Stand up, and speak out

EMS providers know positional asphyxiation can kill, and have a professional and moral obligation to object to it


“I can’t breathe.”

Oct. 19, 2005 – West Palm Beach, Florida, police restrain an excited delirium patient, Donald Lewis, by placing him prone and hogtying him, with an officer kneeling between his shoulders. Donald Lewis died at the scene. His family filed suit against the City of West Palm Beach and the officers involved. Police training officer Gerald MacCauley testified during proceedings that, "it is not department policy to hogtie arrestees,” yet the lawsuit is dismissed by summary judgment. None of the officers involved are disciplined.

“I can’t breathe.”

People confront police officers during a protest over the death of George Floyd in Chicago, Saturday, May 30, 2020.
People confront police officers during a protest over the death of George Floyd in Chicago, Saturday, May 30, 2020. (AP Photo/Nam Y. Huh)

Sept. 9, 2010 – Minneapolis Police officers TASER and restrain a mentally ill man behaving bizarrely at a local YMCA. The man, David Smith, is restrained prone, with a knee in his back for several minutes. He goes into respiratory arrest and dies at the hospital a week later. The coroner ruled his cause of death as mechanical asphyxia due to prone restraint. Although the officers faced no disciplinary charges, a lawsuit against the city resulted in a settlement of $3.075 million, the second-largest settlement for police misconduct in Minneapolis Police history at the time.

The plaintiff’s attorney, Robert Bennett, stated at the time that as part of the settlement, the city’s police officers will receive additional training on how to restrain suspects, although he said many officers had already gotten the training that would have prevented Smith’s death.

“I can’t breathe.”

July 17, 2014Eric Garner is detained and arrested by NYPD officers for the heinous crime of selling loose cigarettes. Garner was put in a chokehold by the arresting officer, Daniel Pantaleo, and wrestled to the ground and restrained prone. He pleaded with the officers, “I can’t breathe,” 11 times before he lost consciousness, then lay on his side for an additional seven minutes before FDNY EMS personnel arrived. He was pronounced dead at Richmond University Medical Center an hour later.

Garner’s death was ruled by the medical examiner as resulting from “compression of neck (chokehold), compression of chest and prone positioning during physical restraint by police.”

No state or Federal criminal charges are brought against Pantaleo, although the City of New York paid the Garner family $5.9 million in an out-of-court settlement. It takes the NYPD an additional five years to hold a disciplinary hearing and fire Pantaleo.

“I can’t breathe.”

July 18, 2015Southaven, MS police arrest Troy Goode leaving a Widespread Panic concert, for public drunkenness and disorderly conduct. He is restrained prone while officers sit on his back and apply hogtie restraints. Despite repeatedly pleading with officers that he can’t breathe, he remains in prone position throughout transport by Southaven Fire/EMS to Southaven, and dies, after two hours of prone, hogtie restraint, on a bed at Baptist Memorial Hospital.

Toxicology reports from the autopsy revealed Goode was under the influence of LSD and marijuana, and his cause of death was ruled by the Misssissippi State Medical Examiner’s Office as complications of LSD toxicity, an exceedingly rare cause of death. In the report, the medical examiner noted “markedly edematous lungs,” and an independent autopsy commissioned by the family ruled his death due to restraint asphyxia.  

None of the officers faced disciplinary action. In justifying the use of prone and hogtied restraint, a Southaven Police Department spokesman stated, "It is normal protocol and procedure to use the restraint that is deemed necessary to stop an individual from continuing to hurt himself or herself or to protect medical personnel while they treat them."

Goode’s wife, Kelli, filed suit against the city of Southaven and the police officers involved. The defendants attempted to have the case dismissed by summary judgment and were denied. They appealed, and the denial was upheld by the Fifth Circuit Court of Appeals on Apr. 24, 2020. In the filing, the judges noted,

In sum, hog-tying a nonviolent, drug-affected person in a state of drug-induced psychosis and placing him in a prone position for an extended period is objectively unreasonable. In light of the similarities between the facts of Gutierrez and those here, the state of the law in 2015 was sufficiently clear to provide fair warning to the Officers that their alleged conduct was unlawful.

Mrs. Goode’s suit against the city of Southaven is ongoing.

“I can’t breathe.”

May 25, 2020George Floyd is detained by Minneapolis Police Department officers for a complaint by a local businessman of check forgery. Officers initially state that Mr. Floyd resisted arrest, but numerous cellphone videos and security videos disprove the officers’ claim; George Floyd was compliant and non-combative. Nonetheless, he is placed face-down on the pavement with his hands cuffed behind his back, and MPD officer Derek Chauvin kneels on his neck for eight and a half minutes, despite pleas from Floyd that he couldn’t breathe. Numerous witnesses, including an off-duty firefighter, beg officers to let the man up and check his pulse, to no avail.

George Floyd dies.

The callousness and depraved indifference of the arresting officers is obvious on the video. Subsequently, Minneapolis and many other cities in America erupt in violence, even after the four officers are fired and the kneeling officer is arrested and charged for third-degree murder. The actions of four men made the job of every single cop in America that much harder and more dangerous.

“I can’t breathe.”

Positional asphyxia doesn’t discriminate

In an era which has seen increased militarization of police departments and growing distrust of law enforcement officers, our country is at a flashpoint. Many in our society are questioning whether the men and women we trust to protect us and enforce the laws of society have instead become our oppressors. It has caused many citizens to question, “Do we truly stand for liberty, and justice for all?”

It should be pretty obvious by now that we don’t.

I count a number of law enforcement officers as close friends, and know a great many more. Without exception, they are appalled at the actions of the four officers responsible for George Floyd’s death. Those four do not represent the vast majority of cops in America. We need to remember that it is possible to “back the blue” without condoning the actions of a few bad apples.

I’m not going to ascribe a racial motive to George Floyd’s death. I am not going speculate as to the officers’ intent, nor do I care about the moral character and rap sheets of the men who died. I’m a simple paramedic, not a cop or a civil rights advocate. I believe that social justice is best accomplished by personally practicing it.

But as a paramedic, I do know that positional asphyxia doesn’t discriminate. Prone restraint, hogtying, chokeholds and knees pressed into backs, necks or shoulders kills people, and it needs to stop.

Every police officer in America, and particularly those of Minneapolis Police Department, should know it too. Apparently, they did not learn their lesson from the David Smith incident.

As medical professionals, it is our professional and moral obligation to object to it whenever we see it. We can’t afford to be silent on the issue, lest we shatter the trust in our profession as badly as Derek Chauvin, Tou Thoa, J.K. Keung and Thomas Lane shattered the public trust in law enforcement.

Several bystanders did speak out, but were ignored by the officers, likely due to the increasingly adversarial relationship between the police and the citizenry they are sworn to protect. Parties who lack trust in each other don’t often communicate effectively.

“I can’t breathe.”

Nothing can be gained by cursing and berating the cops engaged in the mistreatment of a prisoner. It may be satisfying, but it doesn’t stop the abuse. Instead, you need to practice some professionalism and subtlety that gives the officer a way to save face while re-evaluating the appropriateness of his actions. Complaints can be filed later, but the restraint needs to stop now, in time to save the prisoner.

Respected law enforcement trainer Greg Ellifritz in his blog, Active Response Training, offers some practical tips on how to do just that. I encourage you to read it, and employ some of those strategies to intervene if you ever find yourself witnessing anyone abusing a prisoner. And if he tells you, “I can’t breathe,” you had damned well better believe him, or he may be dead in less time than it took to read this article.

Read next: EMS Attorney David Givot, Esq., analyzes the legal considerations of the death of George Floyd: “Bystander duty of care: Off-duty EMS liability

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