E. Karl Koiwai, M.D.
The “choke holds” known as shime-waza used in the sport of judo have been taught and used by law enforcement officers to subdue violent suspects. Recently, however, there have been reports of deaths allegedly caused by the use of choke holds, which have led to class action suits against its use from local to state to the U.S. Supreme Court. Apparently, the use of choke holds was thought to be a safe and harmless way of controlling and subduing violent suspect s without the use of weapons. The use of choke holds or shime-waza in judo is similar or identical to the techniques used by the law enforcement officers.
Investigations have shown that no deaths had occurred by these techniques since the sport of judo was founded by Professor Jigoro Kano in 1882 in Tokyo, Japan. A survey made by this author in 1979, based on a questionnaire to all International Judo Federation (IJF) country members, revealed that although there were 19 judo fatalities, none was due to shime-waza.
The statistics in the use of shime-waza have been kept by the International Judo Federation on World Class Judo Championships, Olympics (Munich-1972, Montreal-1976, Moscow-1980, and Los Angeles-1984), World Judo Championships (Mexico City-1969, Ludwigshafen-1971, Lausanne-1973, Vienna-1975, Paris-1979, and Maastricht- 1981), and the Junior World Judo Championships in Rio de Janiero-1974. Of the 2198 techniques used to score, 97 were shime-waza (4.41%). No fatalities were recorded.
As of 1985, 113 countries are members of the IJF. All these federations have numerous tournaments at local, regional, national, and international levels where shime-waza is used.
In 1981, a class action suit was brought against the City of Los Angeles regarding fatalities allegedly caused by the “bar-arrn” and carotid artery control holds. The control holds used are similar to the shime-waza used in judo. Since no death has been reported in the sport of judo, other studies on cases of deaths allegedly caused by the use of choke holds had to be investigated.
The reported cause of death was asphyxiation as a result of manual compression of neck.
The reported cause of death was not only mechanical asphyxia but also by compression of the vascular circulation to the brain.
The reported cause of death was acute cardiorespiratory arrest as a result of compression of the neck. The other significant condition was acute heroin-morphine intoxication.
The reported cause of death was asphyxiation to neck restraint procedure for abnormal behavior associated with phencyclidine (PCP) use. Other significant conditions were aspiration of vomitus and sickle cell disorder.
The reported cause of death was cardiorespiratory arrest caused by asphyxia as a result of strangulation and aspiration of gastric contents.
The reported cause of death was sudden cardiorespiratory collapse in a psychotic patient with severe stress and exhaustion after prolonged combativeness, sleeplessness, and refusal to take nourishment.
The reported cause of death was asphyxia as a result of neck compression during restraining procedure. The other significant condition was interstitial myocardial fibrosis.
The reported cause of death was asphyxia as a result of neck compression during restraining procedure.
The reported cause of death was hypoxic encephalopathy as a result of respiratory arrest following struggle with police officers while in a state of acute ethanol and cocaine intoxication.
The reported cause of death was acute cardiorespiratory arrest as a result of carotid control hold of neck. The other significant condition was non-specific cardiomyopathy.
The reported cause of death was hypoxic encephalopathy, probable forearm strangulation.
The subject was a 34 year old male Vietnamese Vo et Vat instructor who was “choked” by one of his own students, age 17. For demonstration purposes, the student was ordered by the instructor to use all his strength when he applied a reverse cross choke (gyaku jujijime). This choke is applied from above with the instructor lying on his back on the mat. The instructor was going to demonstrate a method of resistance and counter attack. The instructor was not able to counter attack, and the student, after the passing of “some minutes,” exhausted by his effort, terminated the “choking.” The instructor apparently died on the mat. His demise was witnessed by his students, who were sitting around the two demonstrating. A doctor was summoned, but he could only state that the instructor was dead. The autopsy findings were published in the Annales de Medicine Legale.
The reported cause of death was not only by mechanical asphyxia but also by compression of the vascular circulation to the brain.
When an order was granted, two police officers were dispatched to his home to bring him to the hospital. Coaxing by the police officers proved futile. In an attempt to overpower and handcuff him, one officer stepped behind the victim and grabbed him about the neck. The hold intended by the officer was the carotid sleeper with the neck of the victim in the crook of the arm and forearm of the officer. After a brief but violent struggle, during which both the officer and victim fell to the floor, the victim became lifeless. He did not respond to CPR. An EKG taken during resuscitation showed cardiac arrest. Witnesses, including family members, stated that the entire struggle lasted only a “short time,” with the neck hold in place several seconds.
The reported cause of death was cardiac arrest, arteriosclerotic hypertensive heart disease, and neck compression, contributory, classified as homicide.
He was forced face down on the bunk while the handcuffs were removed and replaced by nylon flex cuffs. During this time, a guard put the victim’s head in a neck hold which the guard described as the carotid sleeper. The prisoner ceased to struggle aand the guards left him to recover. A few minutes later when a guard returned to check on the prisoner, the prisoner was found apneic. CPR was immediately begun, and in a matter of minutes medical personnel arrived at the scene. EKG showed fine ventricular fibrillation which progressed to cardiac standstill.
The reported cause of death was neck hold.
Choke Holds Used by the Police
The Carotid Takedown Modified and Control
A right-handed officer maneuvers behind the suspect, wraps his right arm around the suspect’s neck between the throat and the carotid. At this point, pressure is applied to the suspect’s neck between the throat and the carotid artery with the lower forearm. The suspect is then pulled backwards so that the suspect’s back is in contact with the officer’s chest. The technique is the same as hadakajime used in judo in the standing position. The suspect is then pulled down to a sitting position. If the suspect continues to resist, the move is made to go into the “locked carotid control.” The officer can do this by driving the right thumb into the left armpit, then griping the upper left arm with the right hand. The right arm is flexed and the left hand is extended beyond the right shoulder. This maneuver will draw the officer’s right arm tighter around the neck.
The Bar Arm Takedown and Control
In the event that the suspect is uncontrollable and the officer is unable to apply the modified carotid hold, the officer may have to resort to the bar arm to take the suspect down. The locked bar arm control is performed by gripping the left biceps with the right hand. At the same time, the officer bears down with the left and against the back of down to a sitting position with the same maneuver as the carotid takedown and control. This technique is the same as the one method of hadakajime (naked choke-lock) used in judo.
It is important to point out that the police training manuals emphasize that the application of pressure must be stopped as soon as the suspect ceases resisting or goes limp. When a situation escalates to the point that a control hold is necessary to restrain and control a suspect, both the officer and the suspect are prone to injury. It is preferable to use persuasion and command presence to control a situation. When it does become necessary to apply a control hold, proficiency with the control holds described will help to restrain a combative suspect.
The 14 fatalities presented were allegedly caused by “choke holds”, 13 by law enforcement officers, 1 by a student learning Vo et Vat, a Vietnamese version of judo. In the sport of judo, which started in 1882, no fatalities have been reported. Judoists are taught to apply shime-waza using the principle “maximum efficiency with minimum effort.” The maximum pressure is applied directly on the “carotid triangle” without applying the pressure on other parts of e neck, causing unnecessary damage. In all 14 cases, this author has noted evidence of injuries to the structures of the neck from bruises, ecchymosis, hemorrhages to fractures of the cartilage of the neck (Cases 1, 5, 10, 13, and 14), and intervertebral discs (Case 7). Submucosal or mucosal injuries are noted in the larynx in Cases 1, 2, 6, 11, and 13, All these findings indicate that tremendous force was exerted on the necks of the suspects.
If the carotid artery hold is properly applied, unconsciousness occurs in approximately 10 seconds (8-14 seconds). After release, the subject regains consciousness spontaneously in 10-20 seconds. Neck pressure of 250 mm of Hg or 5 kg of rope tension is required to occlude carotid arteries. The amount of pressure to collapse the airway is six times greater.
Anatomically, the anterior cervical triangle of the neck contains the superior carotid triangle. The pressure can be applied to either side. The anterior cervical triangleis a triangle bordered by the sternocleidomastoid muscle (large neck strap muscle) laterally, the mandible jaw bone above, and medially by the cervical midline, a line drawn from the tip of the jaw to the sternal notch. Within the anterior cervical triangle, there are three smaller triangles:
In the technique of choking, the most important triangle is the superior carotid which contains important structures. This triangle is bordered by the stylohyoid and the posterior belly of the digastric muscle above, the anterior border of the sternocleidomastoid muscle medially. Within the superior carotid triangle are the common carotid artery and branches, the carotid bodies, internal jugular vein, vagus nerve and branches, superior laryngeal nerve, and cervical sympathetic trunk.
Overlying this superior carotid triangle is only skin, superficial fascia which usually are thin although there may be an appreciable amount of subcutaneous fat. Within the superficial fascia is an exceedingly thin (paper-thin) muscle, platysma muscle, which begins in the tela subcutaneous over the upper part of the thorax, passes over the clavicle (collar bone), and runs upward and somewhat medially in the neck and across the mandible to blend with superficially located facial muscles. The platysma muscle has no very important action, but will wrinkle transversely the skin of the neck and help to open the mouth. ‘This muscle does not protect the underlying vital structures.
Consequently, the amount of pressure directed to the superior carotid trianile needs to be no more than 300 mm Hg to cause unconsciousness in an adult. A female can, if the choke is properly performed, without great strength “choke out” a male twice her size.
The state of unconsciousness, according to the investigators of the Society for Scientific Study in Judo, Kodokan, is caused by a temporary hypoxic condition of the cerebral cortex. In judo, the player holds the opponent’s neck by his hands (forearm) or judogi, the bloodflow of the common carotid artery is obstructed, but the vertebral artery is not obstructed. It has been confirmed that complete obstruction of blood flow to the brain or asphyxia by complete closure of the trachea will result in irreversible damage to the body which often results in death. While unconsciousness (ochi) caused by choking (shime) in judo is a temporary reaction which incapacitates the opponent for a short while, its execution is quite harniless.
Experiments with human subjects and animals show the following effects from “choking”:
The effects of carotid artery hold or shimewaza have been studied extensively. However, the use of this hold by law enforcement officers has resulted in deaths. The police department training manuals emphasize that control hold should be used only when necessary to stop a suspect’s resistance and not necessarily to cause unconsciousness.
The enforcement officers, although trained, have great difficulty in subduing violent and uncooperative suspects. Some suspects are under the influence of drugs: Case 3, acute heroin-morphine intoxication; Case 4, phencyclidine (PCP); and Case 9, acute ethanol and cocaine intoxication. These suspects may have had greater tolerance for pain, thus making it more difficult to restrain them and to recognize whether the state of unconsciousness is due to drugs rather than to the restraining holds. In other words, these suspects were not cooperative.
In judo, the participants are taught to “choke” properly and in turn have been “choked” and have the ability to realize its effects before unconsciousness ensues. The officials, referee, judges, and coaches can recognize the player when he is “choked out” (becomes unconscious). If enforcement officers are to use the choke holds to subdue violent suspects as a last resort, they should be properly trained and supervised by trained certified judo instructors. Then possibly there will be less misuse or abuse of the techniques of choking which, when used improperly, result in fatalities.
The number of fatalities resulting from the use of choke holds will decrease if the following procedures are followed: