This comprehensive review of the medical, legal, psychological, and administrative aspects of violent restraint encounters offers insights into controlling such incidents. The authors assess the medical considerations in such cases, including how the stress of an encounter may influence the physiological responses of the subject, how chemical substances may affect the behavior of and contribute to the death of the person in custody, and offer an explanation of the role of excited delirium. The authors also address the use of force involving neck holds, restraints, aerosols, tasers, and other physical restraints. Numerous examples illustrate the nature and problems associated with sudden in-custody restraint deaths, along with a survey of the issues involved in performing a custodial death investigation and the legal question of civil liability. The authors also discuss risk management strategies, policy and procedure concerns, training issues, subject monitoring, prisoner transportation, officer incident reporting, and investigating an incident from an agency perspective.