Top Medical Experts Explore Safety of Vascular Neck Restraints. Will Their Findings Matter?

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Editor’s Note: The full study is available here – Safety of Vascular Neck Restraint Applied by Law Enforcement Officers

In 2021 federal politicians concluded that both chokeholds and carotid restraints – also known as vascular neck restraints (VNR) — were inherently dangerous and had “too often led to tragedy.” With this pronouncement, federal law enforcement officers were prohibited from using either a chokehold or carotid restraint unless deadly force was authorized.1

Reportedly, to incentivize state and local governments to similarly ban “chokeholds,” the U.S. Department of Justice proposed that federal law enforcement grants (e.g., “Byrne” and COPS grants) be limited to jurisdictions in which chokeholds and carotid holds were prohibited by law.2

When assessing relative risk, use-of-force experts question whether chokeholds and carotid restraints should be lumped together. Choke holds are intended to restrict breathing and are reasonably likely to damage airway structures as a result. At the same time, a “properly performed VNR does not apply pressure to the anterior neck, airway, or trachea, and does not impair respiration.”3 Dr. Bill Lewinski, Executive Director at Force Science, adds, “There is important research that indicates the vascular restriction stemming from a properly performed carotid restraint does not impair the vertebral blood flow that supports the critical, life-sustaining areas of the brain.”4

It follows that many agencies have limited chokeholds to deadly force encounters, with some states banning them altogether.  On the other hand, vascular neck restraints have enjoyed a reputation for being highly effective and reducing injuries to both officers and suspects.  That said, civic leaders and communities might reasonably expect that police use-of-force practices, including neck restraints, be founded on more than just reputation, anecdotes, and myths.  They expect to see the evidence.

Beyond Reputation, Anecdotes, and Myths

To better inform policy decisions regarding the training and use of VNRs by law enforcement, a group of highly-credentialed emergency medicine doctors published their latest research titled, Safety of Vascular Neck Restraint applied by law enforcement officers.5

Joined by top criminologists and sociologists, medical researchers reviewed VNR applications by law enforcement in both field and training environments.  Here is what the evidence showed.

Over an 11-year period, three North American law enforcement agencies collectively applied VNRs over 940 times while arresting combative or resistive subjects.6 An additional 230 police uses of the VNRs were identified in a separate 2021 report.7 Combined, these 1,174 instances of law enforcement’s use of VNR found no significant injuries (i.e., moderate or severe injuries) and no deaths. Further, the risk of minor injuries was low.

On the training side, researchers reported that approximately 85,918 officers/trainees received initial and/or refresher training.  During the training, over 14,000 students received at least one VNR with full pressure, and 71,835 received multiple partial pressure applications.

For field uses, the success of a VNR was defined by its effectiveness in allowing apprehension of a resisting or combative subject.  Of the agencies reviewed, the aggregate success rate was 92%.  Notably, one agency reported that 76% of their effective (i.e., allowed apprehension) VNR applications did not result in the suspect losing consciousness.

Effective but How Safe?

Researchers involved in the VNR study were interested in more than just tactical effectiveness.  Hoping to inform both police policy and evidence-based recommendations for medical providers, researchers set out to determine the rate of medical complications after a VNR use.

Of the 944 VNR field uses by law enforcement, researchers observed that there were no fatalities and no significant (moderate or severe) injuries related to VNR uses.  Of the nine subjects with reported injuries following the use of a VNR, only one injury was a direct result of the VNR, and it was mild (i.e., neck soreness).  The remaining injuries were also evaluated as mild and resulted from other causes (e.g., grappling, canine deployment, conducted electrical weapon use).

In the training arena, of the estimated 85,918 students, no fatalities or significant injuries were reported. There were 76 mild injuries reported, most (61%) related to grappling, while only 29 (38%) of the injuries were due to the VNR application (e.g., neck and shoulder soreness, dizziness, headaches).8

Rare but Serious Complications

The large sample in this study allowed the researchers to conclude that the VNR was a highly-effective and safe option for law enforcement.  Even the risk of minor injury was low.  Still, researchers noted, “These findings do not exclude the possibility of a rare serious complication or guarantee safety if the technique is not applied correctly.”

Dr. Lewinski echoed the researchers’ warning, “The safety of the VNR is directly tied to its proper application, and training is key.  Not only do we expect officers to know how to apply a proper VNR against a dynamic and resisting suspect, we expect them to know which people to avoid.  That may mean officers will avoid using the VNR against very young, the elderly, and those people with obvious head or neck injuries.  We would also highlight the risk associated with a VNR against people with features commonly associated with Down syndrome.”

Beyond Safety and Effectiveness

As police reform activists and academics advocate for evidence-based policing, we see a renewed emphasis on pushing research into practice.  That said, as with any measure of police effectiveness, the desired social outcome of the reviewer may determine whether an evidence-based practice will be embraced or rejected.

Unfortunately, myths and misinformation surrounding the VNR (and in-custody deaths generally) will continue to drive policy decisions.  In other words, political and community support for any police practice may involve more than just safety and effectiveness.

Consider, if traditional law and order interests (e.g., officer safety, public safety, law enforcement) are priorities, then intelligence-led policing, problem-oriented policing, and effective and safe force options may prove most useful in accomplishing those goals.

However, where civic leaders prioritize other political or social interests, evidence-based recommendations may be less about effectiveness and safety and more about restoring a perception of legitimacy, accountability, and community involvement.

In announcing the federal limitation on chokeholds, the U.S. Attorney General explained, “The Department of Justice today announced written department-wide policies explicitly prohibiting the use of ‘chokeholds’ and ‘carotid restraints’ unless deadly force is authorized….”

The Attorney General continued, “Building trust and confidence between law enforcement and the public we serve is central to our mission at the Justice Department.” “The limitations implemented today on the use of ‘chokeholds,’ [and] ‘carotid restraints’ […], are among the important steps the department is taking to improve law enforcement safety and accountability.”

With law enforcement (and citizen) safety among the goals of the Department of Justice, then the Safety of Vascular Neck Restraint applied by law enforcement officers will be of great interest in future policy development.

Still, there are challenges for even the most thoughtful civic leaders.  If constituents refuse to distinguish the chokehold from the VNR or choose to view chokeholds—and, by extension, the VNR—as symbols of enduring police racism and abuse, the call to ban all neck manipulations will likely continue.

One local NAACP president opined, “A chokehold by another fancy name is still a chokehold. Whatever the name may be, it is really another attempt by an officer to put his arm around someone’s neck,” “When we see someone with their arms wrapped around someone’s neck, that is a chokehold.”9

Researchers succinctly identified the irony, “The absence of fatalities or significant injuries demonstrated by our data, combined with a high success rate and lower overall subject injury rate compared to other force options reported in another recent study, suggest that these bans may be unnecessary when the VNR technique is executed by well-trained LEOs.”

The researchers continued, “Further, banning a safe and effective force option may be counterproductive by forcing [law enforcement officers] to utilize other force options with higher risks of injury.”

Additional articles related to the Vascular Neck Restraint can be found at:



  1. https://www.justice.gov/opa/pr/department-justice-announces-department-wide-policy-chokeholds-and-no-knock-entries []
  2. https://www.lexipol.com/resources/blog/dojs-proposed-2022-budget-for-grant-funding-reveals-focus-on-police-reform/ []
  3. Safety of Vascular Neck Restraint applied by law enforcement officers []
  4. See Samuel J. Stellpflug, Thomas R. Menton, Jesse J. Corry & Aaron B. Schneir (2020) There is more to the mechanism of unconsciousness from vascular neck restraint than simply carotid compression, International Journal of Neuroscience, 130:1, 103-106, DOI: 10.1080/00207454.2019.1664520 []
  5. William P. Bozeman (Wake Forest University, Emergency Medicine), Gary M. Vilke (University of California, San Diego, Emergency Medicine), Christine Hall (University of British Columbia, Emergency Medicine), Nicholas P. Petit (Wake Forest University, Emergency Medicine), Diane L. Miller (University of North Carolina, Emergency Medicine), Kristy K. Ford (Wake Forest University, Emergency Medicine), Brian Hiestand (Wake Forest University, Emergency Medicine), and Jason P. Stopyr (Wake Forest University, Emergency Medicine []
  6. The three law enforcement agencies participating in the study were the San Diego Police Department, the North Carolina State Highway Patrol, and the Royal Canadian Mounted Police. []
  7. Hickman MJ, Scales RM, Strote JM, Worrall JL. Use of VNRs in law enforcement: a case-study of Spokane, WA. Police Pract Res. 2021;22(6): 1668–1678. https://doi.org/10.1080/15614263.2021.1948849. []

  8. Researchers reported that, “These VNR-related mild injuries included neck and shoulder soreness, sprain/strain, or swelling, dizziness or headache, and one case of hemotympanum. There were no cases of cervical fractures, vascular injuries or dissections, strokes, or other intracranial pathology identified.” []
  9. Police wrestle with definition of chokehold, Los Angeles Times (quoting Gerald Hankerson, president of the Seattle King County NAACP), https://www.latimes.com/nation/la-na-chokehold-20141210-story.html []
7 Responses
  1. Steve Gibbs

    The one time I had to use a VNR, my partner was wrestling with a male on top of a gun that had come out of my partner’s improper, poor choice of a holster. He, the resister, quickly stopped resisting and was taken into custody. He did later collapse in booking but required no hospitalization. The next day in court he pled guilty but told the judge-“all i remember is turning to run and then I woke up in an ER!”

    1. Myself and another constable taught the entire Vancouver Police Department the use of VNRs back in 1986. I read the available literature and did a couple of biopsies on the human throat to gain a better understanding of the structures within the neck.

      I liked Dr. REAY’S paper on this topic:
      Reay DT, Eisele JW. Law enforcement neck holds. Am J Forensic Med Pathol. 1986 Jun;7(2):177. PMID: 3740018.

      There is a lot of misinformation floating around .as even evidenced in the use of the term “carotid” control. With proper training, this is an extremely valuable and safe technique.

  2. Ben O

    Most law enforcement officers are prohibited from using the carotid restraint unless deadly force was authorized. Due to this measure, the training for the carotid Restraint ceased. So what now? Officers respond to how they are trained. Without the training, the option doesn’t avail itself during a deadly encounter. Ironic, officers train in firearms for deadly force, yet not the carotid restraint. However, an eight year old can learn the carotid restraint at any Jiujitsu/ MMA gym. Maybe MMA should be considered “sanctioned murder” matches.

  3. Chris Leblanc

    I am a 25 year LEO with black belts in judo and jiujitsu (BJJ). In Washington State where I work the VNR is banned outright. This removes the most useful, effective, non- or minimally injurious control tool that works for people who are NOT OTHERWISE WELL TRAINED in control measures vs a committed, resisting subject.

    Simply put, police are now even more poorly trained than previously, where VNR was at least a mandatory yearly re-cert along with firearms quals and Taser pops. Removal thus effectively reduces what was already minimal training in physical control, at best.

    Perhaps ironically, in 25 years on the road I used VNR only once or twice. I did not need to, as I know how to control people without putting my arm around their neck. I am a roughly average sized man (though well trained), started LE later than normal (but well trained) and only left Patrol work at the end of last year though already into my 5th decade (but well trained). The theme here should be obvious.

    We have removed the VNR, already minimally trained, but which was a very effective tool for control for people who were not otherwise well trained. An 8 hour cert followed by yearly 3-4 hour re-certs is NOT under any legitimate measure adequate training. But it still worked.

    And we did not replace it with anything. The only effective tool to replace it with will be hands-on, arrest and control that is trained against progressive levels of actual resistance. That is NOT happening, except in small groups here and there espousing police jiujitsu, largely peopled by folks already doing jiujitsu, and thus not needing to be sold on “making it mandatory.”

    This is legitimate research making a valid point, but the article itself points out the issue is not over evidence-based policing, but politics. The same issue that has allowed police to be woefully undertrained and not required to engage in effective subject control training for the two plus decades I have been in the profession, just from a different angle. Hopefully science will prevail, but we have already seen what happens when politics co-opts “science.”

  4. bob tokarchic

    As a detective I once had an abduction/ attempted rape of a female in which the suspect applied a choke hold. I conferred with my medical examiner who stated the hold could have caused her death. By restricting blood flow through the carotid, the pressure builds and if released too quickly it could create a shock to the brain and contribute to death. I charged the man with attempted murder. I’m old school and believe VNR is extremely valuable and appropriate in life-or-death situations. Sgt Koons, LAPD, testified in the Rodney King case that he was prepared to use a VNR rather than use deadly force by shooting King. It’s a tool that has to be well trained and has to be used by mature officers who will adhere to the training under very stressful situations.

  5. Chris

    Except there are some problems with that point of view, regardless of whether it came from a medical examiner. Doctors can be wrong, too.

    For one, it is applied routinely across this country every night in training and every weekend at tournaments in both Judo and Jiujitsu, to a wide variety of people from across society (across the world) and of varying levels of health and we do not see any epidemic of deaths from either asphyxiation or brain shocks. Why? People do this FOR YEARS if not decades without adverse effect. That flies in the face of the assertion that it is on its face a deadly technique.

    However, hold on to it for a long time (in other words no tapping out and well past the point the person loses consciousness), or perform it improperly, and yes injury or death can occur. This speaks to the dearth of training law enforcement still receives.

    A real concern is this: the population described above are not generally long term addicts with additional co-morbidities. So we can’t really “know” whether someone officers may be strangling (its a strangle, not a choke, another big difference) someone whom it could kill, when the very same technique used on a different person would cause no injury. And I don’t see a way to overcome that issue.

  6. Steve Rickeard

    I spent 40 years in LE and was taught the Carotid Control Hold/VNR by Robert Koga in 1969. He was an instructor for LAPD and was the person that really brought this techniques from Judo field to the LE field. It has been used thousands of time in Judo and LE applications with very little injuries. It must be applied correctly which requires training and refresher training.
    The use of the VNR started to go down him when Chief Dayle Gates, LAPD, publicly talked about black people dying from “chokeholds”. Like many chiefs he did not know what he was talking about. Chief/Sheriff and gov. officials will always take the easy way out and get rid of effective police tools or techniques. Big city chiefs do not have to work the streets and deal with resisting suspects. They only care about keeping their jobs. Easy to throw officers “under the bus:”

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