Police and Emergency Medical Services (EMS) deal with a lot of people in crisis – including various medical crises, exacerbated or caused by drugs, alcohol, mental illness, or physical pathologies.
Combining the stress of a contact with police, the medical episode and other contributing factors can cause all sorts of problems, some of them potentially fatal:
- Excited Delirium – a physical condition involving, essentially, the brain and body speeding out of control. It sounds fun – I thought I was in an excited delirium when I met the Bangles. But no, it’s deadly serious.
- Positional Asphyxia – where someone is in, or is being restrained in, a position where they can’t breathe – frequently because their chest is constrained from moving. When combined with the other effects of high stress, the blood becomes “acidotic“, which can quickly lead to cardiac arrest.
A standard method of dealing with Excited Delirium and Positional Asphyxia, while detaining and maintaining physical control over someone, is to turn them on their side. It’s easy enough, relatively, to maintain physical control – but their chest can expand, their diaphragm can expand and contract the lungs which, with someone in crisis, helps bring down the blood acids that lead to Acidosis, lowering the risk of cardiac arrest.
Or at least, that was what the Minneapolis Police Department was taught by Hennepin EMS, the paramedic service for Hennepin County, which helped train Minneapolis cops in basic first aid and other medical techniques used to stabilize people in crisis, even when they needed to be detained an controlled.
And for cases where more intervention is needed, some paramedics use a drug called ketamine. it’s a sedative, used in operating rooms for starting general anaesthesia – but it works just fine for sedating someone in a crisis, letting them breathe and recover while de-stressing, physically as well as mentally. Hennepin EMS was the first paramedic agency in the country to use Ketamin to sedate people in medical emergencied, along with about a third of all EMS agencies in the US. It’s a “very safe drug that works quicker [in his experience] than anything else”, says my source.
But – says my source – the article, the inevitable raft of subsequent lawsuits and regulatory investigations resulted, in my source’s words, in some EMS medics “…being spooked. As an agency, we were less likely to administer optimal treatments.”
It’s also a component in some “date rape” drugs – which we’ll come back to.
Hennepin EMS trained Minneapolis cops – and used Ketamine to de-escalate medical crises.
That is, until just about two years ago.
That’s when a story came out in the Star Tribune, by Andy Mannix, entitled “At urging of Minneapolis police, Hennepin EMS workers subdued dozens with a powerful sedative“.
A source formerly located in Hennepin EMS, speaking on condition of anonymity, tells me the Mannix article got pretty much every substantive fact about the use of Ketamine wrong (“He spelled Hennepin right”, my source quipped).
But the damage was…well, not done. It began. Minneapolis broke its training arrangement with Hennepin EMS, and stopped the use of ketamine.
Breathing: Fast forward to Memorial Day, 2020, and the infamous encounter outside Cup Foods in South Minneaoplis.
The New York Times put together what my source calls an excellent video on the killing – including some camera angles and audio I hadn’t encountered before. My source says the Times did an “outstanding job”.
It’s distressing, but worth a watch.
And as you do, notice – Floyd was clearly having a medical emergency. He was a big guy, so having his wrists cuffed already restricted his breathing. His claustrophobia was self-stated – but as a 6’5 guy (Floyd was 6’6) the thought of being wedged into one of those passive-aggressively cramped little police cruisers makes me a little panicky all by itself. Stress on top of medical crisis – strikes one and two.
And then officers Chauvin and Moua arrived, pulled Lloyd out of the back of the car, and commenced kneeling on his neck and back – seriously impairing his breathing.
Some wannabe social media doctors have missed the point, borrowing lessons from Heimlich Maneuver training and claiming that since Floyd could say “I can’t breathe”, he could breathe.
But, my source relates, it wouldn’t matter, if the killer symptom – acidosis, which Floyd was unable to ventilate – was leading to a cardiac arrest.
One of the officers figured it out, asking Officer Chauvin if they might roll Floyd onto his side – which Chauvin rejected, keeping Floyd under his knee until EMS arrived.
By which point Floyd was well past mere “crisis” – unresponsive, apparently acidotic, sliding toward the cardiac arrest that was reported by the EMS when they reached 36th and Park – mere blocks from Cup Foods.
Did a sloppy news story and a subsequent frenzy of litigation and regulation take a vital tool out of paramedics’ toolkits? One that might have prevented George Floyd’s death, and the orgy of misery that it led to?