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  • Eric Jaeger

Sudden Death in Custody: EMS Protocol Development

Updated: Sep 22

In EMS we must do the hard work to better understand sudden death in custody. A key priority is the development of new and revised protocols concerning the assessment and management of individuals in law enforcement custody.


Protocols must be developed to address the following:

Responsibility to Intervene

An individual in custody is a patient from the moment EMS arrives on scene.

  • EMS has a responsibility to intervene if an individual is being restrained by law enforcement or other EMS providers in an unsafe manner.

  • The prone position is inherently dangerous. An individual kept in the prone position for any extended period of time is at HIGH risk of sudden death.

  • This is true regardless of whether there is any weight on the individual's back or side.

  • Every effort should be made to move an individual out of the prone position immediately.

Restraint by EMS

NO physical or chemical restraint may be applied by EMS unless:

  • EMS has independently assessed that restraint is medically justified

  • EMS should not routinely rely on law enforcement representations regarding the appropriateness of restraint

  • EMS has conducted a medical assessment of the patient

  • Assess the patient's vital signs

  • Look for and treat if found any medical cause for the patient's combativeness. e.g. hypoglycemia

  • All necessary equipment is immediately available to assess and care for the restrained patient, including in the event of a sudden deterioration of the patient's condition.

  • Restrained patients must be monitored continuously. Anticipate the possibility of a sudden deterioration in the patient's condition.


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