FOR EDUCATIONAL PURPOSES ONLY – CONTENT MAY DISTURB AND OFFEND, VIEWER DISCRETION IS STRONGLY ADVISED.
See bottom of this post for download links to the complete video and printable diagrams.
I give permission for the video and attached documents to be downloaded, played, modified and printed anywhere for free – only for the purpose of education.
TOPICS
00:00 – Intro
03:50 – Excited delirium
05:19 – Why are police involved in the first place if we’re talking about medical issues?
06:12 – Death in custody and sudden unexplained death
07:26 – Monitor your own state of mind when dealing with the patient
08:48 – De-escalation
09:54 – “Super Human Strength”
11:01 – Ability to absorb punishment
11:50 – Pain compliance
12:18 – Pain compliance loop
13:21 – Tasers
13:55 – Positional asphyxiation
14:25 – Do not lay prone for too long
14:55 – “I can’t breathe”
18:07 – Banning pressure – my opinion
19:06 – Examples set by martial artists
19:32 – A personal anecdote
20:12 – Restraint-resistance loop
20:51 – Sudden calm
21:22 – Do not make calmness a condition of your use of force
21:44 – Piling on
22:33 – What we lack in training
22:58 – Minimum force in minimum time
23:34 – Access to risks
24:06 – Caution with handcuffs
24:50 – Biting
25:11 – Position in cell/transport – monitor constantly
25:36 – You are always being recorded
26:31 – You are at the mercy of the world
27:24 – Final thoughts
Download video here
Some excellent feedback from a paramedic in the Reddit thread for this video.
Text wall incoming: I would like to add some comments here. I am a paramedic in the urban U.S., so I do not know the training or the things that are taught to LEO, but I would offer some alternative perspective. This was a well thought out video, but I would also add some tools/methods that I have used/seen used to help expedite the process.
- This was a very thoughtful video, and succinctly emphasizes your position when dealing with psych/overdose/mental health patients in delirium. Which is, in between a rock and a hard place. These people need medical evaluation and intervention, which often Law enforcement is ill equipped to provide. It then becomes a matter of how quickly can you get the ambulance to you to assist. Normally, EMS will not go into active scenes because our defense profile is much less robust than yours. But getting on the radio quickly will ensure that once you have compliance, or even 60-75% compliance, the ambulance is already on the way. Even on your way to the call, if your call notes describe someone who will need an evaluation, just start us. If we get pissy when we get there and its not super serious, thats on us and I hope you dont have that kind of working relationship with your EMS agency, because thats a junk attitude for us to have. Better an easy evaluation and refusal than a cardiac arrest.
- There were many clips in this video that show prone positioning, and the continued struggle. OP did a good job of alerting to the cycle of “movement/restraint” that so many of us get into, and how that leads to bad outcomes. If you have to prone someone, then do that, but if the ambulance is coming, there are also safer ways to restrain once we get onscene. The primary intervention is sedation. We all want that person to stop thrashing, so we have to get our drugs onboard. However, once we get there, you now have force multipliers. Do not shy away from using us as help to restrain while the medication takes effect. Limb joint restraint, waist and shoulder control can all be had while prone if need be, and take pressure off the chest. And to be clear, even pressure on the lower back where the abdomen would be can cause asphyxiation, by not allowing proper expansion of the diaphragm.
- Please continue to be observant. Many times, once EMS arrives on scene, the police tend to lower their security posture because “EMS is onscene” and it is a medical patient. But I have been stabbed by a patient with APD standing next to her because they were talking to themselves while I was doing my thing. Anyone who needed EMS and is hyperactive is by definition unstable. Please be ready to jump back into the fight. We may also have to use you as our own force multipliers.
- The pathophysiology of these patients is unpredictable. The reason why these people suddenly arrest with seemingly no pressure is because of whats happening inside the body. Extremely simplified basically, the drugs/psychosis/etc are causing an unregulated adrenaline dump, giving them their super strength, or their resistance to control techniques and the like. Once their body uses up all of their adrenaline, they’re going to arrest. Our sedation medications add onto that effect, especially if we have to give a double dose because of their extreme adrenaline dump. Which means that predicting when they stop fighting is a nonstarter. Once you go hands on, at any point in time, they may run out of energy and go into arrest, ems or no ems assistance. Look for the signs, and act appropriately.
- Thank you OP for not saying that Ketamine from paramedics kills these people.
Sorry for the long wall, I’ve been a paramedic for 11 years-ish now and teach both LEO/EMS team patient control, and basic resuscitation to the police I work with. You guys got the short end of the stick in dealing with these patients, and I dont want any of these cases to happen to you guys.
