Because the possibility of suspension is reduced by the changes in the design of the cells, the possibility of other forms of self-asphyxiation are likely to increase. Self-strangulation by ligature is considered to be possible but difficult (14); because the pressure has to be applied to the neck in these cases by the conscious muscular effort of the hands and arms, it follows that when consciousness is lost and the muscular tone lessens, the pressure on the ligature will decrease, the airway obstruction and/or the vascular occlusion will cease, and death will generally be averted. However, if the ligature is knotted or if the material is "non-slip" and looped around itself, then it is possible for the individual to apply the pressure to the neck and for that pressure to be maintained even after consciousness is lost and, as a result, death may follow.
As with hanging, the key to preventing these deaths lies in careful evaluation and, if necessary, the removal of clothing and observation.
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