"Choking Game" and other Fainting Games

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The game that young people call the "choking game", which has been picked up on in the media and which the media helps to spread, is certainly not new. However, new communication channels have taken away the secrecy surrounding various practices that share the same aim of inducing cerebral hypoxia whilst they portrayed them as trivial or even harmless. Given that it may never be in our power to control the flood of information over the Internet, how can we convey full, objective information, which is still the best means of prevention against the pipe-dreams, manipulations and lark mirrors?

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Published 01 July 2010
Reads 176
EAN13 9782296702547
Language English

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APEAS
International Symposium
“Choking Game” and other Fainting Games
Practices, Consequences and Prevention

Françoise Cochet (ed.)
APEAS President



APEAS
International Symposium
“Choking Game” and other Fainting Games

Practices, Consequences and Prevention



















































L’HARMATTAN

© L’Harmattan, 2010
5-7, rue de l’Ecole-Polytechnique, 75005 Paris

http://www.librairieharmattan.com
diffusion.harmattan@wanadoo.fr
harmattan1@wanadoo.fr

ISBN : 978-2-296-12292-5
EAN : 9782296122925



APEAS
International Symposium
“ChokingGame” and other
FaintingGames: Practices,
Consequences and Prevention

INTRODUCTION............................................................................ 13
FRANÇOISECOCHET................................................................. 13
APEAS President
DOMINIQUEDEPENANSTER..................................................... 17
Promotion de la santé et prévention des maladies
chroniques
Direction Générale de la Santé
JEAN-LOUISNEMBRINI............................................................. 21
Chief Director – Primary and Secondary Education
INTRODUCTION............................................................................ 26
JEAN-FRANÇOISDEHECQ.......................................................... 26
Chairman ofthe Sanofi-Aventis Board of Directors
JOCELYNLACHANCE................................................................. 30
PhD Student in Sociology, University of Strasbourg,
Université Laval de Québec
FAINTING ANDSUFFOCATIONPRACTICES INCHILDREN:
IMMEDIATE ANDLONG-TERMCONSEQUENCES........................ 31
DRJEANLAVAUD..................................................................... 31
Doctor and Emergency Paediatrician

6

International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

THECHOKINGGAME ANDITSVARIANTS: A
PHYSIOPATHOLOGICALAPPROACH TORISKS INTERMS OF
MORTALITY ANDSUBSEQUENTEFFECTS INCHILDREN AND
ADOLESCENTS.............................................................................. 35
DRFRÉDÉRICJOYE................................................................... 35
Director of Emergency Care Training Centre – Aude
ASPHYXIALGAMES OR“THECHOKINGGAME”:
EVALUATION OF APOTENTIALLYFATALRISKBEHAVIOUR... 41
DRANDREWMACNAB.............................................................. 41
Paediatrician, Professor at the University of British
Columbia – Vancouver, Canada
ASPHYXIALGAMES INCHILDREN ANDYOUTH......................... 46
DRTHOMASANDREW............................................................... 46
Paediatrician, Forensic Scientist, Chief Medical
Examiner – State of New Hampshire
ONCONSTRICTION OF THENECK ANDALTEREDSTATES
OFCONSCIOUSNESS: WHAT THEMEDICALLITERATURE
TEACHESUS................................................................................. 50
ANNECORREAGUEDES............................................................ 50
Professor – Universidade Autonoma, Lisbon
FROMLACK OFPREVENTION TOCHOKINGGAME
INCITEMENT. WHATPRACTICESLAWMUSTCONSIDER? ....... 60
MARIE-LAURELAFFAIRE.......................................................... 60
Trial Lawyer, Paris Bar
JEAN-MARIEHUET.................................................................... 64
Magistrate Director ofCriminal Affairs and Pardons
Ministry of Justice – Paris
CHOOSINGPUBLICPOLICIES TOPREVENTSUFFOCATION
PRACTICES INCHILDREN ANDADOLESCENTS.......................... 66
HAKIMAAITELCADI............................................................... 66
Sociologist, Anthropologist, Specialist in Adolescence,
Avignon
GAMES, DANGERS ANDRITES..................................................... 68
THIERRYGOGUEL D'ALLONDANS............................................. 68
Educator, Anthropologist – University of Strasbourg

APEAS -International Symposium, Paris the 3rd- 4th dec. 2009

7

ANTHROPOLOGY OFVERTIGO ANDFAINTING.......................... 70
DAVIDLEBRETON.................................................................... 70
Professor ofUniversitysociology and anthropology –
of Strasbourg
DISCUSSION WITH THEAUDIENCE.............................................. 83
JOSÉFERNANDEZ...................................................................... 83
Chousingha Association Founder
BREATHLESS................................................................................ 89
DRJEAN-CLAUDEFISHER......................................................... 89
Psychiatrist specialising in Adolescents
Marseille
ISTHERESUCHTHINGAS ANAT-RISKCHILD? THE
VIEWPOINT OF ACHILDPSYCHIATRIST.................................... 93
DRMARIE-FRANCELEHEUZEY............................................... 93
Child and Adolescent Psychiatrist
Robert Debré Hospital, Paris
TOEACHAGEITSFAINTINGPRACTICE? .................................. 96
DRCHRISTOPHERATHELOT..................................................... 96
Child and Adolescent Psychiatrist –Edouard-Toulouse
Hospital Complex, Marseille
DISCUSSION WITH THEAUDIENCE............................................ 102
HYPOXYPHILIA: THREECASESINCLUDINGA TWO-FOLD
ONE............................................................................................. 106
ANNECORREAGUEDES.......................................................... 106
Professeur – Universidade Autonoma, Lisbonne
INTERNATIONALROUNDTABLE............................................... 111
PRESENTATION OF THENATIONALACTION BYTHE
VICTIMSDELEGATION.............................................................. 135
MARYVONNECHAPALAIN...................................................... 135
Retired Police Officer
THEBPDJ’SPREVENTIONEFFORTS: WORK WITH
STUDENTS, STUDENTRESPONSE, TEACHER ANDPARENT
POSITIONS, AWARENESS-RAISING IN THEMILITARY
POLICE........................................................................................ 139

8

International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

ALAINBOUCHERIE.................................................................. 139
Captain, ofGard BPDJ
HERVÉARREDONDO............................................................... 144
Captain of the Pyrénées Orientales BPDJ
FAINTINGGAMES: ANOVERVIEW
OFAWARENESSRAISINGEFFORTS...................................................................... 147
SCOTTMETHENY.................................................................... 147
Police Officer Specialised in Prevention, Willow Grove,
Pennsylvania, United States
DISCUSSION WITH THE AUDIENCE............................................ 153
ROLE ANDPLACE OFNATIONALEDUCATION IN THE
PREVENTION ANDRECOGNITION OF THECHOKINGGAME
AND ITSDERIVEDFORMS.......................................................... 161
FRANÇOISECUSIN................................................................... 161
Technical Medical Advisor, Academic Inspectorate of
Mâcon
INFORMATION ANDPREVENTIONMETHODS INSTITUTED IN
VARIOUSCOUNTRIESSTRATEGIES ANDAVENUES FOR
EFFECTIVEACTION ATNATIONAL ANDINTERNATIONAL
LEVELS....................................................................................... 168
DRFRÉDÉRICJOYE................................................................. 168
Director ofEmergency Care Training Centre – Aude
CARRIEDRAHER..................................................................... 173
Mother to Levi, Wichita, Kansas, USA, Author of the
ED4ED Programme
SHARRONGRANT.................................................................... 175
Mother ofJesse, President of the Association GASP,
Ontario, Canada
& KRISTENGRANT................................................................. 175
JOSEFERNANDEZ.................................................................... 177
Chousingha Association President
JEAN-LUCDENNY................................................................... 181
Head Educational Advisor and Trainer, Strasbourg
Rectorate
FRANÇOISECOCHET............................................................... 183
APEAS President

APEAS -International Symposium, Paris the 3rd- 4th dec. 2009

9


DRCHARLYFAMPOUTOUNDJI............................................... 187
Head of Public Health, Municipal Health Centre,
Noisyle-Sec
DISCUSSION WITH THE AUDIENCE............................................ 191
CONFERENCECLOSING............................................................. 198
FRANÇOISECOCHET............................................................... 198
APEAS President
JOSÉFERNANDEZ.................................................................... 200
President of Chousingha Association








rd
Thursday, 3December 2009




Introduction

Françoise Cochet
APEAS President

I think we willget started now, even though we are still
awaiting anumber ofpeople, who are at the registration desk,
because we do not want to get too far behind schedule.
On behalf of Apeas Association, of which I am President, I
would like to thankyou for attending. I also thank all those who
hadplanned to attend today andwho wereprevented from doing
so, either bythe flu or vaccine shot requirements. We have not had
much luck, given the concurrence of this issue.
Inparticular, I wish to thank Roselyne Bachelot-Narquin,
Minister of Health and Sport, for havingkindlyagreed to host this
event, and lent us this room and all of the equipment in it for these
two days of our conference. She will be represented by Doctor
Penanster, from the French National Health Directorate.
I also thank Luc Chatel, Minister of Education, who was unable
to make himself available over these two days, but who will be
represented by theDirector General of Primary and Secondary
Education, Jean-Louis Nembrini.
I wish to thank Marie-Dominique Simonet, Minister of
Compulsoryin the French-S Educationpeaking Community of
Belgium, for her support. She will be represented by Etienne
Jockir, Advisor to the PMS Centres.
Patrick Gérard, Rector of the School Board and Chancellor of
the Universities of Paris, whom I thank for his support, kindlysent
Sylvie Gonnet, Technical Advisor to the Rector’s Office, to
represent him.
Mysincerestgratitudegoes to Jean-François Dehecq, Chairman
of Sanofi-Aventis, who, foryears now, since 2002, when upon
being informedof our initiative, he immediately recognised it as
the serious health issue that it is and the need to break the taboo on
this form of children’s “play” – for, indeed, it is “play”, which

14International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

actually translatesintopractices that can turn out deadly orhave
disastrous consequences (i.e.,permanent disabilities). These
practices have been so widespread for dozens ofyears,yet
ultimatelyonlycame under scrutinyin 2000,previouslyunknown
toparents andprofessionals, meaning physicians or nurses, alike.
Jean-François Dehecq recognised this as apublic health issue
before us and has unceasingly supportinghel us,ping usout and
advisingus. His sponsorshipdepartment at Sanofi-Aventis,present
with us today, also deserves our sincerest thanks for its support,
headed by DirectorCaty Forget, as well as the entire team at the
department.
I would also like to thank the French MPspresent in the room
or soon to arrive, inparticular those from the UMP, who worked
all summer on a report on this topic: Cécile Dumoulin, Member of
Parliament representingYvelines and Patrice Verchère, MP the
representingthe Rhône. As well, I thank the Belgian MPs and their
representatives.
On behalf of the association, I would like to express our
profoundgratitude to all of those who agreed to speak at this
conference.
Jean-Marie Huet, Judge and Director of Criminal Affairs and
Pardons at the Ministry ofJustice, kindly agreed to share with us
howpenal law considers these practices. He will join us later this
morning.
Professors Andrew MacNab and Thomas Andrew, who crossed
oceans to be with us for these two days, will share their work and
thoughts with us as well.
Doctor Marie-France Le Heuzey, who agreed to come share her
opinion, as a child and adolescent psychiatrist, as well as her
conclusions.
Dr CharlyFampou-Toundji and the cityof Noisy-le-Sec, where
he ispublic health coordinator, who will talk about his experience
in prevention.
Naturally, I think all of the members of our Scientific
Committee, composed –you will hear each of them, so I will not
mention them each by name– doctors, emergency doctors,
paediatricians, sociologists specialised in risk behaviours,
including one Professor from the University of Strasbourg,

APEAS -International Symposium, Paris the 3rd- 4th dec. 2009

15

psychiatrists, childpsychiatrists, as well as oneperson who comes
from Lisbon, who has carried out agreat deal of research on the
existingliterature and will address a particularly thorny topic for us
tonight.
I also wish to thank the National Civil Police Force, the
National MilitaryPolice Force, the United States Police Force, also
represented today, the Ministry ofthe Interior’s victims’
delegation, which has launched a number of very important
initiatives,preciselyat informin aimedgcivil thepolice, the
military police and also the fire-fighters. The Victims’ Delegation
will be represented by Ms Chapalain, a police officer who retired
this summer.
I also thank the entire national education community. In
addition to Mr Nembrini, it is represented inparticular by
Françoise Cusin,physician and technical advisor to the
Saône-etLoire School Board, which has beenpartner to our association for
many years. She will also speak tomorrow afternoon and her
presentation of what her department has achieved will be very
valuable to us.
My sincerestgratitudegoes to the families of the victims
present and who will remain with us throughout these two days.
Not all of the victims’ families are here, of course, as their large
numbers would have more than filled this venue, Salle Laroque.
These are families of victims andparents who have committed to
carryingout information andprevention initiatives, orparents who
areprofessionals themselves, for instance, in medicine or biology
or nursing. I thank all of theparents who came from different
continents, spending manyin air hoursplanes tojoin us and who
will speak, tomorrow, about the initiatives underwaytheir in
countries and how they managed to break the taboo on thisgame
that has taken so many lives.We learned of further deaths this
week in France as well as abroad.
I will conclude by addressing special thanks to theparents of
victims who have come together in two associations, Chousingha
and Gasp, and the Caljar Support Committee, several
representatives of which are here today.
Thanks to Cabu, for the drawinghegave us for this conference.
Thanks to Davywho will sing us his “Indian Dream” Kilembe,
song tomorrow.

16International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

As stated, we will start bysettingout the issue. We will tryto
understand the why, the how, the causes and the consequences.
Whyare thesepractices so dangerous? How can we warnparents,
of course, but also children – from theyoungest to those at
universityof the horrif –ying consequences of thesepractices,
which they believeto be harmless, which theyare totall thinky
commonplace and which cause deaths, as I toldyou, every month
in France and, as I stated, across the world. Thank you.

APEAS -International Symposium, Paris the 3rd- 4th dec. 2009

17

Dominique De Penanster
Promotion de la santé et prévention des maladies chroniques
Direction Générale de la Santé

Madame Françoise Cochet, Chairperson,
Ladies and Gentlemen,
I would first like to apologise on behalf of Roselyne
BACHELOT, Minister of Health and Didier HOUSSIN, Chief
medical officer in France, who are sorry thatthey areunable to
open this conference but have been detained elsewhere in
connection with the ongoing flupandemic, as I'm sureyou will
understand. They haveasked me to represent them and to assure
you of the close attention with which theyare following the topic
that has brought us together for these two days.
I amparticularly pleased to welcomeyou to the Ministry of
Health, to demonstrate the support of the FrenchDepartment of
Health and my department inparticular for the work of the
Association of Parents of Children Involved in Strangulation
Accidents (Association de Parents d’Enfants Accidentéspar
Strangulation, Apeas), which has organised this event. Preventing
risk behaviour inyoung people is one of the key aspects of the
public healthpolicythis se ingment of thepopulation which
Roselyne Bachelot initiated in February 2008 in the Youth Health
Plan.
Every accidentis a tragedy. And it is all the more so when a
young person is involved and when the outcome is disability or
death. But these causes of morbiditymortalit andyavoidable are
and that is why theMinistryHealth undertook to fi ofght against
dangerousgames twoyears ago, whenyou, Madame Cochet, came
to present the problem to me at our first meeting.
On that occasion, introducing your association to me,you said
that: “Our onlyis that no one should ex wishperience the
nightmare that we have been through, and that no another child or
teenager should die because he or she tookpart in a foolishgame,
unaware of or under-estimatingthe danger involved”. We can only
reiterate these words and make the battle thatyou are fightingour
battle. Eachyear in France and in Europe, many children and teens
become victims of hazardous games.

18International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

By engaging ortaking part in them, voluntarilyotherwise, or
theseyoung people are often unaware of the dangers involved or
the disastrous consequences to which they expose themselves.
Even thougresultinh, accidentsg"scarf fromgame(the most
widely-known) and the work developed byA thepeas in reaching
the authorities' and media's attention, has started to encourage
discussions on this tophealthcareic, families,professionals and
professionals workingin contact withyoung people are still largely
unaware of the extent of thephenomenon of dangerousgames and
their consequences. Added to this, there is a heavy silence
surroundingthephenomenon, both amongthe children andyoung
people themselves and sometimes amongofficial bodies, hence the
limited amount of data about the actual frequency of such
activities.
When a tragic accident does occur, it is difficult to identifyit as
such, since dangerousplaynot necessaril doesy cometo mind as
thepossible cause. This explains whyepidemiological data on the
topic are scarce and scattered, coming froma variety ofsources
which cannot easilycom bepared in order to establish reliable
national statistics.These sources include the Ministry of
Education, hospital emergencythe French emer rooms,gency
services, the civilpolice, military police,local authorities,
associations like Apeas and others still.
It is estimated that 15 to 20young people die eachyear in
France as a result of engagingthese ingames. Thesefigures
probably under-represent the reality, since some accidents are
considered to be suicides byhangingor strangulation, or even the
accidental outcome of traditional games.
It is therefore very difficultto establish trends and ideas are
needed as to how data can begathered more effectively, so as to
obtain a better understandingof thisphenomenon and therebyadd
to the studies that have been carried out in France and
internationally. These dangerousgames areplayed bychildren and
teenagers withinthe familyas well as in the school circle
environment, and are spread inparticular by theInternet, where
certain sitespromote such games without any warning about the
hazards involved.
Several types ofgames exist, and are categorised as intentional
or forced (meaning that the child takes part in the game

APEAS -International Symposium, Paris the 3rd- 4th dec. 2009

19

unwillingly), but mayalso varyin how theyare carried out and in
the circumstances surroundingA distinction is made them.
between the following, under a wide variety ofnames:games of
assault, in whichgratuitousphysical violence is used by agroup
against a child chosen as a target or scapegoat throughout an entire
day, based on apretence determined in the morning(e.g., clothing
of a certain colour, their birthday, etc.)games of
oxygendeprivation, choking, suffocation or fainting, to which the “scarf
game” belongs, and which are some of the oldest.This categoryof
play, which is the focus of this conference, consists of obstructing
breathing, thus slowing oxygen flow to the brain and creating
anoxia, in order to experience intense sensations
orpseudohallucinatory visions,sometimes heightened by attempting to
hyperventilate, leadingto loss of consciousness, coma and, in some
cases, death.The risk of death is even higher when the young
person repeats the game alone at home.

This two-dayevent will focus on oxygen-deprivation or fainting
games. Myoffices also addressgames of assault, in view of their
impact on theyoung people's health and the violence they
represent. As well asgainingbetter agraspthis devastatin ofg
trend, it is important that we fight it and, in this respect, the best
weapon is prevention.

Prevention means spreading informationabout the risks
associated with such activities to thegeneralpublic and healthcare
professionals, who need to be aware of certain symptoms that
young people maydisplay(signs on the skin of the neck, buzzing
in the ears, headache, withdrawal, etc.), as well as toprofessionals
workingin contact withyoung people, especiallythose in the State
education system. When targetingat informationyoung people,
special care must be taken in determining thequantity, angle and
educational impact of the messages, so as not toproduce the
opposite effect from the one sought and instead put ideas into
young people’s heads.

Madame Cochet, I am aware of the many conferences,
discussions and information andprevention sessionsyou hold with
young people and know thatyou will fight unfailingly toprevent
families from experiencing tragedies like these. Dissemination of
the materialsyou have developed topreventyoung people from
taking part in fainting games is vital for professionals in the fields

20International Symposium, Paris the 3rd- 4th dec. 2009- APEAS

of healthcare and education.Theyhelpthem work effectivelywith
children and contribute to buckingthe trend and, ultimately wiping
it out, in line with the target you have set out.
For this reason, over these last twoyears, the Ministryof Health
and Sport hasprovided its support to Apeas, so that there can be
moreprevention initiatives and so that healthcare and education
professionals can be informed of and trained in theprevention
methods that can be used toprevent such tragedies. Our work also
completes the work beingb doneyMinistr theyEducation and of
more specially, the Directorate General for Primaryand Secondary
Education, which has also been involved, for many years in action
toprevent violence, one example of which is the brochure,
“Dangerous Games and Violent Practices”, available at the
Eduscol Web site.
Thepthe officialsfrom the Ministrresence ofy ofEducation
and National Police Force at this conference, as well as the address
byDirector General of Primar theySecondar andy Education
scheduled for tomorrow show that all of the relevant Ministries are
now mobilised to fight this seriousproblem in our society. You
stated that these two days should broach the topic of dangerous
games, exploring eventheir most complex aspects.The agenda
shows a wide range ofpresentations which will surelycontribute to
an extremely productive exchange,particularly through
experience-sharing with the foreign representatives expected
tomorrow.
I will unfortunately notbe able to be here withyou for both
days, but will keepa keen ear to the conference conclusions.We
will meet again to officiallyu setp otherinitiatives, of which this
conference is onlythe start. I wishyou all a successful conference,
one that allowsyou to makeyour contribution to fightingthis trend
affectingour children andyoung people and to which no one could
be indifferent, whether they are a parent or not.