For decades, police in the United States have been warned about the dangers of handcuffing someone while they are facedown. This position, known as prone restraint, can become deadly if officers put too much pressure on the person or keep them in that position for too long. Recommendations from major police departments and associations first led to a federal safety bulletin in 1995. This bulletin explained that keeping someone on their chest can restrict their breathing dangerously. The solution offered was simple: after handcuffing someone, turn them onto their side.

Despite these clear guidelines, some officers today are still using methods that conflict with these safety recommendations. This ongoing issue reveals significant gaps in police training, as discovered in an investigation by the Associated Press (AP).

The AP found that prone restraint was involved in over 1,000 cases of people who died after police used force that was not intended to be lethal. Out of these, at least 740 cases involved prone restraint, making it the most common tactic used. Unfortunately, this method was often misapplied.

Each state has its own standards for police training, and individual departments and training centers decide what officers learn. This means that the safest techniques do not always reach the officers on the street. What officers know about the risks of prone restraint often depends on where they are located.

Most states have a Peace Officer Standards and Training (POST) agency that sets the required training content. The AP asked each state’s POST commission whether they include training on positional asphyxia, which happens when a person’s chest cannot expand properly, cutting off their oxygen supply. Out of the states that responded, 10 said they did not require training on positional asphyxia, while 20 said they did include it in their training.

To understand what officers knew before deaths involving prone restraint, reporters examined thousands of pages of interviews and depositions. In nearly 100 cases, AP found documents showing whether officers had training in or knowledge of the risk of positional asphyxia. In 80 of these deaths, at least one involved officer had been trained or knew the dangers but did not always move the person off their stomach quickly. In 14 other deaths, officers either said they had no training, could not recall their training, or were taught that the prone position is safe.

Some officers held onto two common misconceptions: that if someone can talk, they can breathe, and that struggling for air means they are resisting arrest. However, to speak, air must pass over the vocal cords, which does not mean the person is breathing properly. There is a significant difference between someone fighting officers and someone fighting to breathe.

“There’s a big difference between fighting the officers and fighting for breath,” said Seth Stoughton, a University of South Carolina law professor and national use-of-force expert. Stoughton, a former officer and police trainer, has written extensively about prone restraint.

California passed a law in 2021 stating that police departments “shall not authorize techniques or transport methods that involve a substantial risk of positional asphyxia.” The law’s sponsor intended to limit prone restraint. However, some instructors at state-certified training centers continue to teach that holding someone facedown is safe.

David Rose, a senior instructor in California, has taught thousands of officers that prone restraint is safe over his 40-year career. Rose advises officers to use as little pressure as necessary unless the person is combative. He believes his methods comply with California’s law because he does not think prone restraint carries a serious risk of positional asphyxia. “Positional asphyxia doesn’t happen at all. In the field, it doesn’t happen,” Rose said in an interview.

Rose’s belief is based on studies from police-aligned lawyers, professors, and experts who defend officers in court. According to the AP’s database, medical officials cited prone position or asphyxia due to restraint as a cause or contributing factor in 61 of the 740 cases during the 2012-2021 timeframe. In many other cases, drugs or medical conditions were listed as the cause of death instead of the force used by police.

The California Commission on Peace Officer Standards and Training (POST) was contacted by AP about Rose’s teachings. POST confirmed that Rose’s methods did not comply with state requirements. “POST is taking action and has notified the (Sacramento training) center that they are not compliant with the law. The issue will be remedied,” said spokesperson Meagan Poulos.

This ongoing issue highlights the importance of consistent and thorough training for police officers to prevent unnecessary deaths and ensure the safe handling of suspects.