The Role of the WRAP Restraint in Law Enforcement Restraint-Related Deaths

The WRAP (TW) is a full body restraint device increasingly used by law enforcement to control and immobilize individuals. Recent well-publicized fatalities associated with its use have raised questions of safety, especially as its instructions recommend use of prone positioning. To date, no study of these deaths has been performed. Our goal was to evaluate and describe the circumstances surrounding TW-associated deaths.

This is a retrospective descriptive study of TW-associated deaths. Cases were identified using Google, ChatGPT, and a publicly available Associated Press database. Autopsy reports were collected from medical examiners within the counties where the deaths occurred. Subject demographics, types of force and restraint used, and reported manner and causes of death were collected.

31 cases of TW-associated deaths were identified. Average subject age was 35 with a range of 17 to 57. Males comprised 97% of the population; 42% were Black; 39% White, and 19% Hispanic. Deaths occurred with restraint only (no additional types of force used) in 61% of cases. Prone restraint was specifically described in 74%. Among the multiple causes of death listed for each individual, stimulant use was described in 67%, restraint in 33%, and “excited delirium” in 11%. Deaths were deemed accidental in 58%, homicide in 16%, and undetermined in 26%.

In this study, limited to publicly reported cases, the demographics of and conditions surrounding TW-associated deaths are similar to other law enforcement restraint-related deaths. Described causes tended to be multi-factorial, and frequently involved a hyperadrenergic state, prone positioning, and/or prolonged struggle against restraints, all of which can lead to increased acidosis. Due to its design and instructions for use, TW has the potential to increase use of and length of time in prone positioning during restraint and further study is warranted.