, and take pressure off the chest. And to be clear, even pressure on the lower back where the abdomen would be can cause asphyxiation, by not allowing proper expansion of the diaphragm.
Please continue to be observant. Many times, once EMS arrives on scene, the police tend to lower their security posture because “EMS is onscene” and it is a medical patient. But I have been stabbed by a patient with APD standing next to her because they were talking to themselves while I was doing my thing. Anyone who needed EMS and is hyperactive is by definition unstable. Please be ready to jump back into the fight. We may also have to use you as our own force multipliers.
The pathophysiology of these patients is unpredictable. The reason why these people suddenly arrest with seemingly no pressure is because of whats happening inside the body. Extremely simplified basically, the drugs/psychosis/etc are causing an unregulated adrenaline dump, giving them their super strength, or their resistance to control techniques and the like. Once their body uses up all of their adrenaline, they’re going to arrest. Our sedation medications add onto that effect, especially if we have to give a double dose because of their extreme adrenaline dump. Which means that predicting when they stop fighting is a nonstarter. Once you go hands on, at any point in time, they may run out of energy and go into arrest, ems or no ems assistance. Look for the signs, and act appropriately.
Thank you OP for not saying that Ketamine from paramedics kills these people.
Sorry for the long wall, I’ve been a paramedic for 11 years-ish now and teach both LEO/EMS team patient control, and basic resuscitation to the police I work with. You guys got the short end of the stick in dealing with these patients, and I dont want any of these cases to happen to you guys.
The situation was entirely preventable. These are young men seeking to prove themselves to their peers by showing bravery and demonstrating their prowess and composure in a fight. They were seeking confrontation, with one man arming themselves when they knew a physical confrontation was about to kick off.
We can minimise this kind of outcome by providing opportunity, role models, purpose and discipline to young men, and an outlet to prove themselves and achieve self-worth. Suppressing competitive behaviour in boys and denying them these opportunities is how you amplify toxic masculinity. Their energy has to be directed into productive and benign pursuits. If they aren’t provided a positive group of peers and role models, they will find their own who may be antisocial in nature.
Scissors are lethal weapons
Secondly, this demonstrates just how lethal any type of blade can be. The next time you hear about police shooting someone after they attempted to stab someone with scissors, go back and watch this video, and remember what just a pair of scissors can do.
Bans on specific types of blades are fruitless
Where I live, we have banned the following types of knives:
Flickknife
Ballistic knife
Sheath knife
Urban Skinner
Trench knife
Butterfly knife or “balisong”
Star knife
Zombie Knife
Any object made of strong material with a point can be used to stab, and any hard material with an edge can be used to cut.
Banning any type of blade only results in the use of blades which are not prohibited, especially kitchen knives. Kitchen knives are typically made of steel, have a long sharp blade and a point, with a full or partial tang, and ergonomic handle.
These attributes make kitchen knives more effective as weapons than many of the banned knives, which are mostly designed for their appearance.
Knife designs can increase reliability and practicality, but they are all lethal, including cheap scissors purchased from a late-night corner store.
Laws which prohibit the carrying of blades and other weapons in a public place have more merit and real effect on outcomes, depending on the area and cultural context.
This clip (courtesy of World Star Hip Hop, of course), illustrates several concepts I’ve covered in detail in a previous article and video, which you can find at the bottom of this post.
In the video we’re looking at today, a topless black male in blue jeans performs exceptionally well in terms of managing multiple opponents.
After knocking down his first opponent, he sees another male stepping forward and crossing the line of bystanders. He identifies this as someone who intends to intervene in the fight.
Typically, the plan of the bystander is to attack from the side while their target is focused on someone else.
Our main character immediately target switches. Target switching is a key component of fighting multiple opponents. He hasn’t completely taken the first man out of the fight, but he now has to prioritise the man who is moving forward because that is now the most serious threat.
As he approaches the second man he takes a wide angle, keeping the rest of the crowd in his peripheral vision. This avoids having the crowd behind him, completely out of sight.
At this moment, a third man approaches, but he’s on the side of our main character, and they form a line standing roughly shoulder to shoulder.
Main character sees his first opponent coming back to attempt a flank while he’s focused on the second man.
Main character correctly switches back to him, prioritising the opponent who is approaching from a dangerous angle.
This is exactly what I talked about in my multiple opponents video. An excellent demonstration of target switching.
The second man then crosses the line, which is often a big mistake because it exposes the flank, but main character was not in a position to take advantage of it.
It then becomes two individual fights which is a very common occurrence in a brawl.
While you’re dealing with your own problem however, you should try to remain aware of what the others are doing, because one of them is going to transfer over to your side when their problem is dealt with.
Which is what main character does. When he gets the chance, he transfers to the hoodie and blindsides him in exactly the same way they were attempting earlier but didn’t have the skill to pull it off.
And here you have the contrast between one man who could remain situationally aware enough to target switch, and another man who could not.
The other failure is wearing a hoodie in a fight, which can be for control in grappling.
This is why I advocate for spending at least some time grappling and sparring in a gi. People do wear jackets and other clothes that can be gripped in a fight.
Another video I’ve made which is relevant to this is about issues around bystanders, you can also find that below.
