In 2000-2001, there were 1.25 million people arrested for notifiable offenses in the United Kingdom by 130,000 officers, with each detention involving the potential for several restraint techniques, so it is inevitable that forensic physicians will have involvement with restraint issues (1). Although this topic is common, doctors ignore it at their potential peril. Forensic physicians' involvement with these issues involves many of the core attributes needed in the practice of high-quality forensic medicine, including the need for good history taking from as many involved parties as is practical to clearly establish events, and a precise examination recorded clearly and contemporaneously. Objectivity must be maintained in the light of differing histories, and there is a need to keep abreast of developing restraint techniques that may bring new clinical problems. However, regardless of how careful police officers may be, there is the potential for serious injury requiring further medical intervention, and the real possibility of being a witness in a legal process, such as police disciplinary procedures.

During restraint, any force used must be proportionate to the threat faced, lawful, and necessary. The restraint process is particularly challenging where the potential detainee has a mental health problem or is intoxicated. In addition, the officer, in retrospect and under close scrutiny, must be able to demonstrate that his or her actions were entirely appropriate. It must be recognized

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

that at the time of restraint, officers may not have the luxury of time for a full analysis using prior information or the knowledge that experience, combined with extensive training and retraining, brings. As an independent doctor, excellent clinical management by the forensic physician throughout the case enables the doctor to act as a high-quality witness if needed. The doctor also has a duty to report any instance where excessive restraint appears to have been used, and such concerns should be communicated to the senior police officer on duty immediately. The forensic physician needs to be aware that equipment may be misused; for example, a long-barreled metal torch could be used as a striking weapon in some circumstances, and, indeed such lights were withdrawn in the United States to prevent this from happening.

Although the basic principles of restraint are similar throughout the world, there are many variations both throughout countries and within individual states where there are no national police forces. It is also an evolving subject involving research by organizations, such as the Police Scientific Development Branch in the United Kingdom, as well as the practical outcome of restraint techniques when used by officers.

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