AAN: Ban Chokeholds, Strangleholds in Law Enforcement

Chokeholds and strangleholds should be prohibited in law enforcement, the American Academy of Neurology (AAN) said Wednesday.

“The deaths of George Floyd, Eric Garner, and other instances where neck restraints were used by law enforcement have called into question whether these restraints are controllable, safe, and non-lethal,” the AAN wrote in a new position statement.

“Because of the inherently dangerous nature of these techniques, the AAN strongly encourages federal, state, and local law enforcement and policymakers in all jurisdictions to classify neck restraints, at a minimum, as a form of deadly force,” they continued.

“Furthermore, because there is no amount of training or method of application of neck restraints that can mitigate the risk of death or permanent profound neurologic damage with this maneuver, the AAN recommends prohibiting the use of neck restraints.”

The statement referred to a JAMA Neurology editorial published last year that reviewed carotid artery physiology and neurological sequelae that result when blood flow or oxygen to the brain is restricted.

“As neurologists, we have been inculcated with the adage ‘time is brain’ throughout our training, emphasizing the rapid loss of human nervous tissue with each second that flow of oxygen to the brain is reduced or stopped,” Altaf Saadi, MD, MSc, of Massachusetts General Hospital and Harvard Medical School in Boston, and co-authors wrote in JAMA Neurology.

“In a stroke, where there is an abrupt interruption of blood flow to the brain, the typical patient loses 1.9 million neurons each minute in which stroke is untreated,” Saadi and colleagues noted. “George Floyd was not killed by a stroke; nonetheless, we found ourselves considering the profound neurologic value of time once again as Derek Chauvin knelt on George Floyd’s neck for 8 minutes and 46 seconds.”

Chokeholds and strangleholds are two neck restraint techniques used by law enforcement. Chokeholds involve pressure on the trachea to restrict the airway; strangleholds (also known as vascular neck restraints) restrict blood flow to the brain by applying pressure to the carotid arteries. The tactics may involve using an officer’s arm to restrain the neck, pressing or laying on someone’s back to keep them face-down, or knee-to-neck holds.

Medical literature and cumulative experience of neurologists indicate that restricting cerebral blood flow or oxygen delivery can cause permanent injury to the brain, including stroke, cognitive impairment, and death, the AAN pointed out.

“Unconsciousness resulting from such maneuvers is a manifestation of catastrophic global brain dysfunction,” the group wrote. “In addition, individuals with underlying cardiovascular risk factors are more vulnerable to suffering significant neurological injury from neck restraint techniques, and the burden of cardiovascular disease in the United States, particularly in communities of color, remains high.”

“In sum, the neurological sequelae that result from limiting blood flow or oxygen to the brain due to the use of neck restraints are potentially irreversible and entirely preventable,” the AAN stated.

AAN is the world’s largest association of neurologists and neuroscience professionals with 36,000 members. “Neurology and neuroscientist professionals have a responsibility to work toward improving the health of all members of society and educating the public on how to prevent neurologic injury,” the group said.