Wild

Many years ago, I watched a long video of a police scene in California, where a man who was reported to be on “angel dust” (PCP), was being held down by police officers.  The officers chatted among themselves while the camera focused in on the man who was pleading for help.  I watched as the man’s breathing slowly changed to a pattern unmistakable to a paramedic.  His breathing became agonal.  Think of a fish lying on a pier, tiring out, gasping, respirations slowing as it slowly dies.  A normal person breathes 14-20 times a minute.  He was breathing 4, then 2 times a minute, then he wasn’t breathing at all.  The officer remained on top of him.  Minutes passed.  An EMS crew showed up, and then a officer said so them.  “Be careful, he’s crazy.  He’ll go wild on you.”

The crew picked him up and put him on their stretcher.  You could see them put him in the back of the ambulance.  One EMT was putting a nonbreather on him, and then another said loudly, “He’s not breathing!”  Then you could them doing CPR.

The whole video, which a medic gave to me on a CD was about 18 minutes.  It was horrifying to watch.  I played it at some CMEs.  We can see the man dying and yet the officers have no idea what is happening to the man in their custody.   I played the video as an example of how you need to pay attention to your patient and the dangers of positioning that can lead to asphyxia.  I don’t know the upshot of that particular case.  I would bet the autopsy showed the man had drugs on board (likely amphetamines or PCP) and that he died of excited delirium complicated by positional asphyxia.  Excited delirium can kill with a combination of overheating, rapid heart rate, exertion (physical and mental fighting against restraint) and a faulty regulatory system.

There is much controversy on the subject and some have said, excited delirium is an excuse to cover up deaths in police custody.

Death by Excited Delirium: Diagnosis or Coverup?

What is “excited delirium” and how should police react?

Here is a police training video about it, and as a warning, it includes a graphic video of a man dying, and the officers being slow to recognize it.

It is not uncommon for EMS to show up at scenes where police officers are holding agitated people on the ground.  In Hartford, these patients are often on PCP, which is even more prevalent than heroin in our city.  When I show up I always sedate these patients.  I don’t believe in just using physical restraints, and would rather not use them at all.  While the police hold them down, I give the agitated patients 10 milligrams of Versed though an intramuscular shot, and then I tell the police officers not to rile the person while we wait for the medicine to take effect.  Usually by the time we get to the hospital, the patient is sound asleep.  Most officers are cool.  But there have been some cases were I have seen what I would call excess force. Most will listen if you tell them to ease up.  I don’t recall seeing anyone hold their boot on a man’s neck. 

I haven’t watched the George Floyd video.  My memory of the scene I described is still quite vivid.  And having just watched the training video above, I don’t have the stomach right now to watch another death.

I am not saying George Floyd was on drugs or that he died of excited delirium.  It doesn’t matter.  What matters is that a man died who didn’t have to.  We can point all our anger at the officer who did it, but we have to recognize the system that allowed it to happen.  You can bring racism into it, and I think that is fair.  If George Floyd was white, this probably wouldn’t have happened to him. 

In the end, whether you are a paramedic, a police officer or a regular citizen, what matters is caring about your fellow man.  Solid citizen or someone who has lost their way, it doesn’t matter.  It’s not cops and robbers.  Yes, you have to arrest people who break the law, but no don’t treat them with disrespect and you don’t allow harm to be done to them.  We don’t live in the wild west.  We have to fight for each other.  Not us against them.

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