The hogtie position, in one variant or another, is known to many people and is often considered a “heavy duty” bondage tie. Furthermore, it is a relatively controversial position and can be somewhat risky – particularly some of its variants. A number of deaths have occurred after a person was hogtied. However, essentially all of these deaths occurred under very specific circum-stances that are fairly easy to avoid. I’ll describe them later.
As you already know, the subject of bondage is a very far-ranging one, and I had to make some editorial decisions regarding what I would and would not cover in this (relatively fundamental) book. Some of the more “heavy duty“ bondage practices that I decided to omit were suspension bondage, prolonged bondage, and bondage applied to someone who was resisting. (Among other things, as of this writing I am not particularly educated or experienced regarding these practices. That may change.)
On the other hand, I am very well-acquainted with the hogtie position, having spent a considerable amount of time on both the “inside” and the “outside” of it. I feel I can discuss this bondage position with substantial familiarity. Given my extensive personal experience with this bondage position, and that it is otherwise consistent with the parameters of this book, I decided to include it, but many readers will consider the hogtie to be the riskiest and most intense bondage position in this book.
Because of the risks and controversies associated with the hogtie bondage position, I’d like to take a moment to refer you back to the “Risk Factors and Warning Signs” chapter, in which I discuss degrees of monitoring, risk factors, and my philosophy on risk-taking – critical context for the information in this chapter. Having reviewed such matters, let us explore the hogtie.
THE BASIC HOGTIE
In the basic hogtie position, the bottom lies face-down, their wrists are tied behind their back, their ankles are tied together, and finally their ankles are drawn back towards their wrists and tied in place. The stringency of this bondage position depends substantially upon how closely the bottom’s ankles are drawn to their wrists. I’ve seen everything from the ankles drawn back so closely to the wrists that they were touching, to a very loose hogtie in which the ankles were just very slightly lifted off the floor.
The hogtie position, particularly if the bottom’s ankles are drawn back closely to their wrists, can be very immobilizing. While the bottom may be able to wiggle around a bit, that may be about it. Some bottoms find even rolling from the face-down position onto one side or the other to be very difficult if not impossible, and most will not be able to rise to a sitting or kneeling position without assistance. Short of tying someone to a heavy fixed object such as a bed or post, the hogtie is about the most immobilizing bondage position there is.
From a BDSM point of view, the hogtie is something of a mixed blessing. While it frequently offers both a high degree of security and immobility, it can often significantly reduce access to the bottom’s body – particularly if the bottom is lying face-down. Access to their back is fair at best, and access to their buttocks can be significantly blocked by their wrists, their ankles, and the rope running between them. Of course, if the bottom is lying face-down, access to their chest, breasts, nipples, and genitals is usually difficult. This being the case, the classic, face-down hogtie usually works best in a “you just lie there and be tied up until I want you for something – and that may be a while” sort of scene.
Some of the variants and modifications of the hogtie, however, offer a great deal more promise.
For example, if the bottom is hogtied and placed into a kneeling position, this exposes most of the front of their body. Their chest, breasts, and nipples are usually very available, and access to their genitals is often good – particularly if their ankles are tied in a perpendicular or anti-parallel direction. Furthermore, they can often perform oral sex while bound into this position – particularly if the rope running between their wrists and ankles is long enough to allow them to kneel. If the rope running between their wrists and ankles is long enough to allow them to “stand on their knees” (known in “SM 101” as the “kneel up” position), then they can have a nice amount of mobility – enough to greatly enhance their ability to perform oral sex – while still being securely bound.
In the sitting-cross-legged variant of this position, access to the bottom’s upper chest usually remains good, but access to their genitals, buttocks, and anal area is much more limited. (Access to a male bottom’s genitals may be adequate.) One benefit of this position is that the bottom may find it less stressful on their legs than they find the kneeling position, thus they may be able to stay in this position considerably longer.
If the rope running between the bottom’s wrists and ankles is long enough to permit the bottom to move back and forth between a “kneel up” position and a sitting-cross-legged position (they may need assistance in this), they probably will be able to kneel, sit, and lay on their stomach, side, and possibly their back. This allows the top to position the bottom in various ways while still retaining both a high degree of security and a relatively high degree of immobility. A nice combination.
(Caution: ropes that were baby-bear tight around the bottom’s ankles when they were lying down may become uncomfortably tight, or even dangerously tight, when the bottom moves to a kneeling or sitting position.)
Hogtying a bottom and then placing them on their back can create a very high degree of security along with a very high degree of vulnerability and accessibility. Furthermore, many bottoms can stay in this position for a relatively long period of time with reasonable comfort – if some thought is given to the tying technique.
It usually works best for the top to tie the bottom’s wrists behind them in an anti-parallel fashion, with the bottom’s wrists in the small of their back. It’s often a good idea to place a pillow or something similar under the bottom’s buttocks to take some of their body weight off of their wrists and hands. The bottom’s ankles are then bound together (the anti-parallel position often works best for this), drawn up fairly closely to the bottom’s genitals, and tied in place. This position is often enhanced by elevating the bottom’s head and shoulders with one or two pillows, thus allowing them a clearer view of what’s being done to them. (Of course, if the top felt like denying them that view, they could simply not place such pillows.)
Is the hogtie position intrinsically dangerous? In the criminal justice area, there have been a fairly substantial number of deaths reported after a suspect has been place in a hogtie position (also known in those circles as the “hobble” position). So we know the following: (1) the suspect was placed in a hogtie position and (2) they died shortly after being placed in such a position. The obvious question arises: what, if any, is the cause-and-effect relationship between those two facts?
There are two basic categories of hogtie-related deaths: gradual deaths and sudden deaths. Let’s take a closer look at each.
• Gradual hogtie deaths. The primary concern in these cases seems to be the question of to what degree being placed in the hogtie position limits the person’s ability to breathe. Three factors appear to play a significant role here.
The first factor is that, given that the bottom is lying face-down with their hands tied behind them, their abdominal cavity is compressed and the contents of their abdominal cavity are pressing on the underside of their diaphragm with an unusually high degree of pressure. This can limit how easily the diaphragm can move and thus make the bound person have to work harder – expend more muscular effort – to breathe. Over time, this can become a problem – how much of a problem cannot be predicted in advance. Some bottoms can tolerate this position for hours at a time, while others develop significant respiratory difficulty within a few minutes. Heavier bottoms tend to have more problems with this position than lighter bottoms have, and older bottoms tend to have more problems than younger bottoms have.
The second factor is that the standard hogtie position may in some cases limit the bottom’s ability to expand their chest wall adequately when they breathe. This can be due in part to having their arms drawn tightly against the sides of their chest and in part to laying face-down with their chest directly on the surface in question.
The third factor is the surface that the bottom is lying on. In particular, if the bottom is lying on a soft bed with lots of fluffy pillows, covers, and so forth, they may sink into the bed, with the result that their nose and/or mouth may be obstructed.
In all of the above cases, the distress associated with the situation usually comes on rather slowly, with many minutes or even hours passing before the problems become significant. Thus, the bottom is able to give more than adequate notice to the top, and the top can correct these problems with relatively little difficulty – provided, of course, that there is a top present to do so. Once again, we see the crucial importance of a sympathetic monitor.
The conventional wisdom in such cases is that the gradually increasing respiratory distress associated with the hogtie position can often be relieved almost entirely by placing the bound person on their side or back (or almost any other position than face-down; sitting or kneeling can also work). Indeed, many bottoms will move into such positions on their own if they can. Police officers and ambulance crews are often taught that if someone has been hogtied, they are to be placed in an on-their-side position (and closely monitored) while being transported to jail or to the hospital.
• Sudden hogtie deaths. Most of the sudden deaths attributed to the hogtie position have involved males who were being arrested. Many such men were under the influence of substantial amounts of recreational drugs that directly affect heart function, including cocaine, alcohol, and amphetamines. Furthermore, these people often had very high levels of adrenaline (epinephrine) in their systems due to their being in a “for real” fight-or-flight situation. Additionally, there was classically a period of violent struggle while they were being placed in a hogtie position, often with a police officer kneeling on their upper back (and thus further limiting their ability to breathe) during this process.
“I’m getting my boyfriend a complete set of ropes for his birthday.”
It appears that it is this combination of stressors – recreational drugs (especially stimulants), high levels of adrenaline, strong rage and/or fear, violent exercise (often in a person whose level of cardiopulmonary fitness is very poor), and unusual compression of the chest due to someone kneeling on their back – that causes almost all of the sudden deaths. It seems that these people died of what could be thought of as “metabolic suffocation.” That is to say, even though they could still breathe (at least somewhat), the various stressors caused their heart’s demand for oxygen to soar above their body’s ability to supply it, and they died from lack of oxygen.
From the viewpoint of a consensual bondage practitioner, this is good news. It provides us with a set of fairly clear guidelines to help us avoid such mishaps. If we avoid doing things such as kneeling on the bottom’s back while they are enraged and under the influence of recreational drugs, we should have many fewer problems.
THE MILITARY HOGTIE
There are several standard, “learn during your first SM teachings” aphorisms in the SM world. Commonly included among these teachings are phrases such as “SM play should always be consensual,” “always play with a safe word in effect,” and “never tie anything across the front of a bottom’s throat.”
As I’ve mentioned before in this book, all of the above such teachings (and virtually everything else associated with BDSM) are subject to debate, nuance, and exception. For example, there are knowledgeable, experienced BDSM practitioners who sometimes do “consensually nonconsensual” scenes, and there are also knowledgeable, experienced BDSM practitioners who sometimes do “no safe word” scenes. These are very controversial topics, and there is – as I mentioned – a great deal of debate and discussion about them, including whether or not it is possible to do them at all. In any event, the topics of “consensually nonconsensual” scenes or “no safe word” play are definitely beyond the scope of this book – and, candidly, I breathe a sigh of relief upon contemplating that thought. (However, I will advise you to not attempt either type of BDSM play until you know your partner extremely well and both of you have BDSM experience levels that can be measured in terms of years.)
The “never tie anything across the front of the bottom’s throat” issue, however, is more objective. It is certainly possible to do that type of bondage. The fact that this could be risky bondage is obvious. However, the question emerges, what is its actual risk level? Should we automatically put this type of bondage in the “extreme level of risk” category? Many knowledgeable, experienced practitioners strongly think that indeed we should.
The question is made somewhat more complex by the fact that, while this technique is hardly ever explicitly taught or used in the BDSM world (atleast in public), it is very widely taught and used in the military/martial arts world as a method of binding prisoners, and there are not numerous reports of prisoners dying after being tied in this way.
In this hogtie variant – seen fairly frequently in gay male bondage photos – the bottom’s hands are tied behind their back (often in an anti-parallel position) and their wrists are then pushed relatively high up on their back, typically so that the angle of their elbow joints is less than 90 degrees. The rope is then looped around the bottom’s neck – usually only once, but sometimes more than once – and then brought back down to their wrists and once again secured there. The bottom’s ankles are then drawn back towards their wrists (how closely they are drawn to the wrists can vary widely) and tied in place – thus completing the tie. Because this variant of the hogtie is widely taught to soldiers as a means of securing enemy prisoners, I have named it “the military hogtie” – a phrase that is becoming more popular.
The basic idea of this hogtie position is that as long as the bound person stays relatively still, the bondage is not particularly uncomfortable. Indeed, the bound person may even be able to sleep while tied this way. However, if they struggle in an attempt to free themselves, the pressure across the front of their throat might increase to the point of significant discomfort. If they were to pull strongly, the pressure across the front of their throat might increase to the point where it could cause injury, unconsciousness, or, in an extreme case, even death. Thus the point of this tie is to discourage struggling, not to inflict unavoidable strangulation. As long as the bottom stays still, no significant pressure is applied to their neck and the bondage often feels no more uncomfortable than a slightly snug necktie.
OK, so here is an obvious example of a fairly large number of people outside of the BDSM community engaging in a bondage practice that people inside the BDSM community are commonly taught to never do. What should we make of this?
As part of researching this book, I put out a call for “Type One” and “Type Two” incidents. Type One incidents were cases in which something unexpectedly bad had occurred. Type Two incidents were cases in which something unexpectedly good had occurred (or, more precisely, cases in which the expected bad outcome did not occur.)
What I found, somewhat to my surprise, was a relatively large number of reports of Type Two incidents involving bondage that went across the front of the bottom’s throat, with no problems. A surprisingly large number of knowledgeable bondage practitioners have been doing “never do this” bondage involving the military hogtie (and other methods of running a rope across the front of the bottom’s neck) in their private play fairly frequently and for quite some time. Yet there was a virtually nonexistent rate of significant in-jury – provided that this type of bondage was done within certain parameters. What’s going on here?
First, let’s talk about the cases in which the bottom was harmed, or even killed, by this type of bondage. Interestingly enough, all the cases that have been reported to me as of this writing have involved either (a) cases in which the victim (and in this case I will call them a victim, not a bottom) was tied with “real world” criminal intent or (b) cases in which the bottom was in an unmonitored situation while tied into this position, either due to self-bondage or to being tied this way and then abandoned by their partner.
In other words, despite a diligent search, in numerous case reports of such usage, I have received no reports of a bottom who was injured or killed by a military hogtie provided the bottom was tied by a top who (a) had no criminal intent regarding them and (b) monitored the bottom (either closely or loosely) after tying them into this position. What should we make of this?
I believe the evidence presented to me supports the conclusion that the military hogtie more rationally falls into the “above average” level of risk category than into the “extreme level of risk” category provided that:
1 It is applied by a top who cares about the bottom’s welfare in the usual BDSM sense.
2 The top monitors the bottom after the tie is applied.
3 The tie is applied in a manner that does not apply uncomfortably tight pressure to the front of a bottom’s throat while they are lying still in a resting position.
A few supplemental comments. If the military hogtie was applied in such away that the bottom had to use their muscles to relieve the pressure across the front of their throat, that would certainly qualify as “extreme level of risk.”
If this type of tie is applied, it is especially important that the top have the resources necessary to release the bottom very quickly if a problem develops.
(EMT scissors, or their functional equivalent, would be particularly important in this regard.)
Bottoms with a history of a seizure disorder would be an increased risk if tied this way.
There have been a number of cases in which only a few seconds of strangulation have stopped the recipient’s heart. While such incidents are relatively rare, they are not unheard of. Such cases usually involve a bottom who is older and/or has a history of heart disease, and/or is experiencing significant anger or fear at the time.
There is some reason to believe that pressure applied relatively high on the person’s neck (near what’s called the carotid sinus bodies) was more likely to be involved in such incidents than pressure that was placed relatively low on the person’s neck (away from the carotid sinus bodies). Additionally, it has been reported in the forensic pathology literature that neck pressure due to manual strangulation is significantly more likely to cause this problem than is pressure from a constricting band, since pressure from manual strangulation can be concentrated more locally upon the carotid sinus bodies. (See “Forensic Pathology,” second edition, by Knight.)
There has been the occasional case in which pressure on the arteries in the neck, from whatever cause, have dislodged a cholesterol plaque from the interior wall of the artery, which may then travel up to the brain and cause a stroke. Such incidents are very rare, and almost all of those that do occur involve people over the age of 60.
As is true with any form of bondage, the use of any intoxicants to any degree by either the top or the bottom pretty much automatically increases the level of risk by one level. If both people are using intoxicants the risk level automatically becomes extreme.
The conventional recommendation is that if someone develops difficulty breathing from being placed in a face-down hogtie, this difficulty can often be resolved by rolling the tied person onto their side. While researching this book, we found this recommendation to be true if the person was in a conventional (nonmilitary) hogtie. However, we found that a person in a military hogtie who was rolled onto their side usually experienced an increase in neck-loop pressure, with potentially dangerous results. For people tied into a military hogtie to get relief, it was necessary to roll them all the way over onto their back. Fortunately, this was usually accomplished fairly easily, particularly if the bottom’s wrists were tied in an anti-parallel position.
Interestingly enough, many bottoms reported that being on their back while tied in a military hogtie was a very comfortable position, and that they could stay in this position for the maximum bondage duration of two hours that is recommended in this book without undue difficulty. (Some bottoms needed to have a pillow or something similar put under their buttocks to help take the weight of their body off of their hands and wrists.)
Most of the pressure across the front of the bottom’s throat comes from the quadriceps muscles located on the front of the bottom’s upper thighs, and is transmitted to their throat by the rope running between the bottom’s ankles and their wrists. Thus, if the top wanted to relieve the throat pressure as quickly as possible, it would probably be best to cut this rope first.
If the top wanted to reduce the pressure that could potentially be applied to the front of the bottom’s throat, they might apply the wrist tie and neck loop, but omit running a rope from the bottom’s wrists to their ankles. One of several playfully wicked variants of this technique, used especially on male bottoms, is to apply the wrist tie and neck loop with one rope, and then use one or more additional ropes to tie the bottom’s ankles together and then draw them back and tie them to the bottom’s genitals. (Refer back to the “Harnesses” chapter for more ideas.) As with the standard military hogtie, this technique seems to be an above-average level of risk technique but not an extreme level of risk technique.
“I’m a victim of macrame!”
In summary. As I mentioned earlier, one of the main purposes of this book was to advance the body of knowledge regarding bondage, and to reexamine its teachings and aphorisms with substantial intellectual rigor.
I have made a very diligent inquiry into the military hogtie. I have thoroughly researched the medical, legal, military, and martial arts data, have discussed it with many experienced people, and have both applied it to my partners and had it applied to me on many occasions.
Regarding bondage, SM in general, sex in general, and even life in general, the choice is rarely between “safe” and “unsafe,” but rather a choice of “what risk level are you comfortable with?” Thus, we increasingly see descriptions of “safer sex” rather than “safe sex.”
In this book, I have described three categories of risk: average risk, above-average risk, and extreme risk. While there is no doubt that the military hogtie is riskier than average, my inquiries have led me to the conclusion that it is, when used under the three parameters described in this book, more rationally placed in the “above-average risk” category than in the “extreme risk” category.
BONDAGE AND POSITIONAL ASPHYXIA
“Positional Asphyxia” is a rather scary term. It’s also a term every bondage fan should understand, because it’s one of the relatively few ways that we can get into serious trouble.
Positional Asphyxia, in its simplest form, simply refers to asphyxiation (suffocation) occurring because someone has been placed in a position where it is impossible for them to breathe adequately.
To properly understand positional asphyxia, it helps to review the basics of breathing.
A given breath consists of an inhalation phase and an exhalation phase. An adult at rest typically breathes between 12 to 20 times per minute, with a typical breath volume being around 500 cubic centimeters, and with the inhalation phase lasting slightly longer than the exhalation phase. In most circumstances, inhalation involves a relatively small amount of active muscle contraction of the thoracic (chest) muscles and diaphragm, while exhalation is an entirely passive process, requiring no muscular effort. (Thus, if someone has to work to exhale, or if their exhalation phase is longer than their inhalation phase, they probably have some sort of problem with their breathing.)
In other words, breathing is an activity that takes muscular work, and there is an upper limit to how much work a given muscle or set of muscles can do in a given amount of time. If this work limit is exceeded, the muscles will eventually fatigue to the point where they fail to function, no matter how desperately the person wants them to continue to function.
In positional asphyxia, the person has been placed in a position where the amount of work they must do in order to breathe adequately is greater than the amount of work their respiratory muscles can do indefinitely. Unless this condition is relieved, the person will die of inadequate breathing due to respiratory muscle exhaustion. Depending upon the severity of the condition, this failure could take anywhere from a few minutes to many hours to occur.
I saw my fair share of respiratory failure cases during my ambulance days. It’s my experience that all but the most extremely acute cases typically take at least thirty minutes to develop to the point where they become life-threatening, and most take at least an hour to reach this point. Many take far longer.
Thus, once again, we see the importance of a sympathetic monitor. As long as the person in bondage is even loosely monitored, there should be no significant problems with positional asphyxia. On the other hand, if no such sympathetic monitor is present, such as in a self-bondage situation, the bound person could be facing a slow, painful death.
A few further points.
If a bottom has a medical condition that might make it suddenly more difficult for them to breathe, they should let the top know before allowing themselves to be bound. They should also tell the top what to do if this difficulty in breathing develops. Ideally, of course, this should be covered in pre-play negotiations. Examples of such conditions include asthma and a sudden, severe allergic reaction (particularly allergies to something likely to be in the bedroom or playroom, including dust, scents, cat or dog hair, and so forth).
Also, if the bottom has other respiratory conditions that might make it harder for them to breathe but are relatively unlikely to suddenly become more severe, they should advise the top of this. Examples of such conditions could include emphysema, chronic bronchitis, and chronic congestive heart failure.
(Important Note: people who have chronic congestive heart failure may not be able to lie flat on their back or stomach for any significant length of time, or to have their chest constricted by bondage or by their own weight, without developing a genuinely dangerous degree of respiratory failure. If these people develop problems, they usually breathe better when placed in a sitting position.)
Intoxication can be especially dangerous in these cases. In those cases where positional asphyxia does become a problem, it often takes more than an hour to become life-threatening, and the person will have been in respiratory distress for quite some time before then. Thus, as long as the bound person is aware of their respiratory distress, they can easily communicate this to their top and correction can be accomplished with a great deal of time to spare. However, the bottom must, of course, be aware that they are finding it increasingly difficult to breathe. Therefore, it’s important that the bottom not be so drunk and/or stoned that they are unable to recognize or communicate their situation. Intoxication has been an obvious co-factor in many positional asphyxia deaths, and it is very plausible that had the person not been intoxicated they almost undoubtedly would not have died.
One particularly graphic example found in the medical literature involves a drunken man who passed out while kneeling and bending over the edge of his bathtub (possibly to vomit). When he passed out in this position, the pressure of his body weight on the edge of the tub prevented his diaphragm and chest wall from moving adequately, and he died of positional asphyxia complicated by intoxication. (“Positional Asphyxiation in Adults” by Bell et al. American Journal of Forensic Medicine and Pathology 13(2): 101-107, 1992.)
Of course, if the top is intoxicated, then the hapless bottom (even if they are not intoxicated) may not be able to communicate their respiratory distress to someone who can do something about it. If both the bottom and the top are significantly intoxicated…
BONDAGE AND BREATHING
In my experience, the four positions most likely to be associated with breathing problems are the hogtie position, what I will call the “fetal” position, the crucifixion position, and the top-sitting-on-bottom position.
The Hogtie Position. A person who has been hogtied in a face-down position may, in some cases, develop some degree of respiratory distress. Please note that this is highly variable, and that many bottoms can be quite happily hogtied in a face-down position for the two-hour upper limit recommended in this book with no problems whatsoever – other than feeling disappointed when it becomes time for them to be released. (“Aw, do I gotta be untied?”)
In general, younger and/or lighter bottoms will have fewer problems than older and/or heavier bottoms. In almost all cases, unless the person is some combination of intoxicated, enraged, obese, terrified, and violently struggling, any respiratory distress that might develop tends to develop very gradually, and can usually be remedied by a sympathetic monitor long before it becomes dangerous. In most cases, this distress is fairly simply remedied by having the bottom roll onto their side (many bottoms will figure this out on their own) or by rolling them into that position if they are unable to do this for themselves.
Note that if the bottom is in a military hogtie, they may be better positioned by placing them on their back rather than on their side.
The fetal position. This term refers to a wide range of positions in which the bottom is bent forward at the waist with their knees brought into relatively close proximity to their shoulders. In such a position, the ability of the chest wall to expand, and of the diaphragm to move downward, may be limited to a dangerous degree. This can be done with the bottom standing or sitting and bending forward, with the bottom lying on their side, or with the bottom kneeling and tied over something like a log or ottoman. However, probably the most common position is with the bottom lying on their back with their knees drawn up towards their chest. As with the hogtie, any respiratory distress that may develop – again, it won’t develop in every case – will typically develop relatively slowly and thus can be easily corrected by a sympathetic monitor with plenty of time to spare.
The crucifixion position. This position is a bit outside the stated scope of this book, but it is close enough, and important enough, that I decided to include a brief mention of it anyway, particularly given that its mechanism is somewhat different.
In such cases, a significant portion of the bottom’s body weight hangs from their arms, such as might happen if their hands are fastened above their head while they are in an upright position. (I have heard of no problems with this position if the bottom’s body was relatively horizontal.) This weight can force their chest to expand into a sort of “permanent inhalation” position, making them expend muscular effort to exhale. Given that exhalation is normally a passive process, this increased extra workload may, over time, become more than the bottom can sustain and they will slowly go into respiratory failure due to exhaustion of their breathing muscles. Again, a sympathetic monitor can usually remedy this long before it becomes genuinely dangerous.
For more information, see “On the Physical Death of Jesus Christ” by Gabel and Hosmer, Journal of the American Medical Association, 1986;255:1455-63.
In inverted suspension, in which the bottom is head-down to a significant degree, the chest also may be forced to expand into a sort of permanent in-halation position. This condition may be further worsened by the pressure of the bottom’s intestines and other abdominal organs pressing on the underside of their diaphragm, thus making it harder for the bottom to inhale as well as exhale. Once again, these difficulties generally develop gradually and can usually be easily remedied by a sympathetic monitor. For more information, see “An Unusual Accidental Death from Reverse Suspension” by Purdue, American Journal of Forensic Medicine and Pathology, 13(2); 108-111, 1992.
Footnote: Inverted suspension also has the potential to increase blood pressure in the brain, thus possibly increasing the chances of a stroke due to a ruptured blood vessel. This could happen with no warning signs. (Any bottom who develops a sudden headache while being placed in inverted suspension should be taken down immediately.) Presumably, older bottoms and/or bot-toms with a history of high blood pressure would be at increased risk for such an incident, although to what extent the risk increases with age and/or high blood pressure is difficult to estimate.
Top-sitting-on-bottom position. The top-sitting-on-bottom position has a number of variants. What these variants all have in common is that the bottom has to endure having some or even all of the top’s body weight while the top sits, kneels, or squats on the bottom’s chest, abdomen, or back in a dominant manner. Obviously, this extra weight will force the bottom to increase the amount of work they must do to breathe. As with the other positions, this can be relieved by a sympathetic monitor long before it becomes life-threatening.
Footnote: There is obviously some risk that the bottom might sustain injury to their ribs, spine or internal organs if the top puts some of their body weight on the bottom’s chest, abdomen, or back. Obviously, the degree of risk will vary greatly depending upon a number of factors, including the relative sizes of the top and bottom. For example, a very small top might be able to happily perch on the chest or abdomen of a very large bottom for up to the two-hour upper limit recommended in this book with out the bottom’s condition becoming serious. On the other hand, if a large top were to try to sit on a small bottom, the risk of immediate injury might be very high indeed.
It should be kept in mind, particularly when sitting on the bottom’s chest, that older bottoms have less flexible rib cages than younger bottoms have, and thus the risk of a rib fracture increases accordingly. While no sharp dividing line can be drawn, I urge tops to be particularly careful regarding bottoms who are more than forty years old.
It should also be kept very clearly in mind that sudden increases (or decreases) in chest or abdominal pressure may be much more likely to cause injury than a more gradual increase or decrease in pressure. Thus, the top should both get on and get off slowly, and should not move around in any sudden ways while in position.
However, as with the other positions, as long as a sympathetic monitor is present, there should not be any major problems – particularly if the top does not make any sudden moves while upon the bottom.
In conclusion. We come back again and again to how important it is for the top to stay in the here and now as the scene progresses, to observe what is and what isn’t working, and to play both the role of “captor” and the role of “sympathetic monitor.”
HOGTIE REFERENCES
“Restraint Position and Positional Asphyxia” by Chan, Vilke, Neuman, and Clausen. Annals of Emergency Medicine, November 1997, 30:5 [key article showing no intrinsic problem with hog-tie position]
“You tie your ankles, then I’ll tie your wrists.”
“Restraint Asphyxiation: Letter to the Editor” by Hirsch. American Journal of Forensic Medicine and Pathology, 15(3): 266-267, 1994
“The Perils of Investigating and Certifying Deaths in Police Custody” by Luke and Reay. American Journal of Forensic Medicine and Pathology, 13(2): 98-100, 1992
“An Unusual Accidental Death From Reverse Suspension” by Purdue. American Journal of Forensic Medicine and Pathology, 13(2): 108-111, 1992
“Positional Asphyxia During Law Enforcement Transport” by D. T. Reay et al. American Journal of Forensic Medicine and Pathology, 13(2): 90-97, 1992.
“Restraint Asphyxiation in Excited Delirium” by O’Halloran and Lewman. American Journal of Forensic Medicine and Pathology, 14(4): 289-295, 1993.
“Sudden Death in Individuals in Hobble Restraints During Paramedic Transport” by Stratton et al. Annals of Emergency Medicine 25:5, May 1995
“Effects of Positional Restraint on Oxygen Saturation and Heart Rate Following Exercise” by Reay et al. American Journal of Forensic Medicine and Pathology, (9)1: 16-18, 1988
“Positional Asphyxia in Adults” by Bell et al. American Journal of Forensic Medicine and Pathology, 13(2): 101-107, 1992
“A Case of Death by Physical Restraints: New Lessons from a Photograph” by Miles. Journal of the American Geriatrics Society, March 1996-Vol.44 # 3
“Deaths Caused by Physical Restraints” by Miles and Irvine. The Gerontologist, Vol. 32, No. 6, 762-766
“Positional Asphyxia during Law Enforcement Transport – letter to the Editor” by Laposata. American Journal of Forensic Medicine and Pathology, Vol. 14, No. 1, 1993
“Death by Reverse Suspension – letter to the Editor” by Lawler. American Journal of Forensic Medicine and Pathology, Vol. 13, No. 1, 1992.