Neurologists Call For an End to Police Use of Neck Restraints

Eight minutes and 46 seconds: That’s how long George Floyd pleaded for air as a police officer pinned him to the ground.

Six minutes into a neck restraint, Hector Arreola’s heart stopped. 

One minute inside a chokehold triggered Eric Garner’s death.  

But four seconds of a neck restraint is all it takes for medical consequences to ensue, according to Jillian Berkman, MD, a neurology resident in Boston, Massachusetts.

That’s one of the reasons she and her colleagues at Mass General Brigham are calling for a nationwide ban on all types of vascular neck restraints in law enforcement. 

In a Viewpoint article published in JAMA Neurology in December, Altaf Saadi, MD, MSc, Joseph Rosenthal, MD, PhD, and Berkman use their neurological expertise to unravel the extensive damage that neck restraints can cause. They emphasize that there is no medical justification for this technique.

“It’s unclear if there have ever been medical providers who were counseled prior to the use of neck restraints becoming a policy," Berkman tells Verywell. "I do think that they’ve been occurring for so long without the public really knowing about them, and social media has made it so people are capturing and witnessing these events more. It’s impossible to know how much damage has been caused in the past, but I do know that these dangerous techniques need to be put to an end.” 

Hidden Consequences of Carotid Restraints 

The term "neck restraint" encompasses two types of compressions: strangleholds, which block blood flow to the brain through two pressure points on the neck, and chokeholds, which bar airflow through the windpipe. 

Police departments all across the U.S. employ both types of neck restraints to subdue aggressive civilians and render them unconscious.

Chokeholds are typically deemed the more dangerous of the two, so many states and cities are taking extensive measures to prohibit and penalize them. In June of 2020, President Trump signed an executive order that bans the use of chokeholds unless an officer is in imminent danger. 

However, the Viewpoint highlights a massive hole in both the national narrative and the legislation: A stranglehold is just as detrimental as a chokehold.

While the phrase “I can’t breathe” dominates the movement against police brutality, the problems with neck restraints go beyond the breath and spill into the blood.

“The whole importance of the blood flow itself is that the blood is what’s carrying the oxygen, so if you’re not getting blood up to the brain, you’re not getting oxygen to the brain,” Berkman says. “The end result could still be the same as when you’re choking someone. Both chokeholds and strangleholds have the potential to be deadly.”

The brain requires 15-20% of the blood in circulation to properly function, and this blood predominately travels through the two carotid arteries—both of which are blocked during strangleholds. This interruption can cause multiple medical malfunctions, including seizures, strokes, arrhythmias, and vascular damage.

"If someone is on top of you, they’re not seeing signs of any of these, so there’s no way to know it is happening," Berkman says. "In the case of immediate death, what likely happens is you experience cardiac arrest from not getting enough oxygen to the heart and the lungs. Having a large stroke can definitely lead to death, but that usually takes hours because the brain tissue will swell and then compress the area responsible for consciousness. People can also die of seizures, but that's also rarer."

The Role of Time and Force

The JAMA article emphasizes that time means everything when someone is subjected to a neck restraint, and every second can either cause or reverse the damage.

The phrase “time is brain” serves as the backbone of neurology, and it refers to the impact of every second that the brain is starved of oxygen. According to Berkman, this idea is used mainly in the science of strokes, where a blocked or burst blood clot prevents oxygen from traveling to the brain. Here, 1.9 million neurons die per minute, which can lead to loss of function in specific areas of the brain. 

“Every part of our brain has a purpose, and a stroke could damage areas responsible for memory, speech, or language," Berkman says. "If brain tissue starts to die during a neck restraint and the person survives, they may have problems speaking, interpreting language, writing, reading, or using one side of their body."

The emphasis on time plays an important role in neck restraints because many officers lack the training to do them correctly, and end up pressing down too hard for too long, which is what leads to irreversible damage and deaths.

"You only need a force of about six kilograms, which is approximately 13 pounds, to compress the carotid arteries. This would be the weight of a household cat or 1/14th the weight of an average adult male," Berkman says. "This means the entire male body holds much more weight than is needed to make someone lose consciousness—eight minutes and 46 seconds is about 131 times longer than what is necessary to make your victim lose consciousness."

The Psychological Toll 

Although it wasn't highlighted in the article, Berkman says that psychological traumas are likely to accompany the neurological side effects of neck restraints.

Jaime Zuckerman, PsyD, a clinical psychologist based in Pennsylvania who treats many psychiatric illnesses rooted in trauma, says that the psychological traumas that can result from being in this type of vulnerable position are significant. 

“Any type of sudden or threatened physical attack or violation can lead to trauma responses. Post traumatic stress disorder (PTSD), acute stress disorder, panic disorder, and even depression can develop in response to such an event,” she tells Verywell. “The resulting mental health symptoms can have far-reaching implications, particularly within populations where mental health treatment is difficult to access and/or there is a significant stigma surrounding mental health. This not only makes it less likely that people will seek treatment but also increases the risk of substance abuse as a way to self-medicate.” 

The effects of trauma can also affect the lives of a victim's loved ones. Zuckerman says that a traumatic event witnessed by a close friend or family member can also lead to PTSD. 

“The serious use of force can have a negative impact on the mental health of not only the person involved but their families and communities as well. This has been particularly noted within communities of people of color,” she says. “Given the long-standing implications of systemic racism on the Black community, coupled with a long-standing reported distrust of law enforcement within these communities, such experiences can further perpetuate the cycle of intergenerational trauma. This is especially relevant given the pervasiveness of social media, as body and dashcam videos of authorities using neck restraints are almost always seen by family, friends, and the community.” 

A Push for Accountability and Reform

This Viewpoint was penned in the summer of 2020, as protests against police brutality were at their peak. Berkman says that the authors found it imperative to contribute to the movement in the best way they could: by utilizing their experience in neurology to build a case against neck restraints. 

She explains that the article is meant to serve as a call to action for more data collection, as there are no solid statistics on the occurrence and consequences of these techniques.

“In the past few years there has been more momentum in a demand for transparency,” she says.

This data tracking is important because even states that enacted neck restraint bans still have incidents that fall through the cracks.

“That’s why we need to not just ban the use of this technique, but also implement public health data collection and reporting of police violence,” she says. “I think that this topic will forever be relevant until we live in a place that does not support the systemic killing of Black people.” 

In conjunction with stricter bans and broader data, she recommends de-escalation tactics that include talking a person down or using hand and leg restraints as an alternative.

To further bolster the neurological aspect of these techniques, she says professional organizations such as the American Academy of Neurology or the American Neurological Association should push for policy changes. She also encourages other neurologists to speak out.

“It takes a lot of time and it takes a lot of people putting pressure on local governments to see real changes, and what is unfortunate is sometimes this becomes a political issue, when really this is a people issue,” Berkman says. “It’s important to see these issues through the lens of science because it provides facts. We are writing this as physicians who care about the health of the community and we are trying to just break it down to the science of what’s actually happening. This isn't about politics. It's about making sure that we’re not killing people for stealing cigarettes—because that’s not worth someone’s life.”