Sudden Death in Custody: An Overview
Updated: Sep 27
In EMS we must do the hard work to better understand sudden death in custody. To understand how Elijah McClain and George Floyd and others in custody died, and how to reduce the risk of it happening in the future. To understand how to reduce the risk for patients in custody, for EMS providers and for our law enforcement colleagues.
Much attention has been focused on the roles of the individuals involved in these deaths. The actions of these individuals will be judged by others in various civil and criminal proceedings. While these reviews are important, our focus must look beyond individual actions and ask whether there are critical deficiencies of EMS protocols, training and leadership that must be addressed.
In a series of blog posts, we outline many of the key topics that need to be examined:
In EMS we must do the hard work to better understand sudden death in custody, including understanding the role implicit racial bias plays in the actions of EMS and law enforcement personnel.
For years, many deaths in custody have been justified as having been caused by “excited delirium.” Is excited delirium a real diagnosis, or instead a justification for deaths that were precipitated by physical restraint?
A key priority is the development of new and revised protocols concerning the assessment and management of individuals in law enforcement custody. Important topics include EMS' responsibility to intervene to protect the safety of individuals in custody and the steps needed to assess the necessity of restraint and how to provide restraint safely.
A key priority is the development and delivery of training focused on the assessment and management of individuals in law enforcement custody.
A key priority is having EMS leadership at multiple levels make the issues related to sudden death in custody a priority. The issues requiring focus include not only EMS protocols and training, but also the implicit bias that is intertwined with this topic.
There has been controversy surrounding the use of ketamine in the prehospital environment, especially for agitated/combative patients, following the death of Elijah McClain. A recently published study provides good evidence that ketamine use is safe in the prehospital environment. The conclusion that ketamine is safe in the prehospital environment is welcome, but does nothing to address the larger question of death in custody.
Links to various important resources related to sudden death in custody