Massad Ayoob on Choke Holds

Excerpted by Jay Wiseman, JD

The following is taken from “Fundamentals of Modern Police Impact Weapons” by Massad Ayoob – published by Police Bookshelf books in 1996. Some of you likely recognize the name. Mr. Ayoob is a police officer and a nationally prominent expert on the police use of force, both lethal and non-lethal, with many publications and a great deal of expert witness court experience to his credit.

This essay of his soberly weighs the risks involved in the use of choke-holds by police against the social usefulness of using such holds to subdue suspects.

In a breath-play situation, one would weigh the risks involved in the use of choke-holds against the social usefulness of using such holds to engage in “recreational sexual strangulation.”

Beginning on page 132:

THE “SLEEPER HOLD”: IS IT TOO DANGEROUS FOR POLICE TO USE?

The “sleeper hold,” which mystified commercial wrestling audiences for years, exists. Martial artists have known of it for centuries. It operates on the very simple premise that (a) the carotid arteries carry blood into the brain via the neck; (b) the brain requires a substantial quantity of freshly oxygenated blood to function; therefore (c) if one blocks the carotid arteries the subject’s brain ceases to function, beginning almost immediately with unconsciousness.

But it isn’t that simple. The brain is the most complex organ of the body, and when you start messing with it you can cause a lot of problems you don’t realize.

Various sleeper holds, or “choke-outs,” are taught in law enforcement. Let’s look at them, then examine their use in the light of tactical applicability, morality, and the basic laws of both society and medicine.

Applying the Sleeper Hold

Forget about putting an opponent to sleep by grinding your knuckle into the hollow beneath his ear. The carotids are located beneath and ahead of the bone of the jaw. To occlude them – block them off – you must apply pressure on both sides. On one side only, impairment of consciousness will take much, much longer and besides, in a fight situation, it is virtually impossible to hold the neck still enough to apply pressure on one side if you aren’t already applying it to the other.

There are many methods, and most of them work better when applied from behind. There are several stick techniques, useful with conventional batons (preferably 18 inches or more), the Prosecutor baton, or the nunchaku sticks that more and more officers are carrying. They are explained in Figures 53 and 54. One trouble with all of them, as will readily be seen, is that it is extremely hard to apply them without putting pressure on the cervical spine as well as the carotids.

Properly applied, the “mugger’s lock” can be transformed into a sleeper hold. It won’t work as fast, because the bearing surfaces (your forearm on one side, your bicep on the other) are neither narrow enough nor unyielding enough to equal the degree of pressure you can generate with a baton “choke-out.” This technique is seen in Figure 55. Because the effect of this hold is so immediate, the officer should take care to protect his groin and eyes from a clawing hand, and his sidearm should be turned away from the suspect.

Judo-style choke-outs can simply involve grasping the collars a few inches down from the throat and forcibly crossing one’s hands, thus tightening the fabric of the collar sharply against the carotids. This works great if the man is wearing a heavy judo gi or a denim jacket, but most ordinary shirt will tear during the struggle, destroying the effect of the hold and leaving the officer with his hands uselessly tied up as the suspect counter-attacks. Any choke-out technique, or for that matter any two-handed hold applied from the front, is always dangerous to the officer for just this reason: The attacker’s hands are free while the officer’s hands are busy, and those hands may claw at the policeman’s eyes or groin, or punch his navel right into his lumbar spine.

There are other choke-out/sleeper-hold techniques, but those illustrated with this article comprise the ones that are most effectively applied by someone not in the martial arts, and the ones most commonly needed by American police.

Why the Sleeper?

On the surface, the sleeper hold appears to be an ideal technique for stopping trouble. If properly applied, it renders the subject unconscious in six to eight seconds – sometimes less if he is in debilitated physical condition, but often longer if he has thick neck muscles and is fighting furiously. If the officer doesn’t have it quite right, it can take much longer.

But let’s assume, oh, seven seconds. Here is a man subdued fairly rapidly, without a head broken by a baton, and without additional blood being spilled. And it often does work like this. In tough Camden, New Jersey, black belt Jim Phillips teaches a scissor hold on bar fighters and rambunctious drunks; usually, he and his students will apply just enough pressure to convince the subject to come along under his own power, but frequently, the subject will have to be rendered unconscious by the nutcracker-like pressure of the sticks. Phillips reports no serious injuries and states that physicians he has consulted in his police-instructor capacity have approved the technique as safe. That is at odds, however, with other medical opinion, as we shall see later.

Physical After-Effects

In most cases, the choke-out produces little in the way of after-effects. Most subjects will experience a headache when they wake up. Often, they will vomit upon awakening, just as do many who are rendered unconscious by blows. They may be disoriented or a little “spacey” for a period of time.

Duration of unconsciousness is unpredictable. If the hold has been applied for the minimum amount of time, the person regains consciousness in less than a minute. It will usually take several. At worst, if the lock has been held too long, if the person has the wrong kind of chemicals in his system, or there are physical problems that have been aggravated by what has happened, he may never wake up.

And these possibilities are many. They were pointed out to us by doctors who were familiarized with the various choke-out techniques and asked about what could be expected. They included a neurosurgeon, a cardiologist, an ophthalmologist, and a specialist in internal medicine. They told us we could expect the following in a certain percentage of choke-out victims.

STROKE. A stroke occurs when the blood supply to the brain is interrupted. A choke-out or sleeper hold also works when the blood supply to the brain is interrupted. The difference is one of degree. When talking about something as delicate as the human brain and central nervous system, those degrees are often too subtle for the layman to attempt to distinguish between. A stroke is especially likely in a suspect who, unknown to the officer who is forced to subdue him, has high blood pressure or any number of other cardiovascular problems. The physical condition of the subject is an unknown quantity to the officer, in terms of medical problems that he may have, and stroke is something that must be considered whenever the officer attempts to close off the carotid arteries of even a young and vigorous-appearing suspect.

HEART ATTACK. The pressure applied in a sleeper hold often focuses on a part of the arterial complex called the carotid sinus. In oversimplified terms, what happens here is a backup reflex on blood flow that can throw the heart into a violent response, causing heart attack.

CONVULSIVE SEIZURES. It is not at all uncommon for an individual to go into a series of convulsions resembling a grand mal fit of epilepsy when the carotid arteries have been occluded. This may occur in a person who does not suffer epilepsy, and I have witnessed such occurrences during martial arts exercises. It is, of course, much more likely in epileptics but can be expected to occur in the healthiest of subjects. [Note: In case it didn't come through, everything after the word "epileptics" in the last sentence is italicized in the original article.]

ASPIRATION OF VOMIT. Though vomiting is most common after the choke-out suspect has regained consciousness, it may well occur while he is still passed out. To prevent the vomit from being inspired (breathed) into the lungs, one has to suction out the victim’s mouth and throat. Well-equipped ambulance teams do this with electrically operated or bulb-type aspirators. The officer who has to keep alive a vomiting suspect he has choked into unconsciousness will have to resort to the other alternative: suck the vomit out of the suspect’s mouth with his own. Enough said.

BLINDNESS. We have been assured by both a neurosurgeon and an ophthalmologist that a properly applied choke-out, held for twenty seconds or longer, may cause permanent blindness. If you doubt it, and if you are certain that you have no cardiovascular, neurological, or eye problems, put down this book, then reach up and take your left collar firmly in your right hand and vice versa. Pull crossways, hard. You will feel immediately the pounding of your pulse, a flushing of the face, a sense of light-headedness, and, in a few seconds, a definite pressure in the back of your eyeballs. If you are still awake, pick the book back up and read on.

RUPTURED ARTERIES. This is most likely to occur in a suspect who suffers from arteriosclerosis, or hardening of the arteries with attendant narrowing of the actual passageways of the blood vessels. The backed-up blood pressure that occurs in a sleeper hold may burst the weakened arteries; so may release of the hold, when the blood comes rushing back in, again stressing the arterial walls. “So what,” say some advocates of the sleeper hold. “We’ll never apply this technique to any senior citizen with hardening of the arteries.” In fact, the condition may be present in people in their late twenties and a lot of people in their thirties, and it is particularly common among the alcoholics who start so many brawls. In the aftermath of such a subject’s untimely death, his unknown medical history may be obscured by the fact that “he dropped dead after the cop choked him.”

PERMANENT BRAIN DAMAGE. “Brain death” begins when oxygenated blood is withheld from the brain for a period of four to six minutes. Once those brain cells die, they never grow back. In the heat of a fight, most officers will keep the hold on until they are sure that the subject is really out. Indeed, if the hold is released too early, the suspect may recover his full faculties almost instantly. Few officers will hold a choke-out for five minutes, but they may hold it long enough to impair blood supply to certain parts of the brain long enough to kill them. The result can be a human vegetable, or one resembling a victim of advanced Parkinson’s disease. Quite apart from the moral considerations, such people are likely to win six and seven figure damage suits against police departments and individual officers.

SPINAL INJURY. Since by definition the choke-out involves a very forcible manipulation of the suspect’s neck, the danger of a broken cervical spine is always great. These holds are applied in such a way that if the neck does break (probably separating somewhere between the fourth and seventh vertebrae), the sharp ends of the spine will, under pressure, slice right through the spinal cord, which is the consistency of thick cheese or fatty meat, cuts easily, and can never heal. The result is a suspect who is now either instantly dead, mortally injured, or permanently quadriplegic.

This isn’t supposed to happen, some instructors say. It’s never supposed to happen, and in a training environment, it looks safe. As a police combat instructor, I have applied these techniques and had them applied to me without injury. But out on the street, they are tricky. Baton techniques are particularly dangerous in choke-outs, and particularly the Prosecutor baton, with which the handle goes behind the neck and can act like a fulcrum over which the bones are forced and snapped.

Sure, you’re pushing sideways so the neck won’t break, and applying just enough pressure to cause unconsciousness. But suppose the suspect suddenly goes limp, and 150 or 200 pounds of dead weight suddenly drop in a direction they aren’t supposed to? Or, what if (as you are applying your perfectly executed hold) another 200-pound barfighter is thrown into either you or your suspect, causing one or both of you to lose your balance or even fall?

At that moment, the sharp cracking sound you hear will be the suspect’s neck breaking, and the finality of that sound could be the end of your law enforcement career. A suspect accidentally killed or permanently maimed in a “non-lethal force,” “subdual” situation is extremely hard to explain away.

THROAT INJURIES. When you wrap sticks or brawny arms around people’s necks, it’s hard to avoid their throats. Even if you apply your hold perfectly to the sides of a person’s neck, totally avoiding the larynx and windpipe, you may slip during the struggle, or the fighting opponent may turn at an inopportune moment. Since you are concentrating on applying the pressure, you may not realize that you are crushing the throat until it is too late, until you hear the sound of the cartilage caving in, a sound like a hornet makes when you step on it, only louder and wetter.

A crushed larynx, at best, results in a suspect with a permanent vocal impairment. Most often, it means an airway that is blocked against everything, including artificial resuscitation. The only way out for this victim/offender is a tracheostomy, the slitting open of the windpipe below the injury coupled with the insertion of a breathing tube. This procedure, once “taught” to everyone but, or perhaps including, the Boy Scouts, is actually very easy to foul up. It is no longer taught even to Emergency Medical Technician classes (as one instructor put it, the EMTs are only “familiarized” with it), because so many people died after being clumsily “traked.”

Conclusions

It’s not hard to understand why something that renders a man unconscious in seconds with, supposedly, no after-effects, catches the imagination of lawmen who have to deal with violent physical confrontations.

But one must understand its shortcomings. First, it is hard to on a man you don’t already have at a tactical disadvantage and if that’s the case why choke him unconscious at all?

The danger of broken necks, crushed throats, strokes, ruptured arteries, seizures, and other life-threatening trauma is great in this supposedly “safe technique.” These things must be considered. The officer who does choose to apply them should be highly trained and skilled in emergency first aid treatment for the injuries that may result.

The Sleeper Hold: Most of the time, if you do it right, it will work great. But no matter how good you are, the time will come when you face a person who can’t take what it does to their bodies: a belligerent barfighter, who may have earned some bruises but who doesn’t deserve to die; a drunk who’s like you when he’s sober but isn’t going to be anymore because a choke-out hold has left him permanently injured or dead.

The sleeper hold works if you know how to use it. But it brings you into that dangerous area of a policeman’s use of force, that area between what you are allowed to do with your hands, and what you are supposed to do, if you have to do it at all, with your gun.

Know it. Be able to use it. But understand it, and only use it if there is no other choice that is safer to you and those you protect, and more humane to the person you must subdue.

If that sounds like the rules that govern your gun, it’s no coincidence. Both can kill. Both demand the respect of those who command their power.


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