חניקה במהלך סקס

5. Medical Aspects of Breath Play

We know that "older people" face higher odds of a fatal outcome from engaging in breath play than "younger people" face, but nobody knows what the shape of the curve on the age/risk graph looks like. (Some medical authorities have drawn a line between "older" and "younger" people at age 40, although why they drew the line specifically there isn't clear.)

We know that "sicker" people, perhaps especially people with heart disease, face higher odds of a fatal outcome than "healthier" people face but, again, nobody knows the shape of the risk curve, nor is there a bright line separating the two populations.

In addition to increased age and poorer underlying health, other factors known to increase the odds of a fatal outcome occurring (not a complete list) include: concurrent alcohol use, concurrent cocaine use, concurrent tricyclic antidepressant use, oxygen depletion due to concurrent physical exertion (such as by fighting or vigorously engaging in sex), history of a seizure disorder, and concurrent elevated levels of adrenalin in the blood due to anger or fear. Additionally, as stated in the forensic pathology literature, some people may simply be, unknown to them or others, genetically more susceptible to damage by low oxygen levels than other people are. (This concept of genetic variability in one's ability to tolerate hypoxia is consistent with my experience in treating actual victims. During my EMS days, I saw victims of a relatively minor "hypoxic insult" be terribly damaged by it, while others who suffered a much more severe insult seemed to recover entirely.)

The issue of sudden death occurring from only very brief periods of suffocation or strangulation is especially controversial. Here's the overall picture from a medical point of view: The nervous system is composed of the central and peripheral nervous systems. The central nervous system includes the brain and spinal cord. The peripheral nervous system includes the sensory nerves, the motor nerves, and the autonomic nerves. The autonomic nerves largely regulate involuntary functions such as digestion and are mostly beyond a person's ability to control.

The autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. The sympathetic is the "fight or flight" system and can be thought of as the body's gas pedal. The parasympathetic is the "feed and breed" system and can be thought of as the body's brake pedal.

We know that strong parasympathetic stimulation of the heart -- which occurs by way of the vagus nerve -- slows down the heart's rate and force of contraction. Most of the time, strong vagal stimulation of the heart causes about a one-third decrease in rate and force of cardiac contraction. "Sometimes" strong vagal stimulation of the heart causes a cardiac arrest, with such an arrest usually being fatal. It is the definition and understanding of the term "sometimes" that is highly controversial.

It's the vagal aspect of breath play, especially choking, that makes it so unpredictable and dangerous. If it weren't for that aspect, the practices involved might be considered about as harmless as taking a blood pressure (a practice that also involves squeezing an artery shut) provided they weren't continued for "too long" -- whatever that means. There is just no telling what a heart that is receiving strong vagal stimulation is going to do in a given instance, especially if that heart is also low on oxygen. To enter this area is to necessarily enter a "zone of uncertainty" as to what will occur. That a cardiac arrest could result under these circumstances hardly seems unreasonable to believe. If the heart is also simultaneously soaked in adrenalin, and/or if any of the other known risk factors are also present, then we've really got an ominous "synergy of risk factors" situation on our hands.

6. The Chokehold Question

We know that various "properly applied" chokeholds -- as taught in judo, other martial arts, and to the police and the military -- put pressure on the carotid arteries in the neck supplying blood to the brain while avoiding the trachea (windpipe). The belief is that unconsciousness can be caused fairly quickly and harmlessly by doing so, allowing such things as a victory in a martial arts match or the subduing of a person resisting arrest.

While it is true that a "properly applied" chokehold for the most part avoids the windpipe, when such chokeholds press upon the carotid arteries, they almost unavoidably also press upon what are called the carotid sinus bodies, located at the base of the internal carotid arteries. Pressure upon these carotid sinus bodies dilate the arteries in the brain, causing a drop in cerebral blood pressure, and also cause reflex parasympathetic slowing of the heartbeat via the vagus nerve. This combination of effects often produce an unconscious state that usually (repeat: usually) resolves when the chokehold is released.

It is not in dispute that such harmless unconsciousness does indeed seem to result when such chokeholds are applied briefly during formal practice sessions or during official martial arts tournaments. Such chokeholds, when "properly" done, have been applied within the martial arts world millions of times without a single documented fatality. Indeed, those areas almost seem to be "vagal-free zones."

While acknowledging this safety record when such chokeholds are attempted INSIDE the walls of a martial arts academy, when they are attempted OUTSIDE the walls of such a place then the picture rapidly becomes much murkier and much more controversial. In police work, for example, so many people have died after having chokeholds applied to them by "properly trained" police officers, with consequences such as numerous wrongful death civil suits, that many police departments have either now reclassified chokeholds from "non-deadly force" to "deadly force" measures (meaning that an officer is justified in applying a chokehold to someone only if the officer would also be justified in shooting them), or have outright banned the use of chokeholds entirely.

There is also a sizable laundry list of documented secondary chokehold complications, including but not limited to fracture of the larynx, paralysis of one or both of the vocal cords due to contusion of one or both recurrent laryngeal nerves, sudden blindness, hoarseness of speech, cerebral hemorrhage, fracture of the hyoid bone in the neck, fracture/dislocation of the cervical vertebrae and/or damage to the spinal cord, dislodging of an atherosclerotic plaque in the carotid arteries which then travels up to the brain and causes a stroke, and deaths occurring up to three full days following the application of the chokehold due to either the forming and dislodging of a clot or to post-chokehold swelling of the tissues, but in this writing I shall mention those "trivial" secondary matters only briefly and occasionally.

Because of the medical and legal risks all forms of breath control play practices are perceived to involve, BDSM organizations and establishments have almost universally banned both the engaging in breath control play techniques, including martial-arts-style chokeholds. (Given the role my writings have created in establishing this perception, I get both a lot of credit and a lot of criticism for such bans being in place.) Some martial artists who are also BDSM enthusiasts feel that this ban is unreasonable and overly-broad, and have strongly argued that "properly" done chokeholds have an excellent safety record in the martial arts world and therefore those chokeholds should be both practiced and taught as part of BDSM play even if other practices related to breath control, such as suffocation, remain banned.

Defenders of chokeholds, especially BDSM people who believe that "properly applied" chokeholds should be allowed at BDSM events, argue, in part:

1. In the cases of "in the street" fatal outcomes the chokeholds are often applied by relatively unskilled personnel.

2. That the conditions of applying a chokehold are often far more uncontrollable and turbulent under "street" circumstances than is the case in a martial arts school (or in a bedroom or BDSM event space).

3. That drugs and alcohol are often present as co-factors that increase the risk in street situations, but that such substances are largely avoided by people engaging in BDSM play.

4. That "in the street" the chokehold may be applied with substantial malice and held far longer than necessary, but that such would not be the case in consensual BDSM play.

5. That the surge in adrenalin level that accompanies having the chokehold applied in a "real world" situation increases the instability of the recipient's heart, but that a comparable adrenalin surge would likely not occur in people who were "only playing" as would be the case for people engaging in consensual BDSM.

6. That only a vanishingly small number of people are unusually sensitive to the effects of a chokehold.

7. That what "recreational" deaths from chokeholds have been reported were almost invariably due to extraordinarily reckless conduct or to outright criminal behavior.

Critics of chokeholds argue, in part:

1. That even skilled personnel will probably apply a chokehold in a way that presses on the carotid sinus bodies with resultant and always risky vagal slowing of the heart.

2. That most martial artists are relatively young people in robust health and thus likely more "resistant" to a chokehold's more ominous effects whereas BDSM people are often older and/or in much poorer health, and therefore less resistant to a chokehold's effect.

3. That martial artists are acting in an environment where what they do is closely monitored by highly trained third parties who can and will intervene if necessary (and not alone with their partner in a bedroom while both people are in the throes of passion. Under these circumstances, as one breath play enthusiast herself noted, "It's easy to go too far.")

4. That concurrent usage of drugs and/or alcohol are not essential co-factors in producing a fatal outcome and, further, that drug and alcohol usage during sex are fairly common, making the giver more prone to reckless conduct and the receiver both less able to signal their distress by calling a safeword and more physiologically vulnerable to complications from being choked.

5. That there are many reports of even very brief chokings causing cardiac arrest -- indicating, among other things, that such deaths occurred so quickly that an adrenalin surge could not have had time to occur, which means that they almost had to be "pure vagal" deaths.

6. That vagal-induced cardiac arrests are known to occur even in entirely healthy people with no known specific sensitivity to the effects of a chokehold.

7. That "recreational" deaths can result even from the most careful choking (and that media reports of such "recreational" deaths are often sensationalized and contain substantial amount of inaccurate and/or incomplete information).

7. The Ongoing Controversy Regarding Chokeholds in the Forensic Pathology Literature

The controversy regarding sudden deaths being caused by chokeholds (and other forms of strangulation) rages not only in the BDSM world, but also in the forensic pathology literature. Some authors of forensic pathology textbooks assert that vagal-induced sudden deaths from relatively brief periods of choking are all but unheard of and therefore are "extremely unlikely." Other authors of forensic pathology textbooks assert that vagal-induced sudden deaths from relatively brief periods of choking are indeed heard of and therefore are "not extremely unlikely."

The Medical Realities of Breath Control Play

Copyright 1997 by Jay Wiseman, author of "SM 101: A Realistic Introduction". All rights reserved.

For some time now, I have felt that the practices of suffocation and/or strangulation done in an erotic context (generically known as breath control play; more properly known as asphyxiophilia) were in fact far more dangerous than they are generally perceived to be.

As a person with years of medical education and experience, I know of no way whatsoever that either suffocation or strangulation can be done in a way that does not intrinsically put the recipient at risk of cardiac arrest. (There are also numerous additional risks; more on them later.)

Furthermore, and my biggest concern, I know of no reliable way to determine when such a cardiac arrest has become imminent.

Often the first detectable sign that an arrest is approaching is the arrest itself. Furthermore, if the recipient does arrest, the probability of resuscitating them, even with optimal CPR, is distinctly small. Thus the recipient is dead and their partner, if any, is in a very perilous legal situation. (The authorities could consider such deaths first-degree murders until proven otherwise, with the burden of such proof being on the defendant). There are also the real and major concerns of the surviving partner's own life-long remorse to having caused such a death, and the trauma to the friends and family members of both parties.

Some breath control fans say that what they do is acceptably safe because they do not take what they do up to the point of unconsciousness. I find this statement worrisome for two reasons:

(1) You can't really know when a person is about to go unconscious until they actually do so, thus it's extremely difficult to know where the actual point of unconsciousness is until you actually reach it.

(2) More importantly, unconsciousness is a symptom, not a condition in and of itself. It has numerous underlying causes ranging from simple fainting to cardiac arrest, and which of these will cause the unconsciousness cannot be known in advance.

I have discussed my concerns regarding breath control with well over a dozen SM-positive physicians, and with numerous other SM-positive health professionals, and all share my concerns. We have discussed how breath control might be done in a way that is not life-threatening, and come up blank. We have discussed how the risk might be significantly reduced, and come up blank. We have discussed how it might be determined that an arrest is imminent, and come up blank.

Indeed, so far not one (repeat, not one) single physician, nurse, paramedic, chiropractor, physiologist, or other person with substantial training in how a human body works has been willing to step forth and teach a form of breath control play that they are willing to assert is acceptably safe -- i.e., does not put the recipient at imminent, unpredictable risk of dying. I believe this fact makes a major statement.

Other "edge play" topics such as suspension bondage, electricity play, cutting, piercing, branding, enemas, water sports, and scat play can and have been taught with reasonable safety, but not breath control play. Indeed, it seems that the more somebody knows about how a human body works, the more likely they are to caution people about how dangerous breath control is, and about how little can be done to reduce the degree of risk.

In many ways, oxygen is to the human body, and particularly to the heart and brain, what oil is to a car's engine. Indeed, there's a medical adage that goes "hypoxia (becoming dangerously low on oxygen) not only stops the motor, but also wrecks the engine." Therefore, asking how one can play safely with breath control is very similar to asking how one can drive a car safely while draining it of oil.

Some people tell the "mechanics" something like, "Well, I'm going to drain my car of oil anyway, and I'm not going to keep track of how low the oil level is getting while I'm driving my car, so tell me how to do this with as much safety as possible." (They may even add something like "Hey, I always shut the engine off before it catches fire.") They then get frustrated when the mechanics scratch their heads and say that they don't know. They may even label such mechanics as "anti-education."

A bit about my background may help explain my concerns. I was an ambulance crewman for over eight years. I attended medical school for three years, and passed my four-year boards, (then ran out of money). I am a former member of the American Academy of Family Physicians and a former American Heart Association instructor in Advanced Cardiac Life Support. I have an extensive martial arts background that includes a first-degree black belt in Tae Kwon Do. My martial arts training included several months of judo that involved both my choking and being choked.

I have been an instructor in first aid, CPR, and various advanced emergency care techniques for over sixteen years. My students have included physicians, nurses, paramedics, police officers, fire fighters, wilderness emergency personnel, martial artists, and large numbers of ordinary citizens. I currently offer both basic and advanced first aid and CPR training to the SM community.

During my ambulance days, I responded to at least one call involving the death of a young teenage boy who died from autoerotic strangulation, and to several other calls where this was suspected but could not be confirmed. (Family members often "sanitize" such scenes before calling 911.) Additionally, I personally know two members of my local SM community who went to prison after their partners died during breath control play.

The primary danger of suffocation play is that it is not a condition that gets worse over time (regarding the heart, anyway, it does get worse over time regarding the brain). Rather, what happens is that the more the play is prolonged, the greater the odds that a cardiac arrest will occur. Sometimes even one minute of suffocation can cause this; sometimes even less.

Quick pathophysiology lesson # 1: When the heart gets low on oxygen, it starts to fire off "extra" pacemaker sites. These usually appear in the ventricles and are thus called premature ventricular contractions -- PVC's for short. If a PVC happens to fire off during the electrical repolarization phase of cardiac contraction (the dreaded "PVC on T" phenomenon, also sometimes called "R on T") it can kick the heart over into ventricular fibrillation -- a form of cardiac arrest. The lower the heart gets on oxygen, the more PVC's it generates, and the more vulnerable to their effect it becomes, thus hypoxia increases both the probability of a PVC-on-T occurring and of its causing a cardiac arrest.

When this will happen to a particular person in a particular session is simply not predictable. This is exactly where most of the medical people I have discussed this topic with "hit the wall." Virtually all medical folks know that PVC's are both life-threatening and hard to detect unless the patient is hooked to a cardiac monitor. When medical folks discuss breath control play, the question quickly becomes: How can you tell when they start throwing PVC's? The answer is: You basically can't.

Quick pathophysiology lesson # 2: When breathing is restricted, the body cannot eliminate carbon dioxide as it should, and the amount of carbon dioxide in the blood increases. Carbon dioxide (CO2) and water (H2O) exist in equilibrium with what's called carbonic acid (H2CO3) in a reaction catalyzed by an enzyme called carbonic anhydrase. (Sorry, but I can't do subscripts in this program.)

Thus: CO2 + H2O H2CO3

A molecule of carbonic acid dissociates on its own into a molecule of what's called bicarbonate (HCO3-) and an (acidic) hydrogen ion. (H+)

Thus: H2CO3 = HCO3- and H+

Thus the overall pattern is:

H2O + CO2 = H2CO3 = HCO3- + H+

Therefore, if breathing is restricted, CO2 builds up and the reaction shifts to the right in an attempt to balance things out, ultimately making the blood more acidic and thus decreasing its pH. This is called respiratory acidosis. (If the patient hyperventilates, they "blow off CO2" and the reaction shifts to the left, thus increasing the pH. This is called respiratory alkalosis, and has its own dangers.)

Quick pathophysiology lesson # 3:

Again, if breathing is restricted, not only does carbon dioxide have a hard time getting out, but oxygen also has a hard time getting in. A molecule of glucose (C6H12O6) breaks down within the cell by a process called glycolysis into two molecules of pyruvate, thus creating a small amount of ATP for the body to use as energy. Under normal circumstances, pyruvate quickly combines with oxygen to produce a much larger amount of ATP. However, if there's not enough oxygen to properly metabolize the pyruvate, it is converted into lactic acid and produces one form of what's called a metabolic acidosis.

As you can see, either a build-up in the blood of carbon dioxide or a decrease in the blood of oxygen will cause the pH of the blood to fall. If both occur at the same time, as they do in cases of suffocation, the pH of the blood will plummet to life-threatening levels within a very few minutes. The pH of normal human blood is in the 7.35 to 7.45 range (slightly alkaline). A pH falling to 6.9 (or raising to 7. is "incompatible with life."

Past experience, either with others or with that same person, is not particularly useful. Carefully watching their level of consciousness, skin color, and pulse rate is of only limited value. Even hooking the bottom up to both a pulse oximeter and a cardiac monitor (assuming you had either piece of equipment, and they're not cheap) would be of only limited additional value.

While an experienced clinician can sometimes detect PVC's by feeling the patient's pulse, in reality the only reliable way to detect them is to hook the patient up to a cardiac monitor. The problem is that each PVC is potentially lethal, particularly if the heart is low on oxygen. Even if you "ease up" on the bottom immediately, there's no telling when the PVC's will stop. They could stop almost at once, or they could continue for hours.

In addition to the primary danger of cardiac arrest, there is good evidence to document that there is a very real risk of cumulative brain damage if the practice is repeated often enough. In particular, laboratory studies of repeated brief interruption of blood flow to the brains of animals and studies of people with what's called "sleep apnea syndrome" (in which they stop breathing for up to two minutes while sleeping) document that cumulative brain damage does occur in such cases.

There are many documented additional dangers. These include, but are not limited to: rupture of the windpipe, fracture of the larynx, damage to the blood vessels in the neck, dislodging a fatty plaque in a neck artery which then travels to the brain and causes a stroke, damage to the cervical spine, seizures, airway obstruction by the tongue, and aspiration of vomitus. Additionally, there are documented cases in which the recipient appeared to fully recover but was found dead several hours later.

The American Psychiatric Association estimates a death rate of one person per year per million of population -- thus about 250 deaths last year in the U.S. Law enforcement estimates go as much as four times higher. Most such deaths occur during solo play, however there are many documented cases of deaths that occurred during play with a partner. It should be noted that the presence of a partner does nothing to limit the primary danger, and does little or nothing to limit most of the secondary dangers.

Some people teach that choking can be safely done if pressure on the windpipe is avoided. Their belief is that pressing on the arteries leading to the brain while avoiding pressure on the windpipe can safely cause unconsciousness. The reality, unfortunately, is that pressing on the carotid arteries, exactly as they recommend, presses on baroreceptors known as the carotid sinus bodies. These bodies then cause vasodilation in the brain, thus there is not enough blood to perfuse the brain and the recipient loses consciousness. However, that's not the whole story.

Unfortunately, a message is also sent to the main pacemaker of the heart, via the vagus nerve, to decrease the rate and force of the heartbeat. Most of the time, under strong vagal influence, the rate and force of the heartbeat decreases by one third. However, every now and then, the rate and force decreases to zero and the bottom "flatlines" into asystole -- another, and more difficult to treat, form of cardiac arrest. There is no way to tell whether or not this will happen in any particular instance, or how quickly. There are many documented cases of as little as five seconds of choking causing a vagal-outflow-induced cardiac arrest.

For the reason cited above, many police departments have now either entirely banned the use of choke holds or have reclassified them as a form of deadly force. Indeed, a local CHP officer recently had a $250,000 judgment brought against him after a nonviolent suspect died while being choked by him.

Finally, as a CPR instructor myself, I want to caution that knowing CPR does little to make the risk of death from breath control play significantly smaller. While CPR can and should be done, understand that the probability of success is likely to be less than 10%.

I'm not going to state that breath control is something that nobody should ever do under any circumstances. I have no problem with informed, freely consenting people taking any degree of risk they wish. I am going to state that there is a great deal of ignorance regarding what actually happens to a body when it's suffocated or strangled, and that the actual degree of risk associated with these practices is far greater than most people believe.

I have noticed that, when people are educated regarding the severity and unpredictability of the risks, fewer and fewer choose to play in this area, and those who do continue tend to play less often. I also notice that, because of its severe and unpredictable risks, more and more SM party-givers are banning any form of breath control play at their events.

If you'd like to look into this matter further, here are some references to get you started:

"Emergency Care in the Streets" by Nancy Caroline, M.D. (I'd recommend starting here.)

"Medical Physiology" by A.C. Guyton, MD

"The Pathologic Basis of Disease" by Robbins, MD

"Textbook of Advanced Cardiac Life Support" by American Heart Association

"The Physiology Coloring Book" by Kapit, Macey, and Meisami

"Forensic Pathology" by DeMaio and Demaio

"Autoerotic Fatalities" by Hazelwood

"Melloni's Illustrated Medical Dictionary" by Dox, Melloni, and Eisner

People with questions or comments can contact me at www.jaywiseman.com or write to me at P.O. Box 1261, Berkeley, CA 94701.

Regards,

Jay Wiseman

Massad Ayoob on Choke Holds


Excerpted by Jay Wiseman, JD

The following is taken from “Fundamentals of Modern Police Impact Weapons” by Massad Ayoob – published by Police Bookshelf books in 1996. Some of you likely recognize the name. Mr. Ayoob is a police officer and a nationally prominent expert on the police use of force, both lethal and non-lethal, with many publications and a great deal of expert witness court experience to his credit.

This essay of his soberly weighs the risks involved in the use of choke-holds by police against the social usefulness of using such holds to subdue suspects.

In a breath-play situation, one would weigh the risks involved in the use of choke-holds against the social usefulness of using such holds to engage in “recreational sexual strangulation.”

Beginning on page 132:

THE “SLEEPER HOLD”: IS IT TOO DANGEROUS FOR POLICE TO USE?

The “sleeper hold,” which mystified commercial wrestling audiences for years, exists. Martial artists have known of it for centuries. It operates on the very simple premise that (a) the carotid arteries carry blood into the brain via the neck; (b) the brain requires a substantial quantity of freshly oxygenated blood to function; therefore (c) if one blocks the carotid arteries the subject’s brain ceases to function, beginning almost immediately with unconsciousness.

But it isn’t that simple. The brain is the most complex organ of the body, and when you start messing with it you can cause a lot of problems you don’t realize.

Various sleeper holds, or “choke-outs,” are taught in law enforcement. Let’s look at them, then examine their use in the light of tactical applicability, morality, and the basic laws of both society and medicine.

Applying the Sleeper Hold

Forget about putting an opponent to sleep by grinding your knuckle into the hollow beneath his ear. The carotids are located beneath and ahead of the bone of the jaw. To occlude them – block them off – you must apply pressure on both sides. On one side only, impairment of consciousness will take much, much longer and besides, in a fight situation, it is virtually impossible to hold the neck still enough to apply pressure on one side if you aren’t already applying it to the other.

There are many methods, and most of them work better when applied from behind. There are several stick techniques, useful with conventional batons (preferably 18 inches or more), the Prosecutor baton, or the nunchaku sticks that more and more officers are carrying. They are explained in Figures 53 and 54. One trouble with all of them, as will readily be seen, is that it is extremely hard to apply them without putting pressure on the cervical spine as well as the carotids.

Properly applied, the “mugger’s lock” can be transformed into a sleeper hold. It won’t work as fast, because the bearing surfaces (your forearm on one side, your bicep on the other) are neither narrow enough nor unyielding enough to equal the degree of pressure you can generate with a baton “choke-out.” This technique is seen in Figure 55. Because the effect of this hold is so immediate, the officer should take care to protect his groin and eyes from a clawing hand, and his sidearm should be turned away from the suspect.

Judo-style choke-outs can simply involve grasping the collars a few inches down from the throat and forcibly crossing one’s hands, thus tightening the fabric of the collar sharply against the carotids. This works great if the man is wearing a heavy judo gi or a denim jacket, but most ordinary shirt will tear during the struggle, destroying the effect of the hold and leaving the officer with his hands uselessly tied up as the suspect counter-attacks. Any choke-out technique, or for that matter any two-handed hold applied from the front, is always dangerous to the officer for just this reason: The attacker’s hands are free while the officer’s hands are busy, and those hands may claw at the policeman’s eyes or groin, or punch his navel right into his lumbar spine.

There are other choke-out/sleeper-hold techniques, but those illustrated with this article comprise the ones that are most effectively applied by someone not in the martial arts, and the ones most commonly needed by American police.

Why the Sleeper?

On the surface, the sleeper hold appears to be an ideal technique for stopping trouble. If properly applied, it renders the subject unconscious in six to eight seconds – sometimes less if he is in debilitated physical condition, but often longer if he has thick neck muscles and is fighting furiously. If the officer doesn’t have it quite right, it can take much longer.

But let’s assume, oh, seven seconds. Here is a man subdued fairly rapidly, without a head broken by a baton, and without additional blood being spilled. And it often does work like this. In tough Camden, New Jersey, black belt Jim Phillips teaches a scissor hold on bar fighters and rambunctious drunks; usually, he and his students will apply just enough pressure to convince the subject to come along under his own power, but frequently, the subject will have to be rendered unconscious by the nutcracker-like pressure of the sticks. Phillips reports no serious injuries and states that physicians he has consulted in his police-instructor capacity have approved the technique as safe. That is at odds, however, with other medical opinion, as we shall see later.

Physical After-Effects

In most cases, the choke-out produces little in the way of after-effects. Most subjects will experience a headache when they wake up. Often, they will vomit upon awakening, just as do many who are rendered unconscious by blows. They may be disoriented or a little “spacey” for a period of time.

Duration of unconsciousness is unpredictable. If the hold has been applied for the minimum amount of time, the person regains consciousness in less than a minute. It will usually take several. At worst, if the lock has been held too long, if the person has the wrong kind of chemicals in his system, or there are physical problems that have been aggravated by what has happened, he may never wake up.

And these possibilities are many. They were pointed out to us by doctors who were familiarized with the various choke-out techniques and asked about what could be expected. They included a neurosurgeon, a cardiologist, an ophthalmologist, and a specialist in internal medicine. They told us we could expect the following in a certain percentage of choke-out victims.

STROKE. A stroke occurs when the blood supply to the brain is interrupted. A choke-out or sleeper hold also works when the blood supply to the brain is interrupted. The difference is one of degree. When talking about something as delicate as the human brain and central nervous system, those degrees are often too subtle for the layman to attempt to distinguish between. A stroke is especially likely in a suspect who, unknown to the officer who is forced to subdue him, has high blood pressure or any number of other cardiovascular problems. The physical condition of the subject is an unknown quantity to the officer, in terms of medical problems that he may have, and stroke is something that must be considered whenever the officer attempts to close off the carotid arteries of even a young and vigorous-appearing suspect.

HEART ATTACK. The pressure applied in a sleeper hold often focuses on a part of the arterial complex called the carotid sinus. In oversimplified terms, what happens here is a backup reflex on blood flow that can throw the heart into a violent response, causing heart attack.

CONVULSIVE SEIZURES. It is not at all uncommon for an individual to go into a series of convulsions resembling a grand mal fit of epilepsy when the carotid arteries have been occluded. This may occur in a person who does not suffer epilepsy, and I have witnessed such occurrences during martial arts exercises. It is, of course, much more likely in epileptics but can be expected to occur in the healthiest of subjects. [Note: In case it didn't come through, everything after the word "epileptics" in the last sentence is italicized in the original article.]

ASPIRATION OF VOMIT. Though vomiting is most common after the choke-out suspect has regained consciousness, it may well occur while he is still passed out. To prevent the vomit from being inspired (breathed) into the lungs, one has to suction out the victim’s mouth and throat. Well-equipped ambulance teams do this with electrically operated or bulb-type aspirators. The officer who has to keep alive a vomiting suspect he has choked into unconsciousness will have to resort to the other alternative: suck the vomit out of the suspect’s mouth with his own. Enough said.

BLINDNESS. We have been assured by both a neurosurgeon and an ophthalmologist that a properly applied choke-out, held for twenty seconds or longer, may cause permanent blindness. If you doubt it, and if you are certain that you have no cardiovascular, neurological, or eye problems, put down this book, then reach up and take your left collar firmly in your right hand and vice versa. Pull crossways, hard. You will feel immediately the pounding of your pulse, a flushing of the face, a sense of light-headedness, and, in a few seconds, a definite pressure in the back of your eyeballs. If you are still awake, pick the book back up and read on.

RUPTURED ARTERIES. This is most likely to occur in a suspect who suffers from arteriosclerosis, or hardening of the arteries with attendant narrowing of the actual passageways of the blood vessels. The backed-up blood pressure that occurs in a sleeper hold may burst the weakened arteries; so may release of the hold, when the blood comes rushing back in, again stressing the arterial walls. “So what,” say some advocates of the sleeper hold. “We’ll never apply this technique to any senior citizen with hardening of the arteries.” In fact, the condition may be present in people in their late twenties and a lot of people in their thirties, and it is particularly common among the alcoholics who start so many brawls. In the aftermath of such a subject’s untimely death, his unknown medical history may be obscured by the fact that “he dropped dead after the cop choked him.”

PERMANENT BRAIN DAMAGE. “Brain death” begins when oxygenated blood is withheld from the brain for a period of four to six minutes. Once those brain cells die, they never grow back. In the heat of a fight, most officers will keep the hold on until they are sure that the subject is really out. Indeed, if the hold is released too early, the suspect may recover his full faculties almost instantly. Few officers will hold a choke-out for five minutes, but they may hold it long enough to impair blood supply to certain parts of the brain long enough to kill them. The result can be a human vegetable, or one resembling a victim of advanced Parkinson’s disease. Quite apart from the moral considerations, such people are likely to win six and seven figure damage suits against police departments and individual officers.

SPINAL INJURY. Since by definition the choke-out involves a very forcible manipulation of the suspect’s neck, the danger of a broken cervical spine is always great. These holds are applied in such a way that if the neck does break (probably separating somewhere between the fourth and seventh vertebrae), the sharp ends of the spine will, under pressure, slice right through the spinal cord, which is the consistency of thick cheese or fatty meat, cuts easily, and can never heal. The result is a suspect who is now either instantly dead, mortally injured, or permanently quadriplegic.

This isn’t supposed to happen, some instructors say. It’s never supposed to happen, and in a training environment, it looks safe. As a police combat instructor, I have applied these techniques and had them applied to me without injury. But out on the street, they are tricky. Baton techniques are particularly dangerous in choke-outs, and particularly the Prosecutor baton, with which the handle goes behind the neck and can act like a fulcrum over which the bones are forced and snapped.

Sure, you’re pushing sideways so the neck won’t break, and applying just enough pressure to cause unconsciousness. But suppose the suspect suddenly goes limp, and 150 or 200 pounds of dead weight suddenly drop in a direction they aren’t supposed to? Or, what if (as you are applying your perfectly executed hold) another 200-pound barfighter is thrown into either you or your suspect, causing one or both of you to lose your balance or even fall?

At that moment, the sharp cracking sound you hear will be the suspect’s neck breaking, and the finality of that sound could be the end of your law enforcement career. A suspect accidentally killed or permanently maimed in a “non-lethal force,” “subdual” situation is extremely hard to explain away.

THROAT INJURIES. When you wrap sticks or brawny arms around people’s necks, it’s hard to avoid their throats. Even if you apply your hold perfectly to the sides of a person’s neck, totally avoiding the larynx and windpipe, you may slip during the struggle, or the fighting opponent may turn at an inopportune moment. Since you are concentrating on applying the pressure, you may not realize that you are crushing the throat until it is too late, until you hear the sound of the cartilage caving in, a sound like a hornet makes when you step on it, only louder and wetter.

A crushed larynx, at best, results in a suspect with a permanent vocal impairment. Most often, it means an airway that is blocked against everything, including artificial resuscitation. The only way out for this victim/offender is a tracheostomy, the slitting open of the windpipe below the injury coupled with the insertion of a breathing tube. This procedure, once “taught” to everyone but, or perhaps including, the Boy Scouts, is actually very easy to foul up. It is no longer taught even to Emergency Medical Technician classes (as one instructor put it, the EMTs are only “familiarized” with it), because so many people died after being clumsily “traked.”

Conclusions

It’s not hard to understand why something that renders a man unconscious in seconds with, supposedly, no after-effects, catches the imagination of lawmen who have to deal with violent physical confrontations.

But one must understand its shortcomings. First, it is hard to on a man you don’t already have at a tactical disadvantage and if that’s the case why choke him unconscious at all?

The danger of broken necks, crushed throats, strokes, ruptured arteries, seizures, and other life-threatening trauma is great in this supposedly “safe technique.” These things must be considered. The officer who does choose to apply them should be highly trained and skilled in emergency first aid treatment for the injuries that may result.

The Sleeper Hold: Most of the time, if you do it right, it will work great. But no matter how good you are, the time will come when you face a person who can’t take what it does to their bodies: a belligerent barfighter, who may have earned some bruises but who doesn’t deserve to die; a drunk who’s like you when he’s sober but isn’t going to be anymore because a choke-out hold has left him permanently injured or dead.

The sleeper hold works if you know how to use it. But it brings you into that dangerous area of a policeman’s use of force, that area between what you are allowed to do with your hands, and what you are supposed to do, if you have to do it at all, with your gun.

Know it. Be able to use it. But understand it, and only use it if there is no other choice that is safer to you and those you protect, and more humane to the person you must subdue.

If that sounds like the rules that govern your gun, it’s no coincidence. Both can kill. Both demand the respect of those who command their power.